Intro

Question 1

Terminology:
1. Incidence
2. Incidence rate
3. Mortality Rate
4. Case fatality rate
5. Prevalence
6. Survival Rate

Answer 1

1. Incidence: number of new cases identified in a specified population within a time period (e.g., 1 year)
2. Incidence rate: number developing cancer per 100,000 population per year
3. Mortality rate: number dying per 100,000/year (e.g., 2.6 per 100,000/year)
4. Case fatality rate: percentage of people with specific cancer diagnosis that die from that cancer (e.g., 40% fatality rate)
5. Prevalence: number of cases per population at a specific point in time (e.g., 50,234 documented cases in the United States)
6. Survival rate: the percentage of people who are alive at certain stages after their diagnosis or the start of treatment, usually described as a five-year survival rate.

Question 2

Cancer Age Ranges
<20

Answer 2

-brain/CNS/nerves (neuroblastoma = nerves)
-Eye - retinoblastotma
-blood/lymph (leukemia, lymphoma (hodgkin/nonhodgkin)
-Bone (Ewing sarcoma and osteosarcoma)
-skeletal muscles (rhabdomyosarcoma)

Question 3

Age + Cancer: 21-49

Answer 3

-breast, cervix, uterine, ovarian
-testes (20-35)
-kidney
-bowel
lymph nodes (non-hodgkin)
-skin (melanoma)

Question 4

Age + Cancer: 50-64

Answer 4

-lung
-Breast, cervix, uterine, ovarian
prostate
-kidney
-bowel + liver + Pancreas
-Skin

Question 5

Age + Cancer > 65

Answer 5

-Oral cavity/pharynx/larynx/ lung
-GI: Esophagus, stomach, colorectal/rectal, pancreas
-breast, ovarian
-prostate
-bladder
-skin

Question 6

Modifiable risk factors for cancer

Answer 6

-Tobacco + Alcohol
-High fat/low-fiber dietst
-High-risk occupations
-Sunscreen usage
-Sedentary life styles
-Cancer-related infecttions

Question 7

Cancer-related infetions

Answer 7

-Helicopactor Hylori
-Hepatitis B and C
-Herpes
-HIV + HPV

Question 8

Non-modifiable risk factors for cancer

Answer 8

-age, sex, race/etthnicity, genetics/family history

Question 9

Healthcare disparities

Answer 9

-low income
-low health literacy
-rural
-lack of healthcare coverage

Question 10

Occupational Cancer Hazards

Answer 10

1. ABC - aspestos, biological agents, cleaning agents
2. Radiation exposure
3. Other (manufacturers, dry cleaners, jewlers, miners, etc

Question 11

Cancer screening -
Skin

Answer 11

Yearly physical for everyon

Question 12

Colorectal CA screening

Answer 12

1. Colonoscopy Q10 yrs ≥ 45
2. CT colonography or sigmoidoscopy Q5 years if NO colonoscopy
3. Fecal Occult Blood or immunochemical test- yearly after 50

Question 13

Cervical CA screenings

Answer 13

Pap smear 25-65 Q 3 years OR every 5 years with HPV screening concurrently

Question 14

Breast

Answer 14

-Mammogram - yearly for average risk women >40 (30 for high risk)
-Clinical breast exam Q3 years 20-30, yearly for 40+
-MRI of breast for high-risk only

Question 15

Endometrial cancer screening

Answer 15

-Yearly for high-risk only, no screening otherwise

Question 16

Prostate cancer screening

Answer 16

-PSA: men over 50, discuss with provider. High-risk men (African American or with family hx) testing should occur at age 45. Further testing depends on PSA level (biopsy or Digital Rectal Exam

Question 17

Lung cancer screening

Answer 17

Annual Low-dose CT scan (LDCT): for at-risk adults ages 50 to 80 years old. Must be in fairly good health and currently smoke or have quit smoking in the past 15 years and have at least a 20 pack-year smoking history.

Question 18

Carcinogenesis

Answer 18

-process of cancer formation
-failure of cell repair and replication of cells with damage that no longer die

Question 19

what causes carcinogenesis

Answer 19

-Mutations in regulatory cells (proto-oncogenes, tumor suppressor genes, DNA repair genes)
-genomic instabilty
-inflammation

Question 20

oncogenes

Answer 20

stimulate or suppress normal apoptosis of cells

Question 21

P53 suppressor gene

Answer 21

produces a protein that detects DNA lesions and prevents cells from entering S phase to either induce rapirs or cell death
-most frequently mutated gene seen in cancer

Question 22

Cytogenetics

Answer 22

The structure and function of the chromosomes
-abnormalities are used to diagnose solid tumor and heme malignancies

Question 23

Common hereditary genes associated with cancer (6)

Answer 23

WT1: Wilms tumor
APC: familial colon polyposis, osteomas, thyroid cancer, hepatoblastoma
CDKN20: familial melanoma
BRCA-1/BRCA-2: familial breast and ovarian cancers
TP53 mutant: hereditary Li-Fraumeni syndrome
MLH1/MSH2/PMS1: hereditary Lynch Syndrome, which can cause colon, rectal, stomach, biliary, brain, endometrium, uterine and renal pelvis cancers

Question 24

Molecular testing and Genetics

Answer 24

BRAF, EGFR, ER receptor, PR receptor, KRAS, HER2/neu, Philadelphia chromosome (Ph+), CD-30

Question 25

What must studies have before participant enrollment?

Answer 25

-IRB approval or IEC approval (independent ethics committee)
-informed consent
-protection of vulnerable populations

Question 26

Clinical trial phase I and II

Answer 26

Phase Ia: studies how a drug acts in humans (FiH trial)
Phase Ib: studies interactions with other drugs (combination therapy)
Phase IIa: studies how a drug functions in disease types
Phase IIb: pivotal trials to evaluate safety and efficacy in humans

Question 27

Clinical trial Phase III and IV

Answer 27

Phase IIIa: trials to generate additional data for specific populations (e.g., patients with renal failure). Data assist in package insert and labeling of a drug.
Phase IIIb: trials done after submission of a New Drug Application (NDA) but before approval and launch
Phase IV: trials done after market launch; may include different formulations, dosages, age groups, and patient groups (aka: “post-marketing surveillance”)