100% tevredenheidsgarantie Direct beschikbaar na je betaling Lees online óf als PDF Geen vaste maandelijkse kosten
logo-home
Eerder door jou gezocht
Eerder door jou gezocht
logo
Lecture Note - TBCB - week 3 €3,99
In winkelwagen
Snel navigeren naar
Voorbeeld
  2.  
  3. Vrije Universiteit Amsterdam (VU)
  4.  
  5. Tumor Biology and Clinical Behaviour

College aantekeningen

Lecture Note - TBCB - week 3
 0 keer verkocht

Lectures included: second malignancy risk (case: HL & testicular cancer), intraoperative imaging, molecular imaging, ctDNA & liquid biopsy, cervical cancer prevention, CRC screening, ethical issues in molecular genetics

Voorbeeld 3 van de 21  pagina's

Document informatie

  • 9 januari 2020
  • 21
  • 2018/2019
  • College aantekeningen
  • Onbekend
  • Alle colleges

Onderwerpen

  • tumor biology clinical behavior
  • mandatory courses master oncology vu amsterdam

Geschreven voor

Alle documenten voor dit vak (7)

Verkoper

avatar-seller
oddsters

Voorbeeld van de inhoud

Week 3: Tumor Biology & Clinical Behavior

LECTURE: SECOND MALIGNANCY RISK IN SURVIVORS OF HL & TESTICULAR CANCER Monday, 12/11/2018

Effects of cancer Tx = undesired consequence of Tx; risk of surviving cancer is increasing, however secondary cancer is also
possible to arise (e.g. breast cancer after lymphoma  is it really secondary cancer?)

Somatic SE: second malignancy (mostly occur long after chemoTx, e.g. 10-20 years), cardiovascular disease, infertility, etc

HL & testicular cancer: 33% of new cancer in young adults, already occur at early age (high chance to reduce productivity),
excellent prognosis & high survival rate  good models for late effects of cancer

Testicular cancer: (different origin)

a. Seminoma  radiation-sensitive
b. Non-seminoma  radiation-insensitive, requires combination chemoTx

Cause of second malignancy: aging  long-term survival = risk of cancer >>, Tx consequence, lifestyle & environment, genetic
susceptibility (BRCA, Lynch, SNP variant)

Reasons for occurrence of 2 primary malignancies:

a. Host susceptibility (e.g. genetic predisposition, immunodeficiency, hormones, etc)
b. Common carcinogenic influences (smoking, obesity, alcohol use)
c. Tx of first tumor
d. Chance (unrelated to first cancer)

Tx related risk factor:

a. radioTx: any cancer, long-term increase risk of cancer in irradiated sites
b. chemoTx: systemic effect
 AML & myelodysplastic syndrome d/t alkylating agents  characterized by specific chromosome
rearrangements, short term occurrence/soon after Tx, e.g. 1-8 years after chemoTx, poorer prognosis!
 Solid malignancy (d/t procarbazine, anthracyclines, cisplatin)  new data emerging!
c. Hormonal agents (e.g. tamoxifen-related endometrial cancer following breast cancer Tx)
d. ImmunoTx

Determining factors of time to occurrence of secondary malignancy: dx, lifestyle, genetic alterations, tx approach (shorter
time span among patients treated with combination tx)

Radiotherapy in HL & testicular cancer
HL: large, extended radiation field  involve many
Lnn, using high energy radiation Tx e.g. Linac
(“bombing” the tumor), allow prophylactic
irradiation to prevent disease progression; more
organ exposed = risk of SE >>

Testicular cancer: lower dose of radiation is
sufficient because seminoma is radiation sensitive;
for non-seminoma, the radioTx dose is greater

SIR = standardized incidence risk  observed/expected incidence ratio; some cancer has increased risk to develop
secondary malignancy following Tx

Leukemia SIR = high, leukemia incidence = low (after 5 year follow up)  leukemia is a rare disease in population, low cases
found compared to other cancers

, Week 3: Tumor Biology & Clinical Behavior

AER = absolute excess number of cases per 10000 patients/year  burden of leukemia is low

Testicular cancer Tx: platinum based chemotx + orchidectomy  current tx protocol: castration + observation (to alleviate the
risk of chemoTx), if needed: reduced cycles of cisplatin-based chemotx

SIR can also be affected by the choice of Tx & its side effects  increased SIR for soft tissue sarcoma, pancreas, stomach cancer,
etc following non-seminoma testicular cancer Tx

Radiation dose-response for second solid cancer risk

Linear increase w/ higher dose for breast, lung, stomach, pancreas, esophagus & sarcoma

Not all tissue receive the same dose (radiation dose varies between regions of the cancer)  affect the risk of secondary
malignancy; healthy organ is exposed to radiation waves at higher volume, using involved field radioTx reduce occurrence of
secondary cancer

Chemotherapy for HL & testicular cancer

Increased number of cycle = increased risk of SE  adjust cycle protocol for reduction of SE (milder regimen), yet recurrence
still possible

Low radiation dose = less effect of chemoTx  may reduce the risk of SE to healthy organ

Cisplatin: forming DNA adducts, platinum = heavy metal = slow to be eliminated (still traces of platinum after 20 years of
chemoTx), associated w/ long term effect

Tumor blocks of secondary malignancy following testicular cancer  look for DNA adducts in tumor blocks (proving the
presence of cisplatin in the secondary tumor tissue)

What are the risks of decreased cisplatin elimination?

Environmental factors

Smoking increases risk of secondary malignancy following radioTx & chemoTx (e.g. lung cancer following HL)  HL patients
who don’t smoke have less chance to develop lung cancer following HL tx

Future strategies:

 Develop new Tx protocol with low toxicity & equal Tx effectiveness
 Identification of high risk patients

Opportunities:

a. Adapted Tx
Lower volume/dose of radiotx
Lower dose of chemotx
Risk adapted tx (prognostic factor)  based on genetic profile for late effects
Weighing benefit & harm  risk prediction model from all the Tx possibilities (adjusted for age, Dx, sex, etc)
b. Lifestyle advice & chemoprevention
Smoking cessation
Low dose tamoxifen for childhood cancer survivor
c. Survivor monitoring
Identify high-risk group  for SE (cancer/non-cancer)
Survivorship clinic
Screening (introduced much earlier than general population, e.g. several years after Tx irrespective of age)

, Week 3: Tumor Biology & Clinical Behavior

LECTURE: INTRAOPERATIVE FLUORESCENCE IMAGING (R. Meijer) Monday, 12/11/2018

Unmet needs in cancer treatment:

a. Surgery is mainstay of tx in solid cancer
Completeness of surgery improve prognosis
Prevent positive margin  minimizing residual tumor to improve outcome
b. Intraoperative identification of tumor tissue is difficult
c. Need of intraoperative modalities that can identify tumor tissue
d. Improve intraoperative tumor detection by targeting specific surface receptor

Image-guided surgery modalities

a. (pre/intraoperative) Ultrasound  tumor localization in liver
b. Contrast-guided surgery

Fluorescence guided surgery (FGS)


NIR camera + colour vid + collection optics + contrast
agent + light source (NIR: LED/laser, visible light)

Tumor is seen as green/coloured image (colour-NIR
merge)

Why optical imaging

a. Using NIR  able to visualize areas invisible to
human eye
b. Fast acquisition
c. High tissue penetration
d. Easy to combine with contrast & camera system

Fluorescent contrast agent: clinically approved as off
label use (indocyanine green, methylene blue)  time of
administration: depend on the substance; detecting
smaller lesions unseen to naked eye/CT/MRI




Improvement required for fluorescence-guided surgery:

a. Tumor-targeted contrast agent  certain protein expressed in tumor surface
Make sure fluorescence bind to tumor only, leaving healthy tissue unmarked (healthy tissue vs. normal tissue)
b. Preclinical study
c. Clinical translation

Agent & tumor characteristics:

 Overexpression of target in tumor tissue (multiple targets are possible)  risk of spectral interference, reduce the
interference: 2 different agents, 2 different wavelength, 2 different time imaging
 High probability of expression  observed in all patients with that tumor
 Cell surface target (close proximity to the tumor)
 Homogenous upregulation (evenly expressed in all parts of the tumor)

Dit zijn jouw voordelen als je samenvattingen koopt bij Stuvia:

Bewezen kwaliteit door reviews

Bewezen kwaliteit door reviews

Studenten hebben al meer dan 850.000 samenvattingen beoordeeld. Zo weet jij zeker dat je de beste keuze maakt!

In een paar klikken geregeld

In een paar klikken geregeld

Geen gedoe — betaal gewoon eenmalig met iDeal, creditcard of je Stuvia-tegoed en je bent klaar. Geen abonnement nodig.

Direct to-the-point

Direct to-the-point

Studenten maken samenvattingen voor studenten. Dat betekent: actuele inhoud waar jij écht wat aan hebt. Geen overbodige details!

Veelgestelde vragen

Wat krijg ik als ik dit document koop?

Je krijgt een PDF, die direct beschikbaar is na je aankoop. Het gekochte document is altijd, overal en oneindig toegankelijk via je profiel.

Tevredenheidsgarantie: hoe werkt dat?

Onze tevredenheidsgarantie zorgt ervoor dat je altijd een studiedocument vindt dat goed bij je past. Je vult een formulier in en onze klantenservice regelt de rest.

Van wie koop ik deze samenvatting?

Stuvia is een marktplaats, je koop dit document dus niet van ons, maar van verkoper oddsters. Stuvia faciliteert de betaling aan de verkoper.

Zit ik meteen vast aan een abonnement?

Nee, je koopt alleen deze samenvatting voor €3,99. Je zit daarna nergens aan vast.

Is Stuvia te vertrouwen?

4,6 sterren op Google & Trustpilot (+1000 reviews)

Afgelopen 30 dagen zijn er 68175 samenvattingen verkocht

Opgericht in 2010, al 15 jaar dé plek om samenvattingen te kopen

Begin nu gratis
€3,99
  • (0)
In winkelwagen
Toegevoegd