What is a tumor?
A tumor is an abnormal mass of tissue caused by uncontrolled cell proliferation, which may be benign or malignant.
What is a lipoma?
A benign tumor of adipose (fat) tissue.
What is a sarcoma?
A malignant tumor of mesenchymal tissue (e.g. bone, muscle, connective tissue).
Name 5 characteristics of a malignant tumor
Invasive growth
Metastasis
Poor differentiation (anaplasia)
High mitotic activity
Recurrence after removal
How does a malignant tumor spread throughout the body?
Lymphatic spread
Hematogenous spread
Local invasion
Tumor from pigment cells of the skin
→ Melanoma
Tumor from lymphoid cells
→ Lymphoma
Tumor from embryonic cells
→ Teratoma / Embryonal tumor
Tumor from striated muscle cells
→ Rhabdomyosarcoma
According to which systems is a tumor classified? (2)
TNM system
UICC staging system
What does stage III tumor mean according to UICC?
Large primary tumor
Regional lymph node involvement
No distant metastases
Breast tumor: T1, N0, M0
Small tumor (≤2 cm)
No lymph node metastases
Breast tumor: T3, N1, M1
Large tumor (>5 cm)
Regional lymph node metastases
Distant metastases present
Name 3 risk factors for tumor development
Smoking
Genetic predisposition
Chronic inflammation
Example of viral tumorigenesis
→ HPV → cervical cancer
Example of bacterial tumorigenesis
→ Helicobacter pylori → gastric cancer
How does a tumor lead to complications?
Compression of organs
Metabolic disturbances
Paraneoplastic syndromes
Why is weight loss caused by cancer?
Increased metabolic demand
Cytokine-mediated cachexia
What does B symptomatology mean?
Systemic symptoms seen especially in lymphomas:
Fever
Night sweats
Unintentional weight loss
Name 8 general therapeutic methods against solid tumors
Surgery
Chemotherapy
Radiotherapy
Immunotherapy
Targeted therapy
Hormone therapy
Hyperthermia
Palliative therapy
Individual options to minimize tumor risk
Avoid smoking
Healthy diet
Physical activity
Vaccinations (e.g. HPV)
Is there prophylactic vaccination against some cancers?
→ Yes (e.g. HPV, Hepatitis B)
Name 2 classic chemotherapeutic agents (INN)
Cisplatin
Cyclophosphamide
What is targeted tumor therapy?
Therapy that specifically targets molecular alterations in cancer cells.
What is immunotherapy?
Treatment that activates the immune system against tumor cells.
Infix –zu and suffix –mab belong to
→ Monoclonal antibodies (humanized)
Therapeutic options for vertebral body fractures
→ Radiotherapy / surgery / bisphosphonates
What do we mean by incidence?
Number of new cases in a population per time period.
What do we mean by prevalence?
Total number of existing cases in a population.
What are hazard and hazard ratio?
Hazard: event risk over time
Hazard ratio: comparison of risk between two groups
BREAST CANCER (MAMMA-CA)
Why has the mortality rate from breast cancer decreased in Germany in recent years?
Improved screening (mammography)
Better systemic therapies
Earlier diagnosis
Is there an ethnicity-dependent mortality rate for breast cancer? Which group has the highest risk?
→ Yes
→ Women of African descent
What is DCIS?
Ductal Carcinoma In Situ → Non-invasive tumor confined to milk ducts
What is LCIS?
Lobular Carcinoma In Situ → Non-invasive tumor of lobules, risk marker
Where in the breast is cancer most likely to occur?
→ Upper outer quadrant
Causes and risk factors for breast cancer
Age
Hormonal exposure (estrogen)
Genetic mutations (BRCA)
Lifestyle factors
What is BRCA 1 and 2?
Tumor suppressor genes involved in DNA repair
What does a BRCA mutation lead to?
Increased risk of breast and ovarian cancer
Earlier onset
Name 3 subtypes of breast cancer
Luminal A
Luminal B
Triple-negative breast cancer (TNBC)
Most common breast cancer subtype
→ Luminal A, Hormone receptor–positive (ER-positive) breast cancer
Most difficult subtype to cure
→ Triple-negative breast cancer (TNBC)
Characteristics of TNBC
ER-, PR-, HER2-negative
Aggressive growth
What is Ki-67?
Marker of cell proliferation
Indicates tumor aggressiveness
What leads to poorer survival in breast cancer? (5)
Large tumor size
Lymph node involvement
Distant metastases
High Ki-67
TNBC positivity without therapy
Name 3 columns of breast cancer therapy
Systemic therapy
Building blocks of systemic tumor therapy
Endocrine therapy
What is a sentinel lymph node? Why examine it?
First lymph node draining the tumor → To assess metastasis and avoid extensive dissection
Aim of breast tumor surgery
Complete tumor removal
Tumor-free margins (R0)
What does neoadjuvant therapy mean?
Systemic therapy before surgery
Positive and negative effects of breast-conserving surgery
(+) Better cosmetic outcome
(–) Requires radiotherapy
Side effect of taxanes
→ Peripheral neuropathy
What is the AGO?
German Gynecological Oncology Group, Arbeitsgemeinschaft Gynäkologische Onkologie
Neoadjuvant therapy in early breast cancer – advantages
Tumor size reduction
Breast conservation
Early systemic treatment
Response evaluation
Define micrometastases
Tumor deposits 0.2–2 mm in lymph nodes
What is HER2?
Growth factor receptor
Promotes cell proliferation
Components of an antibody-drug conjugate (ADC)
Monoclonal antibody
Cytotoxic drug
Linker
How does an ADC work?
Antibody binds tumor antigen
Drug released inside cancer cell
Mode of action of immune checkpoint inhibitors
Block inhibitory immune signals
Activate T-cells against tumor
What does a monoclonal antibody consist of?
Two heavy chains
Two light chains
Variable region
Constant region
Meaning of antibody name components
xi
zu
tu
-xi → chimeric
-zu → humanized
-tu → tumor-targeting
PROSTATE CANCER
Name 4 risk factors for prostate cancer
Increasing age
Family history
African ancestry
High-fat diet
Name 3 common genomic alterations in prostate cancer
TMPRSS2–ERG fusion
PTEN loss
BRCA2 mutation
Name 4 signs of prostate cancer
Weak urine stream
Nocturia
Bone pain
Hematuria
What does PSA mean?
→ Prostate-Specific Antigen
Most common type of primary prostate cancer
→ Adenocarcinoma
Name 4 sites of metastases
Bone (most common)
Lymph nodes
Lung
Liver
How does prostate cancer spread?
Hematogenous spread (bone)
Most common promoter for prostate cancer
→ Androgens (testosterone)
LUNG CANCER
Name the 2 major histological types
Non-small cell lung cancer (NSCLC)
Small cell lung cancer (SCLC)
Median age at diagnosis
→ ~70 years
Which ethnicities are mostly affected?
Caucasians
African Americans
Which lung cancer has higher 5-year survival?
→ NSCLC
Name 4 risk factors
Occupational exposure (asbestos)
Air pollution
Radon
Name 4 signs and symptoms
Chronic cough
Hemoptysis
Dyspnea
Weight loss
What does driver mutation mean?
A genetic alteration that drives tumor growth and survival
Name 4 common driver mutations in NSCLC
EGFR
ALK
KRAS
BRAF
Subdivision of NSCLC
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Where are Cytokeratin 5/6 antibodies used?
Squamous cell carcinoma diagnosis
Lung cancer immunohistochemistry
OVARIAN CANCER
Symptoms of ovarian cancer (6)
Abdominal bloating
Pelvic pain
Ascites
Early satiety
Fatigue
When do symptoms occur?
→ Late stages
Name 5 risk factors
BRCA mutation
Nulliparity
Endometriosis
Known gene alterations
BRCA1
BRCA2
Therapy concept
Radical surgery
Maintenance therapy
Special feature in surgery
→ Complete cytoreduction is crucial
Disadvantage of minimally invasive surgery
→ Risk of incomplete tumor removal
What does FIGO II mean?
→ Tumor limited to pelvis
What is a tyrosine kinase?
An enzyme that:
Phosphorylates tyrosine residues
Transmits growth signals
Regulates cell proliferation
Controls survival pathways
Is often oncogenically activated
Therapeutic significance of tyrosine kinases (targeted therapy).
Used in cancers with:
EGFR mutations
ALK rearrangements
ROS1 fusions
BCR-ABL (CML)
VEGFR activation
HER2 amplification
Three important driver mutations in NSCLC adenocarcinoma.
Idea behind immune checkpoint inhibitor therapy.
Block immune inhibition
Reactivate T-cells
Enhance tumor recognition
Restore anti-tumor immunity
Two immune checkpoints we can control.
PD-1 / PD-L1
CTLA-4
Characteristics of ROS1-fusion–positive patients.
Younger age
Non-smokers
Adenocarcinoma histology
High response to TKIs
SKIN TUMORS
Subdivision of non-melanoma skin tumors
Basal cell carcinoma
What is Basal Cell Carcinoma
Most common skin cancer
Locally invasive
Rare metastases
UV-related
What is Squamous Cell Carcinoma
Malignant keratinocyte tumor
Metastasizes
Often on sun-exposed skin
What is Melanoma
Malignant melanocyte tumor
High metastatic potential
Aggressive
UV-associated
Major driver mutation in melanoma
→ BRAF V600E
Skin cancer prevention
UV protection
Sunscreen
Avoid tanning beds
Regular skin checks
ABCDE rule
A: Asymmetry
B: Border
C: Color
D: Diameter
E: Evolution
What are TILs?
→ Tumor-infiltrating lymphocytes
GASTRIC & RENAL CANCER
Which gender has higher gastric cancer risk?
→ Male
4 risk factors
Helicobacter pylori
Nitrosamines
Chronic gastritis
Paraneoplastic syndrome
Symptoms caused by tumor-related substances, not direct invasion Example: Hypercalcemia
Development
Hormone-like substances
Immune cross-reaction
Wilms tumor
Pediatric kidney tumor
Nephroblastoma
Embryonal origin
Renal cell carcinoma – kidney involvement
→ Often asymptomatic, Painless hematuria
How is RCC (renal cell carcinoma ) discovered?
Incidental imaging
Metastasis sites
Bone
Brain
HEMATOLOGY & ONCOHEMATOLOGY
Meaning of TNM
T: Tumor size
N: Lymph nodes
M: Metastases
Name the Solid blood particles
Erythrocytes
Leukocytes
Thrombocytes
Which progenitor cells for blood cells exist?
Myeloid
Lymphoid
Stem cells
Adult hematopoiesis found in….
Bone marrow
Pelvis
Sternum
Vertebrae
What is a CFU-baso
→ Basophil progenitor cell
Eosinophil function
Parasite defense
Allergy mediation
Immune regulation
Neutrophil function
Phagocytosis
Bacterial killing
Most common WBC
→ Neutrophils
What does a Shift to the left in WBC mean
→ Increased immature neutrophils
Monocytes transform into….
→ Macrophages
Label the bloodcount:
LEUKEMIA, LYMPHOMA & MYELOMA
2 types of lymphocytes & function
B-cells → antibody production
T-cells → cellular immunity
Cells producing antibodies:
→ Plasma cells
5 growth factors
· Epidermal growth factor (EGF)
· Vascular endothelial growth factor (VEGF)
· Platelet-derived growth factor (PDGF)
· Insulin-like growth factor (IGF)
· Fibroblast growth factor (FGF)
Who coined “leukemia”?
→ Rudolf Virchow
6 symptoms of leukemia
Infections
Bleeding
4 types of leukemia
· Acute lymphoblastic leukemia (ALL)
· Acute myeloid leukemia (AML)
· Chronic lymphocytic leukemia (CLL)
· Chronic myeloid leukemia (CML)
Top 3 lymphomas
Hodgkin lymphoma
Diffuse large B-cell lymphoma
Follicular lymphoma
What is CHOP?
Chemotherapy regimen:
Hydroxydaunorubicin
Oncovin
Prednisone
Main symptom of MDS
→ Anemia
Multiple myeloma
→ Plasma cell malignancy in bone marrow
Why anemia in myeloma?
Bone marrow infiltration
Renal failure
Reduced erythropoiesis
Thalidomide is used for…
Leprosy (Erythema nodosum leprosum)
5 risk factors for leukemia
Radiation
Genetic syndromes
Benzene exposure
MODERN ONCOLOGY & FINAL TOPICS
What does CD mean?
→ Cluster of Differentiation
· Cell surface markers
· Used for immunophenotyping
· Classification of hematologic malignancies
Karyotyping
Chromosomal analysis for:
Number
Structure
Translocations
Deletions
Minimal residual disease
→ Remaining tumor cells after therapy
CAR-T cell therapy
Genetic modification of T-cells
Tumor antigen recognition
Immune-mediated killing
5 hallmarks of cancer
Sustained proliferation
Evading apoptosis
Angiogenesis
Immune evasion
What is Estrogen
→ Female sex hormone promoting cell growth
What is/what does Tamoxifen do
· Selective estrogen receptor modulator (SERM)
· Blocks estrogen receptors in breast tissue
· Used in ER-positive breast cancer
· Reduces recurrence risk
Fastest growing lung cancer
→ Small cell lung cancer
Gynecological tumor with highest mortality
+3 reasons
→ Ovarian cancer
3 reasons
Late diagnosis
Unspecific symptoms
Early metastasis
What does CUP mean in oncology?
→ Cancer of Unknown Primary
How would you rate the quality of the study below?
· Randomization minimizes selection bias and balances confounders
Robust statistical analysis
Hazard Ratio (HR): 0.76
95% Confidence Interval: 0.67–0.86
p < 0.0001 → The confidence interval does not cross 1, and the p-value is highly significant
Large sample size and long follow-up
~3,300 patients total (1,702 vs 1,597)
Follow-up of up to 9 years
Numbers at risk are transparently shown over time
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