Oncology and public health
Inhoud
College 2 - Introduction in Oncology................................................................................... 2
College 3 - public health in oncology...................................................................................4
College 4 - Cancer diagnosis and treatment....................................................................... 6
College 5 - Cancer epidemiology..........................................................................................8
College 6 - oncogenesis; tumor biology and clinical behavior....................................... 10
College 7 - targeted therapy and immontherapy...............................................................12
College 8 - psycho oncology.............................................................................................. 14
College 9 - pain management............................................................................................. 18
College 10 - Netherlands cancer registry (NCR)............................................................... 19
College 11 - Late effects after treatment for Hodgin lymphoma...................................... 20
College 12 - risk communication and population cancer screening decisions............. 23
College 13 - cancer and work..............................................................................................25
College 14 - Cognitive functioning..................................................................................... 27
College 15 - Lifestyle........................................................................................................... 29
College 16 - shared decision making................................................................................. 31
College 17 - E-health in oncology.......................................................................................34
College 18 - prevention and screening.............................................................................. 37
College 19 - end-of-life and palliative care........................................................................ 38
College 20 - distress............................................................................................................ 40
College 21 - Adolescents and Young Adults with cancer (AYA’s)................................... 41
College 22 - rare cancers.....................................................................................................42
,College 2 - Introduction in Oncology
● Explain the critical role genomic alterations in oncogenes and tumor suppressor genes
in cancer development
● Describe factors that cause cancer, such as enviromental toxins and diseases
● Explain what the hallmarks of cancer are
● Chapter 1: what is malignancy [https://pmc.ncbi.nlm.nih.gov/articles/PMC5327679/]
Patient case (55 year old male, heavy smoker)
Symptoms: shortness of breath, weight loss, pain near the left hip
Imaging: CT of the chest (massive lung mass) + PET: more metabolic activity (metastasis)
Diagnosis: lung cancer and bone metastasis in the left ilium
Cancer is a disaese characterized by:
1. Abnormal cell growth: cell proliferate uncontrollably
2. Local invasion: cells invade surroundinbg tissue
3. Metastasis: can spread to other organs (lympfe of blood)
Benign tumor: not invading, just pusses the sourounding tissue away
Malignant tumor: irregular shape, necrosis, fast growth and invasive.
Types of cancer
- Carcinoma (85%): originating from epithelial tissues
- Sarcoma: originating from connective tissues (bone and soft)
- Glioma: glial cells of CNS
- Melonoma: skin
- Leukemia: blood-forming tissues of bone marrow
- Lymphoma: immune system (lymfocytes)
- Myeloma: immune system (plasma cells)
- Squamous cell: epithelial surface
- Adenocarcinoma: glandular type
How does cancer arise - mitosis
DNA replication is complex and vulnerable for damage toxins (cigarette smoke,
asbestos), can be direct or indirect. Mistakes normally repaired or undergo
apoptosis. Some cells do survive abnormal change in their DNA > a genomic
alteration (point, deletion, insertion, translocation), type + location important.
Genomic alterations
● Proto-oncogenes: mutations lead to uncontrolled cell growth. Growth factor receptors
remain active even without growth factors.
○ Examples: HER2, B-RAF and MEK
○ Normal Ras is ON/OFF
○ Mutant Ras is always ON > stimulating cell division and proliferation
● Tumor suppressor genes: normally block cell cycle progression. Mutations/ damage
allow abnormal cell proliferation.
○ Examples: TP53 (breast cancer), BRCA1/2
○ Normal P53: activated when DNA damage occurs
○ Non functional P53: cannot bind DNA, damage not stopped
,Hallmarks of cancer
- Stimulates own growth, self-sufficiency in growth signals
- Resist inhibitory signals that stop growth, insensitivity to anti-growth signals
- Resistant to programmes cells death, evading apoptosis
- Limitless replicative potential
- Stimulate growth of new blood vessels, sunstained angiogenesis
- Tissue invasion and metastasis
- Exploit abnormal metabolic pathways allowing them to survive
- Immune system evasion
- Genome instability and mutation
- Tumor-promoting inflammation
How many genes are altered?
In common solid tumors (breast, colorectal), 33-66 genes display (subtle) mutations.
Outliers: lung, melanoma (+-200).
Study showed +- 140 genes, when altered by intragenic mutations, can drive tumorigenesis.
A typical tumor contains 2 to 8 of these ‘driver gene’ mutations. The remaining mutations
are passengers that confer no selective growth advantage (genome instability).
Risk factors of development of cancer
A. Lifestyle
● Smoking causes 20% of cancer deaths
○ Delivers carcogens directly to tissues > new mutation
○ Causes irritation and inflammation > increased cell replication
○ Inteferes with body’s natural protective barriers
● UV-light exposure:
○ Cumulative and repeated intense exposure increases risk of melanoma
○ Tanning booths before age of 35 > 75% increase in risk of melanoma
○ Causes genetic mutations and interferes with cutaneous immune system
● Lack of exercise: reduces immune and hormonal function (5% of deaths)
○ Sedentary lifestyle is associated with 5% of cancer deaths
○ Exercise stimulates immune system, angiognesis, hormonal function
● Obesity: higher hormonal levels (estrogen, insulin, oxidative stress)
● Diet: High-fat diets and low fruit/vegetable intake.
● Alcohol: 3.6% of cancers are associated with chronic alcohol drinking
B. Enviromental
Second hand smoke, air pollution, industrial pollution and chemical exposure.
For example the chimney sooy linked to scrotal cancer in the 18th century.
C. Viruses and bacteria (~10% of all cancers associated)
HPV → genital head and neck cancer
EPV → nasopharyngeal carcinoma, Burkitt lymphoma
Hepatitus B & C → hepatocellular carcinoma
Helicobacter pylori → stomach cancer
D. Inherited risk
~10% of all cancers are inherited. Gene mutations are linked to inherited cancers
- BRCA genes for breast and ovarian cancer
- Lynch syndrome for colon
, College 3 - public health in oncology
● Explain the role of Public Health in cancer prevention
● Explain the relation between lifestyle and cancer risk
● Chapter 13: Adult public health [https://vu.on.worldcat.org/oclc/796938922%20/]
Public health = the science and art of preventing disease, prolonging life and promoting
health through the organized efforts and informed choices of society, organizations, public
and private, communities and individuals. Focus on collective actions to improve health
through prevention, health promotion and organzied societal efforts.
Application of public health
Populations: from local areas to world population
Causes of disease: from bhevaiours to broader enviroments
Prevention of disease: from individual patients to national policies
General health outcomes: from quality of life to halthy life expectancy
Three core public health function (WHO):
1. Assessement health of communities/ populations at risk to identify health problems.
2. Formulation of public policies designed to solve health problems and priorities.
3. Assure that all populations have access to appropriate and cost-effective care.
Achievements
Since 1900: vaccination, safer workplaces and control of infectious diseases
Since 1920: safer and healther foods, healther mothers and babies, family planning
Since 1965: fluoridation of drinking water, motor-vehicle safety, recognition of tobacco use as
a health hazard and decline in death from coronary heart diseases and stroke.
Global burden of cancer
● 2012: 14.1 milion cases and 8.2 milion deaths
● 2030: 21.7 milion cases and 13 milion deaths
Cancer is the leading cause of death 1 in 8 deaths worldwide.
More cancer → increasing global population, increasing age, screening more new cases,
increases in risk factors (smoking, obesity, physical inactivity, unhealthy diet).
Stomach cancer → 7x increased in japan and korea (smoked fish consumption)
Breast and prostate cancer → more frequent in western populations (diet)
Melanoma → Australia and sunny regions (UV exposure)
Liver cancer → South-east Asia and east Afrikca (Hepatitis B)
Thyroid cancer ⇒ defiency of iodine in local food and water supplies
Inhoud
College 2 - Introduction in Oncology................................................................................... 2
College 3 - public health in oncology...................................................................................4
College 4 - Cancer diagnosis and treatment....................................................................... 6
College 5 - Cancer epidemiology..........................................................................................8
College 6 - oncogenesis; tumor biology and clinical behavior....................................... 10
College 7 - targeted therapy and immontherapy...............................................................12
College 8 - psycho oncology.............................................................................................. 14
College 9 - pain management............................................................................................. 18
College 10 - Netherlands cancer registry (NCR)............................................................... 19
College 11 - Late effects after treatment for Hodgin lymphoma...................................... 20
College 12 - risk communication and population cancer screening decisions............. 23
College 13 - cancer and work..............................................................................................25
College 14 - Cognitive functioning..................................................................................... 27
College 15 - Lifestyle........................................................................................................... 29
College 16 - shared decision making................................................................................. 31
College 17 - E-health in oncology.......................................................................................34
College 18 - prevention and screening.............................................................................. 37
College 19 - end-of-life and palliative care........................................................................ 38
College 20 - distress............................................................................................................ 40
College 21 - Adolescents and Young Adults with cancer (AYA’s)................................... 41
College 22 - rare cancers.....................................................................................................42
,College 2 - Introduction in Oncology
● Explain the critical role genomic alterations in oncogenes and tumor suppressor genes
in cancer development
● Describe factors that cause cancer, such as enviromental toxins and diseases
● Explain what the hallmarks of cancer are
● Chapter 1: what is malignancy [https://pmc.ncbi.nlm.nih.gov/articles/PMC5327679/]
Patient case (55 year old male, heavy smoker)
Symptoms: shortness of breath, weight loss, pain near the left hip
Imaging: CT of the chest (massive lung mass) + PET: more metabolic activity (metastasis)
Diagnosis: lung cancer and bone metastasis in the left ilium
Cancer is a disaese characterized by:
1. Abnormal cell growth: cell proliferate uncontrollably
2. Local invasion: cells invade surroundinbg tissue
3. Metastasis: can spread to other organs (lympfe of blood)
Benign tumor: not invading, just pusses the sourounding tissue away
Malignant tumor: irregular shape, necrosis, fast growth and invasive.
Types of cancer
- Carcinoma (85%): originating from epithelial tissues
- Sarcoma: originating from connective tissues (bone and soft)
- Glioma: glial cells of CNS
- Melonoma: skin
- Leukemia: blood-forming tissues of bone marrow
- Lymphoma: immune system (lymfocytes)
- Myeloma: immune system (plasma cells)
- Squamous cell: epithelial surface
- Adenocarcinoma: glandular type
How does cancer arise - mitosis
DNA replication is complex and vulnerable for damage toxins (cigarette smoke,
asbestos), can be direct or indirect. Mistakes normally repaired or undergo
apoptosis. Some cells do survive abnormal change in their DNA > a genomic
alteration (point, deletion, insertion, translocation), type + location important.
Genomic alterations
● Proto-oncogenes: mutations lead to uncontrolled cell growth. Growth factor receptors
remain active even without growth factors.
○ Examples: HER2, B-RAF and MEK
○ Normal Ras is ON/OFF
○ Mutant Ras is always ON > stimulating cell division and proliferation
● Tumor suppressor genes: normally block cell cycle progression. Mutations/ damage
allow abnormal cell proliferation.
○ Examples: TP53 (breast cancer), BRCA1/2
○ Normal P53: activated when DNA damage occurs
○ Non functional P53: cannot bind DNA, damage not stopped
,Hallmarks of cancer
- Stimulates own growth, self-sufficiency in growth signals
- Resist inhibitory signals that stop growth, insensitivity to anti-growth signals
- Resistant to programmes cells death, evading apoptosis
- Limitless replicative potential
- Stimulate growth of new blood vessels, sunstained angiogenesis
- Tissue invasion and metastasis
- Exploit abnormal metabolic pathways allowing them to survive
- Immune system evasion
- Genome instability and mutation
- Tumor-promoting inflammation
How many genes are altered?
In common solid tumors (breast, colorectal), 33-66 genes display (subtle) mutations.
Outliers: lung, melanoma (+-200).
Study showed +- 140 genes, when altered by intragenic mutations, can drive tumorigenesis.
A typical tumor contains 2 to 8 of these ‘driver gene’ mutations. The remaining mutations
are passengers that confer no selective growth advantage (genome instability).
Risk factors of development of cancer
A. Lifestyle
● Smoking causes 20% of cancer deaths
○ Delivers carcogens directly to tissues > new mutation
○ Causes irritation and inflammation > increased cell replication
○ Inteferes with body’s natural protective barriers
● UV-light exposure:
○ Cumulative and repeated intense exposure increases risk of melanoma
○ Tanning booths before age of 35 > 75% increase in risk of melanoma
○ Causes genetic mutations and interferes with cutaneous immune system
● Lack of exercise: reduces immune and hormonal function (5% of deaths)
○ Sedentary lifestyle is associated with 5% of cancer deaths
○ Exercise stimulates immune system, angiognesis, hormonal function
● Obesity: higher hormonal levels (estrogen, insulin, oxidative stress)
● Diet: High-fat diets and low fruit/vegetable intake.
● Alcohol: 3.6% of cancers are associated with chronic alcohol drinking
B. Enviromental
Second hand smoke, air pollution, industrial pollution and chemical exposure.
For example the chimney sooy linked to scrotal cancer in the 18th century.
C. Viruses and bacteria (~10% of all cancers associated)
HPV → genital head and neck cancer
EPV → nasopharyngeal carcinoma, Burkitt lymphoma
Hepatitus B & C → hepatocellular carcinoma
Helicobacter pylori → stomach cancer
D. Inherited risk
~10% of all cancers are inherited. Gene mutations are linked to inherited cancers
- BRCA genes for breast and ovarian cancer
- Lynch syndrome for colon
, College 3 - public health in oncology
● Explain the role of Public Health in cancer prevention
● Explain the relation between lifestyle and cancer risk
● Chapter 13: Adult public health [https://vu.on.worldcat.org/oclc/796938922%20/]
Public health = the science and art of preventing disease, prolonging life and promoting
health through the organized efforts and informed choices of society, organizations, public
and private, communities and individuals. Focus on collective actions to improve health
through prevention, health promotion and organzied societal efforts.
Application of public health
Populations: from local areas to world population
Causes of disease: from bhevaiours to broader enviroments
Prevention of disease: from individual patients to national policies
General health outcomes: from quality of life to halthy life expectancy
Three core public health function (WHO):
1. Assessement health of communities/ populations at risk to identify health problems.
2. Formulation of public policies designed to solve health problems and priorities.
3. Assure that all populations have access to appropriate and cost-effective care.
Achievements
Since 1900: vaccination, safer workplaces and control of infectious diseases
Since 1920: safer and healther foods, healther mothers and babies, family planning
Since 1965: fluoridation of drinking water, motor-vehicle safety, recognition of tobacco use as
a health hazard and decline in death from coronary heart diseases and stroke.
Global burden of cancer
● 2012: 14.1 milion cases and 8.2 milion deaths
● 2030: 21.7 milion cases and 13 milion deaths
Cancer is the leading cause of death 1 in 8 deaths worldwide.
More cancer → increasing global population, increasing age, screening more new cases,
increases in risk factors (smoking, obesity, physical inactivity, unhealthy diet).
Stomach cancer → 7x increased in japan and korea (smoked fish consumption)
Breast and prostate cancer → more frequent in western populations (diet)
Melanoma → Australia and sunny regions (UV exposure)
Liver cancer → South-east Asia and east Afrikca (Hepatitis B)
Thyroid cancer ⇒ defiency of iodine in local food and water supplies
