Clinical Oncology - B80120

• Title: Clinical Oncology
• Guaranteed by: Department of Oncology First Faculty of Medicine Charles University and General University Hospital in Prague (11-00630)
• Faculty: First Faculty of Medicine
• Actual: from 2023
• Semester: winter
• Points: 3
• E-Credits: 3
• Examination process: winter s.:
• Hours per week, examination: winter s.:0/50, C+Ex [HS]
• Extent per academic year: 50 [hours]
• Capacity: unlimited
• Min. number of students: unlimited
• 4EU+: no
• Virtual mobility / capacity: no
• State of the course: taught
• Language: English
• Teaching methods: full-time
• Explanation: MUDr. Martin Matějů, Ph.D.
• Old code: 764
• Guarantor: doc. MUDr. Michal Vočka, Ph.D.
• Comes under: Compulsory for GM 5.y._24/25
• Attributes: Lékařství; Klinický předmět
• Pre-requisite : B80386, B80632, B83161, B83162

Annotation

Students acquire knowledge of carcinogenesis, prevention, diagnosis, treatment modalities and psychosocial aspects of the complex oncological care as well as they get acquainted with most of cancer types and their specifics. Apart from acquiring the oncological knowledge the course focuses on the crucial communication and social skills, attitudes and values that are important in the contact with the oncological patient.

Last update: Kolářová Jana (05.03.2021)

Literature

Recommended:

• John E. Niederhuber & James O. Armitage & James H Doroshow & Michael B. Kastan & Joel E. Tepper. Abeloff's Clinical Oncology, 6th Edition. : Elsevier, 2022, s. ISBN 9780323476744.
• Antonio Russo, Marc Peeters, Lorena Incorvaia. Practical Medical Oncology Textbook. : Springer, 2021, s. ISBN 3030560503.
• Abraham, Jame, Gulley, James L.. Bethesda Handbook of Clinical Oncology. : Lippincott Williams and Wilkins, 2020, s. ISBN .
• DeVita, Vincent T., Lawrence, Theodore S. Rosenberg, Steven A. (eds.). Cancer, Principles and Practice of Oncology. Philadelphia: Wolters Kluwer, 2019, 2390 s. ISBN .
• Cassidy J.. Oxford Handbook of Oncology. : Oxford University Press, 2015, s. ISBN .
• UpToDate, accessible via Institute of Scientific Information,1st Faculty of Medicine [online]. Dostupné z: https://www.uptodate.com
• NCCN guidelines [online]. Dostupné z: https://www.nccn.org/professionals/physician_gls/default.aspx

Last update: Matějů Martin, MUDr., Ph.D. (27.09.2023)

Teaching methods

The course is part of the 5th-year curriculum and spans two weeks. Seminars will take place at five different oncology departments within the First Faculty of Medicine, following the scheduled plan.

Last update: Matějů Martin, MUDr., Ph.D. (20.09.2024)

Requirements to the exam

Questions for final exam:  

The questions are divided into two sections, with students drawing one pair of questions, each containing one question from the primary section and one from the secondary section. If a student does not demonstrate sufficient knowledge in the essential topics of the primary section, the exam will be terminated. The secondary section is intended to "refine" the final grade.
 

Primary Question Section

1. Prevention and Follow-up in Oncology
a. Primary and secondary prevention (+ Screening programs in the Czech Republic)
b. Principles of follow-up (+ Relapse and Secondary malignancies)

2. Radiotherapy
a. Principles and types of radiotherapy, fractionation
b. Radiotherapy planning, OARs (Organs at Risk)
c. Neoadjuvant, adjuvant, curative, and palliative radiotherapy (doses)
d. Side effects, their prevention and treatment
e. Common applications in specific diagnoses

3. Chemotherapy
a. Mechanism and classification of cytostatics
b. Neoadjuvant, adjuvant, and palliative chemotherapy
c. Side effects, their prevention and treatment
d. Resistance to chemotherapy
e. Common applications in specific diagnoses

4. Hormonal Therapy
a. Mechanism, hormone-dependent tumors
b. Neoadjuvant, adjuvant, and palliative hormonal therapy
c. Side effects, their prevention and treatment
d. Common applications in specific diagnoses

5. Targeted (Biological) Therapy
a. Mechanism and common molecular targets
b. Precision medicine, NGS (Next-Generation Sequencing) testing
c. Antibody-drug conjugates (ADCs)
d. Side effects, their prevention and treatment
e. Common applications in specific diagnoses
f. Combination of targeted therapy with chemotherapy

6. Immunotherapy
a. Mechanism, checkpoint inhibitors and CAR-T therapy
b. Side effects, their prevention and treatment
c. Common applications in specific diagnoses
d. Combination of immunotherapy with chemotherapy

7. Supportive Care in Oncology
a. Febrile neutropenia – prevention, treatment
b. CINV (Chemotherapy-Induced Nausea and Vomiting) – prevention, treatment
c. Lymphedema – prevention, treatment
d. Management of malignant effusions
e. Constipation – prevention, treatment
f. Treatment of anxiety and depression
g. Malnutrition, nutritional support
h. Anti-resorptive therapy

8. Pain Management in Oncology
a. Assessment (VAS) and principles of therapy
b. Pharmacological treatment (WHO pain ladder)
c. Specific drug examples, including dosages and side effects
d. Non-pharmacological pain management

9. Research and Clinical Trials in Oncology
a. Treatment response criteria (RECIST, iRECIST)
b. Phases of clinical trials
c. Primary and secondary endpoints of clinical trials
d. Assessment intervals (OS, PFS, DFS, TTP)
e. Basic terminology (Kaplan-Meier survival analysis, median, hazard ratio)

10. Terminal Care and Psychosocial Aspects of Oncology
a. Performance status; quality of life
b. Specifics of communication with oncology patients and their families
c. Termination of specific therapy; palliative care
d. Communicating bad news
e. Types of hospice care; hospices in the Czech Republic
f. Alternative approaches and their risks (Breuss diet and other dietary modifications, supplements, phytotherapy, chiropractic care, Reiki, etc.)

11. Oncological Emergencies
a. Febrile neutropenia
b. Obstructive syndromes
c. Coagulopathies and thromboembolic complications
d. Electrolyte imbalances

12. Hormone-dependent Breast Cancers
a. Treatment of localized disease
b. Treatment of locally advanced and metastatic disease
c. Prognosis

13. Breast Cancer – TNBC, HER2-positive; specifics for BRCA1/2-positive patients
a. Treatment of localized disease
b. Treatment of locally advanced and metastatic disease
c. Prognosis

14. Prostate Cancer
a. Principles of therapy, ADT (Androgen Deprivation Therapy)
b. Treatment of localized disease; risk classification
c. Treatment of locally advanced and metastatic disease (mHSPC, nmCRPC, mCRPC)
d. Prognosis

15. Colorectal Cancer
a. RAS, BRAF, MSI and other molecular targets; therapeutic implications
b. Treatment of localized disease
c. Treatment of locally advanced and metastatic disease
d. Oligometastatic disease
e. Prognosis

16. Lung Cancer
a. SCLC and NSCLC (squamous cell, adenocarcinoma, and others)
b. Molecular diagnostics (EGFR, ALK, ROS, RET, PD-L1, etc.)
c. Treatment of localized disease
d. Treatment of locally advanced and metastatic disease
e. Prognosis

17. Kidney Cancer
a. ccRCC (clear-cell renal cell carcinoma), non-clear cell variants
b. Treatment of localized disease
c. Treatment of locally advanced and metastatic disease
d. Partial resection, cytoreductive nephrectomy
e. Prognosis

18. Pancreatic and Biliary Tract Cancer
a. Treatment of localized disease
b. Treatment of locally advanced and metastatic disease
c. Significance of molecular testing
d. Prognosis

19. Esophageal, Gastric, and Gastroesophageal Junction Cancers
a. Treatment of localized disease
b. Treatment of locally advanced and metastatic disease
c. Predictors guiding therapy selection
d. Prognosis

20. Urothelial Cancer
a. NMIBC, MIBC, UTUC
b. Treatment of localized disease
c. Treatment of locally advanced and metastatic disease
d. Prognosis

21. Malignancies of Unknown Primary Origin
a. Essential diagnostic tests
b. Molecular targets, NGS
c. Principles of empirical therapy

Secondary Question Section

1. Tumor Epidemiology
a. Incidence, mortality, prevalence (absolute, relative)
b. Applicability in clinical practice

2. Risk Factors, Symptoms, and Diagnosis of Cancer
a. "Red flag" symptoms
b. Elementary clinical examination
c. Imaging and laboratory testing

3. Histopathological Verification and Staging of Cancer
a. The role of the pathologist in diagnosis and therapy planning
b. TNM classification
i. General characteristics
ii. Clinical application using an example of a common diagnosis (breast cancer, colorectal cancer, prostate cancer, lung cancer)

4. Guidelines – Proficiency in Navigating Online Resources and Practical Application of Acquired Knowledge
a. NCCN
b. ESMO

5. Oncological Teams
a. Tumor boards (GIT, pulmonary, mammary, urological, etc.)
b. Multidisciplinary team (MDT)
c. Molecular tumor board

6. Testicular Tumors
a. Seminomas, non-seminomas
b. Surgical therapy
c. Curative chemotherapy

7. Malignant Tumors of the Ovaries, Uterus, and Cervix
a. Issues related to fertility-preserving therapy
b. Cytoreductive procedures
c. Therapy for early-stage disease
d. Therapy for advanced disease

8. Malignant Tumors of Endocrine Glands
a. Thyroid tumors
b. NET/NEC
c. Others

9. Malignant Tumors of the Skin
a. Basal cell carcinoma
b. Squamous cell carcinoma
c. Malignant melanoma

10. Soft Tissue and Bone Sarcomas
a. Ewing's sarcoma
b. Soft tissue sarcomas
c. Specifics of surgical therapy for sarcomas
d. HILP

11. Malignant Tumors of CNS and Brain Metastases Management
a. Grading of CNS tumors
b. Stereotactic radiotherapy; gamma knife
c. WBRT

12. Genetic Cancer Syndromes I
a. The most common genetically determined cancer syndromes
b. Indications for testing (who to refer and why)

13. Genetic Cancer Syndromes II
a. Surveillance protocols for BRCA1/2 carriers
b. Surveillance protocols for MLH1, MSH2, MSH6, and PMS2 carriers
c. Empirical risk (risk assessment with negative genetic testing; how is it determined; practical application in monitoring)

14. Malignant Tumors of Pleura and Peritoneum
a. Surgical, cytostatic, and targeted therapy
b. HIPEC

15. Malignant Tumors of Mediastinum
a. Differential diagnosis
b. Most common mediastinal tumors
c. Therapy

16. Head and Neck Tumors
a. Manifestations
b. Therapy for locally advanced stages
c. Supportive therapy

17. Adverse Effects of Radiotherapy
a. Early and late responding tissues
b. Acute vs. late toxicity
c. Prevention and treatment of toxicity

18. Adverse Effects of Chemotherapy
a. Nausea and vomiting; prevention; treatment of acute and delayed vomiting
b. Specific drugs and their dosing

19. Adverse Effects of Targeted Therapy
a. Most common adverse effects by commonly used drugs
b. Comparison with adverse effects of chemotherapy and immunotherapy
c. Treatment and prevention

20. Adverse Effects of Immunotherapy
a. Manifestation of toxicity
i. Manifestation in different organ systems
ii. Most common intervals from administration to onset of adverse effects
b. Treatment, frequently used drugs, and dosing

21. Fundamentals of Biostatistics
a. Hazard ratio, statistical significance, p-value
b. DFS, DSS, PFS, OS
c. Disease control rate, objective response rate
d. Kaplan-Meier curves

Last update: Matějů Martin, MUDr., Ph.D. (20.09.2024)

Learning resources

1. https://www.uptodate.com/contents/search - accesible via Institute of Scientific Information 1st Faculty of Medicine
2. https://www.nccn.org/
3. https://www.medscape.com/
4. https://www.mdanderson.org/

Last update: Matějů Martin, MUDr., Ph.D. (29.05.2019)

Entry requirements

Dear Medical Students,

our first lecture (study groups AP3 and AP4 ) will start on Monday 30th of September at 9 a.m. at the lecture hall at Fakultní poliklinika (FP) in VFN -  Karlovo náměstí 32, building  A - middle part, door no. P.21

!!! Please notice that Monday and Friday lectures are identical for both study groups, whereas a rotation of odd/even groups (i.e.  AP3 is odd whereas 5054 is even) is performed from Tuesday to Thursday both weeks of course - as specified in a detailed timetable below.

Futher information and a detailed time table is available at: https://1url.cz/ZMD1F.

Please notice that some lessons may start at 8 or 8.30 AM !!! 

Students gain the CREDIT on the basis of their attendance and results of the online credit test in Moodle - link: B80120: Oncology Credit Test (cuni.cz).

The key for student registration is the code of the subject: "B80120"

The exam can be taken either during an "early exam slot" (available only to students who have just completed the current course, typically within the next two weeks) or during a "regular exam slot" held at the end of the winter or summer semester, open to all students.

The exam can be held on-line via MS Teams but only under some very special circumstances and by prior arrangement.

I hope you will find our course useful and we are all looking forward to our lectures.

Sincerely,
Martin Mateju

Head of Education at Oncology Clinic: MUDr. Martin Matějů, PhD.; contact:  [e-mail]

Secretary of Oncology Clinic VFN: Mgr. Jana Hůlová; contact: [e-mail]

Last update: Matějů Martin, MUDr., Ph.D. (20.09.2024)