Institute for Continuing Education

Overview and Advances in Oncology

Course Objectives

Upon successful completion of this module, you will be able to:

• Describe recent advances across the major modalities of cancer treatment, including cytotoxic chemotherapy, targeted therapy, and immunotherapy, and explain how these approaches complement one another in contemporary practice.
• Identify and differentiate the principal modalities of cancer therapy, including surgery, radiation therapy, systemic pharmacologic therapy, and cellular therapy.
• Explain the principles of cancer staging and tumor classification, including the TNM system, histologic grading, and the growing role of molecular classification.
• Describe the fundamental characteristics of carcinogenesis and relate them to the recognized hallmarks of cancer.
• Differentiate malignant from benign neoplasms on the basis of their biologic behavior and clinical significance.
• Describe the phases of clinical trials used in the development and testing of new antineoplastic drugs.
• Describe the criteria and methods, including RECIST and tumor markers, by which response to cancer treatment is determined.
• Explain the healthcare professional’s role in the process of obtaining and supporting informed consent.
• Recognize the signs and symptoms of extravasation and infiltration of a vesicant, and outline the appropriate nursing measures to minimize tissue damage.
• Describe the safety precautions and regulatory standards that minimize exposure of healthcare personnel, patients, families, and the environment to the hazardous effects of antineoplastic drugs.
• Recognize the mechanisms and characteristic toxicities of immune-based therapies, including immune-related adverse events and cytokine release syndrome.

Course Information

The American Cancer society traces its origins to 1913, when a group of physicians and laymen met in New York City and founded the American Society for the Control of Cancer. Their original premise at that time, was to disseminate knowledge concerning the symptoms, treatment, and prevention of cancer; investigate the conditions under which the cancer occurred, and compile the statistics. The purpose of the organization is very similar today; to conquer cancer through balanced programs of research, education (preventative), patient service, and rehabilitation.

Cancer is a group of diseases characterized by the uncontrolled growth of abnormal cells that spread from the site of origin. This spread, if uncontrolled, invades vital organs and results, ultimately, in death. Early detection, diagnosis, and treatment can cure many cancers while others can be controlled for many years with a variety of treatment approaches.

Cancer is most often treated by surgery, radiation, chemotherapy, and hormones. Recently immunotherapy has been added to this armament. Cancer occurs at any age, although it is sometimes referred to as a Œdisease of aging¹, with statistics citing 66% of cancer deaths occurring after the age of 65, it is also accountable for the death of more children between the ages of 3 and 14 than any other disease.

More than 6 million Americans alive today have had a history of cancer; most but not all, of the 3 million who were diagnosed five years ago can be considered cured. "Cure" is defined as having no evidence of recurrent cancer, while simultaneously having the same life expectancy as a person who never had cancer.

For most forms of cancer, five years after treatment with no signs of recurrence is a good statistical mark for continued survival, although there still can be an attrition rate beyond that time. In fact, for some of the more aggressive cancers, fatal in a short period of time, a three year survival rate may be considered a "cure". Other cancers may require a much longer period of time without recurrence to be considered cured. In 1991, 1 million people were diagnosed with cancer. These statistics do not include nonmelanoma or carcinoma in situ. Nonmelanoma cancers alone account for 600,000 new cases annually.

At the turn of this century very few people with major cancers had much hope of long - term survival. More than 60 years ago, in the 1930s, less than 1 in 5 persons with cancer was alive 5 years after cancer treatment. In the 1940s it was 1 in 4, and in the 1960s it was 1 in 3. Today 40%, or four out of ten persons who develop cancer, will be alive five years after treatment. The improvement from 1 in 3 to 4 out of 10 represents 69,000 people in 1991 alone. This is an "observed" survival rate. In terms of normal life expectancy when other causes of death (heart disease, accidents, etc.) are taken into account, 50% of the cancer population will be alive five years after cancer treatment. This "relative" survival rate is a more accurate measure of success in the treatment of cancer.

Cancer is a universal disease that affects people without regard to race, gender, socioeconomic status, or culture. However, different forms of cancer strike specific age, ethnic, and gender groups with varying frequency and severity. For example, cancer morbidity and mortality increase5 rapidly with age, and it is believed by many researchers that if you live long enough you will eventually develop some form of cancer.

Socioeconomic factors are thought to explain ethnic differences in cancer. Both the incidence and mortality of certain cancers are higher in African Americans than in Caucasians. Although women are more likely to develop cancer, men are more likely to die of the disease. The sites in men that are associated with the greatest mortality are the lungs, prostate, colon and rectum. In women the leading sites are the lungs, breasts, colon and rectum.