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Oncology

The study and treatment of cancer.

✓ Introduction to Oncology

✓ Introduction to Oncology is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Cancer Biology Basics

✓ Cancer Biology Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Cancer Genetics Basics

✓ Cancer Genetics Basics is an essential biology topic covering living systems, from cellular processes to ecosystems.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Chemotherapy Basics

✓ Chemotherapy Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Radiation Therapy Basics

✓ Radiation Therapy Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Surgical Oncology Basics

✓ Surgical Oncology Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Immunotherapy Basics

✓ Immunotherapy Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Targeted Therapy Basics

✓ Targeted Therapy Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Breast Cancer Basics

✓ Breast Cancer Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Lung Cancer Basics

✓ Lung Cancer Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Colorectal Cancer Basics

✓ Colorectal Cancer Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Prostate Cancer Basics

✓ Prostate Cancer Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Leukemia Basics

✓ Leukemia Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Lymphoma Basics

✓ Lymphoma Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Palliative Care Basics

✓ Palliative Care Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Oncology Ethics Basics

✓ Oncology Ethics Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Cancer Screening Basics

✓ Cancer Screening Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Cancer Prevention Basics

✓ Cancer Prevention Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Cancer Epidemiology Basics

✓ Cancer Epidemiology Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Cancer Staging Basics

✓ Cancer Staging Basics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Oncology Careers

✓ Oncology Careers is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Advanced Oncology

✓ Advanced Oncology is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Cancer Biology

✓ Cancer Biology is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Cancer Genetics

✓ Cancer Genetics is an essential biology topic covering living systems, from cellular processes to ecosystems.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Chemotherapy

✓ Chemotherapy is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Radiation Therapy

✓ Radiation Therapy is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Surgical Oncology

✓ Surgical Oncology is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Immunotherapy

✓ Immunotherapy is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Targeted Therapy

✓ Targeted Therapy is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Breast Cancer

✓ Breast Cancer is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Lung Cancer

✓ Lung Cancer is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Colorectal Cancer

✓ Colorectal Cancer is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Prostate Cancer

✓ Prostate Cancer is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Leukemia

✓ Leukemia is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Lymphoma

✓ Lymphoma is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Palliative Care

✓ Palliative Care is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Oncology Ethics

✓ Oncology Ethics is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Cancer Screening

✓ Cancer Screening is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Cancer Prevention

✓ Cancer Prevention is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Cancer Epidemiology

✓ Cancer Epidemiology is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Cancer Staging

✓ Cancer Staging is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

✓ Oncology Research

✓ Oncology Research is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Time complexity (Big-O), space complexity, correctness proof, and practical implementation trade-offs.

✓ Oncology Innovation

✓ Oncology Innovation is a clinical topic covering pathophysiology, diagnosis, evidence-based treatment, and patient care.

Key points: Core principles, practical applications, and advanced concepts that build deep understanding.

Key Clinical Formulas & Scores

TNM Staging System (AJCC 8th Edition):
T (Tumor): T0 = no evidence, Tis = carcinoma in situ, T1-T4 = increasing size/extent
N (Nodes): N0 = no regional nodes, N1-N3 = increasing nodal involvement
M (Metastasis): M0 = no distant mets, M1 = distant metastasis
Stage grouping: Stage 0 (Tis N0 M0), Stage I-II (localized), Stage III (locally advanced), Stage IV (metastatic)
ECOG Performance Status:
0 = Fully active, able to carry on all pre-disease activity
1 = Restricted in physically strenuous activity but ambulatory
2 = Ambulatory and capable of self-care, up >50% of waking hours
3 = Capable of limited self-care, confined to bed/chair >50%
4 = Completely disabled, cannot carry on self-care
5 = Dead
Gleason Score (Prostate Cancer):
Sum of primary (most common) + secondary (second most common) grade
Grades: 1 (well-diff) to 5 (poorly-diff/anaplastic)
Gleason 6 (3+3): Low risk
Gleason 7 (3+4=7 or 4+3=7): Intermediate risk
Gleason 8-10 (4+4, 4+5, 5+4, 5+5): High risk
ISUP Grade Groups: 1 (GG≤6), 2 (GG 3+4), 3 (GG 4+3), 4 (GG 8), 5 (GG 9-10)
RECIST 1.1 Criteria (Treatment Response):
CR (Complete Response): Disappearance of all target lesions
PR (Partial Response): ≥30% decrease in sum of target lesion diameters
PD (Progressive Disease): ≥20% increase (absolute ≥5mm) or new lesions
SD (Stable Disease): Neither PR nor PD criteria met
Non-target: CR = disappearance, PD = unequivocal progression
Child-Pugh Score (Liver Reserve for Hepatic Mets):
1 point each: Bilirubin <2 mg/dL, Albumin >3.5 g/dL, INR <1.7, No ascites, No encephalopathy
2 points: Bilirubin 2-3, Albumin 2.8-3.5, INR 1.7-2.3, Mild ascites, Grade 1-2 encephalopathy
3 points: Bilirubin >3, Albumin <2.8, INR >2.3, Moderate ascites, Grade 3-4 encephalopathy
Class A (5-6): 1-yr survival 100% | Class B (7-9): 80% | Class C (10-15): 45%

Core Concepts

Cancer Biology & Hallmarks

Hanahan & Weinberg Hallmarks: Sustaining proliferative signaling, evading growth suppressors, resisting cell death, enabling replicative immortality, inducing angiogenesis, activating invasion & metastasis. Emerging: Deregulating cellular energetics, avoiding tumor-promoting inflammation, genome instability & mutation, immune evasion. Tumor microenvironment: CAFs, TAMs, hypoxia, acidosis.

Paraneoplastic Syndromes

Endocrine: SIADH (small cell lung cancer — hyponatremia), Cushing syndrome (ectopic ACTH), hypercalcemia (PTHrP — squamous cell), hypoglycemia (IGF-2 — sarcomas), carcinoid syndrome (flushing, diarrhea, wheezing — serotonin). Neurologic: Lambert-Eaton (SCLC), cerebellar degeneration (anti-Yo — ovarian/breast), limbic encephalitis (anti-Hu — SCLC). Dermatologic: acanthosis nigricans, dermatomyositis, erythema gyratum repens.

Chemotherapy Principles

Cell cycle: Phase-specific (M-phase: vinca alkaloids, taxanes; S-phase: antimetabolites) vs non-specific (alkylating agents, platinum, anthracyclines). Dose intensity vs dose density. Combination regimens: synergistic efficacy, reduced resistance. Adverse effects: myelosuppression (nadir 7-14 days), mucositis, alopecia, nausea/vomiting (5-HT3 antagonists, NK1 antagonists, dexamethasone), organ toxicity (cardiac — doxorubicin, pulmonary — bleomycin, renal — cisplatin, neurotoxicity — vincristine/paclitaxel).

Immunotherapy & Checkpoint Inhibitors

PD-1 inhibitors: pembrolizumab, nivolumab. PD-L1 inhibitors: atezolizumab, durvalumab, avelumab. CTLA-4 inhibitor: ipilimumab. Mechanism: release brakes on T-cell activation. Response patterns: pseudoprogression, hyperprogression. irAEs: pneumonitis, colitis, hepatitis, thyroiditis, hypophysitis, myocarditis, dermatologic toxicity. Biomarkers: PD-L1 expression, MSI-H/dMMR, TMB. Biomarker: TMB (tumor mutational burden).

Targeted Therapy & Precision Oncology

EGFR: osimertinib (T790M), erlotinib, afatinib (lung adenocarcinoma). ALK: crizotinib, alectinib, brigatinib. BRAF: dabrafenib + trametinib (melanoma). HER2: trastuzumab, pertuzumab, T-DM1 (breast/gastric). BRCA: olaparib, rucaparib (ovarian/breast/prostate). NTRK: larotrectinib, entrectinib. MSI-H: pembrolizumab (tumor-agnostic approval).

Clinical Case Studies

Case 1: Metastatic Non-Small Cell Lung Cancer

Patient: 62-year-old male, 40-pack-year smoking history, hemoptysis, weight loss. CT: 4.2 cm left upper lobe mass with hilar lymphadenopathy. Biopsy: adenocarcinoma. PET: solitary bone metastasis (T2aN2M1b = Stage IV).

Molecular testing: EGFR exon 19 deletion positive, ALK negative, ROS1 negative, PD-L1 TPS 5%.

Management: First-line osimertinib 80mg daily (FLAURA trial — superior PFS and OS vs 1st-gen TKIs). Palliative radiotherapy to bone metastasis. Surveillance imaging every 6-12 weeks. At progression: repeat biopsy for resistance mechanisms (T790M, C797S, MET amplification, SCLC transformation).

Case 2: HER2-Positive Breast Cancer

Patient: 45-year-old female, palpable right breast mass, skin dimpling. Biopsy: invasive ductal carcinoma, ER/PR negative, HER2 3+ (IHC). Stage: T2N1M0 (Stage IIB).

Management: Neoadjuvant TCHP (docetaxel, carboplatin, trastuzumab, pertuzumab) × 6 cycles (KRISTINE/TRYPHAENA protocols). Pathologic complete response (pCR) achieved → continue trastuzumab + pertuzumab to complete 1 year total. Adjuvant radiation. If residual disease: T-DM1 (KATHERINE trial) × 14 cycles.

Case 3: Metastatic Colorectal Cancer

Patient: 58-year-old male, iron deficiency anemia, colonoscopy reveals ascending colon mass. Biopsy: adenocarcinoma, moderately differentiated. CT: liver metastases (3 lesions). Molecular: RAS wild-type, BRAF wild-type, MSS, HER2 negative.

Stage:cT4aN0M1a (Stage IV). Management: FOLFOX + bevacizumab (or cetuximab if left-sided) for 4-6 months. If good response and liver lesions become resectable → hepatic resection ± ablation. Adjuvant chemotherapy post-resection. If unresectable: continue systemic therapy, consider liver-directed therapies (TACE, SIRT).

Practice Questions

Q1: A patient with prostate cancer has a Gleason score of 4+3=7. What ISUP grade group is this?
A: ISUP Grade Group 3. Grade groups: 1=GG≤6, 2=GG 3+4=7, 3=GG 4+3=7, 4=GG 8, 5=GG 9-10.
Q2: What is the ECOG performance status of a patient who is ambulatory, capable of self-care, but unable to work and is up more than 50% of waking hours?
A: ECOG 2.
Q3: A patient on pembrolizumab develops grade 3 immune-related colitis. What is the appropriate management?
A: Hold immunotherapy, start high-dose corticosteroids (prednisone 1-2 mg/kg/day or methylprednisolone IV), consider infliximab if no response within 48-72 hours. Grade 3-4 irAEs typically require permanent discontinuation of checkpoint inhibitor.
Q4: What is the mechanism of action of trastuzumab?
A: Monoclonal antibody targeting HER2 (human epidermal growth factor receptor 2), blocking HER2 signaling and marking cells for antibody-dependent cellular cytotoxicity (ADCC).
Q5: A patient with SCLC presents with serum sodium 118 mEq/L, urine osmolality 450 mOsm/kg, urine sodium 40 mEq/L, and euvolemia. What is the diagnosis and cause?
A: SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion) secondary to small cell lung cancer. Treatment: fluid restriction, hypertonic saline if severe symptoms, demeclocycline or vaptans (tolvaptan) if refractory.

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