Associate Editor: Maryann Bishop-Jodoin, BS
Established by the Department of Medicine, Division of Hematology Oncology and the Department of Radiation Oncology at the University of Massachusetts Medical School
The University of Massachusetts Medical School, in the process of revising its undergraduate medical school curriculum, devised a new course, Cancer Concepts, to introduce the general principles of Oncology to first year students. Coverage of specific tumor types is incorporated in the appropriate system blocks over the subsequent years in the new curriculum. In preparing this sequence of material, the course co-directors (JL & RSP) realized that handouts would have to be generated at an appropriate level for medical students. Currently a textbook is not available at that level. As so often happens, the handouts evolved into this textbook.
The goal of the Cancer Concepts course is to begin to prepare students to care for oncology patients in whatever specialty they ultimately choose, and the text provides a foundational guidebook of oncology for non-oncologists. The text is designed from inception as an e-book, not a traditional printed version converted to on-line existence. As an on-line textbook, it provides the opportunity to click through to the online library at the school, for insertion of larger image sets – for example, select CT scans, 3 dimensional anatomy movies, moving drawings demonstrating mechanisms of action - and access to a medical dictionary simply by clicking on the term in question. The text includes hotlinks to provide immediate access to glossary definitions, larger versions of images, such as radiographs, graphs and charts, and even movies, virtual microscopy slides, and, if logged on to a electronic library, complete articles. Interactivity is built into the format.
The book is divided into two sections. The first provides a general introduction to oncology at the cellular, tissue, organ and organism levels, including history and basic principles of the available treatment modalities for malignancies. The second provides an overview of the common malignancies and selected other cancers, either because they are interesting, or because they are examples used in the courses at UMass. Most of the chapters have been authored by members of the oncologic faculty at the University of Massachusetts School of Medicine, and each chapter has been peer reviewed by at least one other oncologist, and reviewed for readability by a non-oncologist attending physician and a medical student.
The book should be an approachable reference, which will create a framework for a common oncology thread through the entire undergraduate and graduate medical curriculum at the University of Massachusetts Medical School. It is also hoped that practicing physicians in non-oncologic specialties will find it a useful guide when oncologic questions arise. The online format allows chapters to be posted as they are completed, and to be readily revised. The first site posting is on the Lamar Souter Library eScholarship site of the University of Massachusetts Medical School, and the book is open access with the Creative Commons license: Attribution Non-Commercial Share Alike (CC BY-NC-SA). Thus, the information in the text is freely available to all.
List of Cancer Concepts chapters:
Mary Linton Peters, Richard S. Pieters, and James Liebmann
This chapter in the Cancer Concepts textbook presents a summary of the most relevant causative agents of cancer. Exposure to many environmental agents is associated with an increased incidence of certain malignancies, although causation is usually difficult to prove. Certain chemicals, infections (parasitic, viral, and bacterial) and ionizing radiation are known carcinogens. Variable genetic susceptibility to carcinogenesis is apparent. Up to 2/3 of human cancers are believed to have an environmental component.
Richard S. Pieters and James Liebmann
This chapter in the Cancer Concepts textbook describes the principles of multi-disciplinary management, meaning multi-specialty physician management of malignancies. Tumor Boards are the model for multi-disciplinary management. They may be site specific or include the entire spectrum of malignancy. At Tumor Boards, staging workup and treatment recommendations are made collectively, and then the treatments are delivered by the respective modality specialists and their individual teams. Improved clinical decision making leading to superior survival for patients with some diseases and better quality of life has been documented with multi-disciplinary management. Just like curative patients, palliative patients require multi-disciplinary management.
Richard J. Homer
Over eighty different compounds have been approved to treat cancer. Their mechanisms of action, effectiveness against specific cancers, and potential toxicity vary greatly. This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist will describe, in terms of mechanism of action, the most important classes of cytotoxic and targeted therapies as well as their most characteristic side effects and clinical uses. A table summarizing the classes of drugs and representative members of those classes is included at the end of the chapter. Rather than an encyclopedia, this will be a schematic diagram or roadmap to more detailed knowledge that you will acquire during your clinical training and subsequent experience.
Mary Linton Peters, Richard S. Pieters, James Liebmann, and Geoffrey Graeber
The “stage” of a cancer is a short-hand way of describing the extent of cancer in a patient. Stage is based on macroscopic involvement of tissues by cancer. Staging of cancer occurs prior to the beginning of treatment, or at the first definitive surgery. Clinical staging, which includes radiography and exam findings, takes place initially. Pathologic staging, which is obtained from surgical specimens, can be acquired during the course of surgical treatment. Patients then carry either the clinical stage or the pathologic stage for the duration of their illness. This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist will describe principles of cancer staging.
Epidemiology is the study of populations using defined research methods to confirm the patterns and causes of disease and applying this information to improve the health of the populations. This branch of science is the basis for understanding the spread of diseases in a defined area or group of people. Epidemiologic studies have been instrumental in improving outcomes by establishing preventive and therapeutic measures for the incidence, prevalence and mortality from cancers. The incidence of malignancy in a country or in our world defines the magnitude of the cancer problem. This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist will introduce the role of epidemiology in the diagnosis and treatment of cancer.
Beverly N. Hay
While the majority of cancers are not inherited, there are a number of well described collections of cancers that occur within families. These cancer syndromes were initially identified based on observation of the family history and subsequently the molecular mechanisms have been elucidated. This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist is intended to allow the reader to recognize when a pattern of cancers occurs in an individual or their family, and to generate an investigation into potential cancer syndromes. With the rapidly expanding understanding of the molecular basis of cancers at the cellular and constitutional levels, appropriate preventive care may be offered and tailored treatment holds great promise.