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Oncology 401
Final
193
Medical
Undergraduate 3
12/12/2009

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Cards

Term
What are the three types of epidemiological studies?
Definition
Episodic, Retrospective, and Prospective
Term
Properties of an episodic observations study
Definition
Observation of isolated cases of cancer in relation to a specific environmental factor that provides info suggesting cause and effect
Term
Properties of a retrospective study
Definition
Done after the fact, and the MOST COMMON, investigates people with a disease, first step in identifying causative factor
Term
Which type of epidemiological study is most common?
Definition
Retrospective study
Term
Properties of Prospective study
Definition
Analyze development of cancer in people with specific social habits, exposures, etc.  Expensive, but the best
Term
How to calculate odds ratio
Definition
Odds ratio = [(disease present + exposed)*(disease absent + not exposed)]/[(disease present + not exposed)*(disease absent + exposed)]
Term
What does an IARC evaluation of 1 mean and what evidence is there of carcinogenicity? 
Definition
Agent is carcinogenic, sufficient human evidence
Term
What does an IARC evaluation of 2A mean and what evidence is there for carcinogenicity?
Definition
Agent is probably carcinogenic, limited evidence in human, but sufficient evidence in animal
Term
What does an IARC evaluation of 2B mean and what evidence is there of carcinogenicity?
Definition
Agent is possibly carcinogenic, limited evidence in humans OR inadequate in humans, but sufficient in animal
Term

What does an IARC evaluation of 3 mean and what evidence is there of carcinogenicity?

Definition
Agent is not classifiable as to carcinogenicity, inadequate evidence in humans, and sufficient in animals but carcinogenic mechanism is not operable in human
Term

What does an IARC evaluation of 4 mean and what evidence is there of carcinogenicity?

Definition
Agent is probably not carcinogenic, inadequate evidence in both animals and humans
Term
Two categories of carcinogenic factors associated with life-styles
Definition
Specific chemical agents and Physiological conditions or processes
Term
Examples of carcinogenic factors that are specific chemical agents
Definition
Alcoholic beverages, and aflatoxins
Term
Examples of carcinogenic factors that are physiologic conditions or processes
Definition
Dietary intake, salted fish (Chinese style), reproductive history, sexual promiscuity, tobacco smoking, tobacco chewing
Term
What neoplasms are associated with consumption of alcoholic beverages?
Definition
Esophagus, live, oropharynx, and larynx
Term
What neoplasms are associated with aflatoxins?
Definition
Liver
Term
What neoplasms are associated with dietary intake (fat, protein, calories)?
Definition
Breast, colon, endometrium, gallbladder
Term
What neoplasms are associated with salted fish (Chinese style)?
Definition
Stomach
Term
What neoplasms are associated with late age at 1st pregnancy?
Definition
Breast
Term
What neoplasms are associated with zero or low parity?
Definition
Ovary
Term
What neoplasms are associated with sexual promiscuity?
Definition
Cervix uteri
Term
What neoplasms are associated with tobacco smoking?
Definition
Mouth, pharynx, larynx, lung, esophagus, bladder
Term
What neoplasms are associated with tobacco chewing?
Definition
Mouth, pharynx
Term
Which neoplasm does estrogen replacement without progestin highly increase the risk for?
Definition
Endometrial cancers
Term
What type of carcinogen is cigarette smoke?
Definition
Complete
Term
What are some common industrial carcinogens?
Definition
Vinyl chloride, 2-Naphthalamine, benzene
Term
What type of cancer does benzene induce?
Definition
Acute myelogenous leukemia
Term
100% of 2-Naphthalamine distillers developed what type of neoplasm?
Definition
Bladder tumors
Term
Transplant patients who receive immunosuppresive drugs are hundreds of times more likely to develop which type of neoplasm?
Definition
Leukemia
Term
Phenacetin is used for pain, but causes development of which type of cancer?
Definition
Kidney cancer
Term
Common medicinal carcinogens
Definition
Estrogens, Steroids, Ionizing radiation, Immunosuppressive drugs, alkylating agents
Term
How does smoking cessation affect risk of death from lung cancer?
Definition
Drops risk dramatically
Term
What are common sources of IR and UV exposure?
Definition
nuclear medicine, medicinal X-rays, radon gas, cosmic
Term
4 common radiogenic neoplasms (induced by IR)
Definition
leukemia (esp. in kids), thyroid carcinoma, breast carcinoma, lung cancer (radon gas exposure)
Term
What type of carcinogen is UV-A?
Definition
Promoting agent
Term

What type of carcinogen is UV-B?

Definition
Initiation agent (causes sunburn)
Term

What type of carcinogen is UV-C?

Definition
Complete carcinogen (most is absorbed by ozone layer)
Term
Besides UV-C, what is another complete carcinogen caused by UV?
Definition
UV-A + UV-B
Term
What types of pathologies are Helicobacter pylori associated with and how does this bacteria cause it?
Definition
Ulcers and gastric (adeno) carcinoma/lymphoma; chronic infection is probably a promoting agent
Term
Which neoplasms is EBV associated with?
Definition
Burkitt's lymphoma, Hodgkin's disease, Nasopharyngeal carcinoma
Term
Which neoplasms are associated with the Hepatitis B virus?
Definition
Hepatocellular carcinoma; relative risk of developing HCC if HepB+ is >100
Term
What neoplasm is associated with HPV?
Definition
Cervical cancer
Term
Which neoplasms are associated with Kaposi's sarcoma herpes virus (HHV8)?
Definition
Kaposi's sarcoma, lymphoma (red/purple patches on skin/mouth/throat)
Term
Which neoplasm is associated with the Hepatitis C virus and what type of virus is it?
Definition
Hepatocellular carcinoma; RNA virus
Term
Which neoplasms are associated with AIDS infected individuals?
Definition
Kaposi's (!!!) non-hodgkins => due to non-existent immune system and acquisition of 2nd infection
Term
What neoplasms are associated with Human T-cell lymphotropoic viruses (HTLV)? What type of virus is HTLV?
Definition
T-cell leukemia/lymphoma; retrovirus (gag/pol/env)
Term
What does the Warburg theory state?
Definition
Unique metabolism in tumors; cells undergo glycolysis (fermentation); cancer cells have a higher rate of glycolysis than normal cells (high levels of lactic acid observed); normal cells go through typical cellular respiration (oxygen dependent); not all tumors exhibit this
Term
What does the Convergence Hypothesis state?
Definition
All neoplasms converge on a common neoplasm (phenotype)
Term
What does the Deletion hypothesis state?
Definition
Carcinogenesis results from "a permanent alteration or loss of protein essential for the control of growth"
Term
What does the Divergence hypothesis state?
Definition
All neoplasms are different and have different biochemical makeup
Term
What are the 4 major biochemical alterations in neoplasms?
Definition
DNA methylation, Cell cycle components, micro-RNAs, and telomerases
Term
What are microarrays done for?
Definition
Look for changes in gene expression between a normal and cancer cell
Term
What evidence did Greenstein use for his convergence hypothesis?
Definition
Normal tissues had varying enzyme levels while tumor tissues had very similar enzyme levels
Term
What are personalized biomarkers used for?
Definition
A microarray can also be used to track changes in gene expression in an individual patient; every tumor is different so if you see that a marker is upregulated then you can use this info to guide treatment options and gauge prognosis
Term
What types of genes are typically upregulated in cancer cells?
Definition
Growth factor receptors, cell cycle regulators, or other oncogenes
Term
What types of genes are usually downregulated in neoplasms?
Definition
Tumor suppressor gene
Term
What does methylation do to the expression of genes?
Definition
Silences genes
Term
What effect does hypomethylation have on gene expression, particularly oncogenes?
Definition
Increased expression
Term
Hypermethylation can lead to gene silencing, especially in which genes for neoplasms?
Definition
Tumor suppressors
Term
Where does methylation usually occur?
Definition
CpG islands which are repeats of cytosine and guanine in the genome
Term
Where are telomeres located on a chromosome?
Definition
At the end
Term
As a person gets older, what happens to their telomeres?
Definition
They shorten
Term
How is telomere length different in neoplastic cells than normal cells
Definition
Often telomere length is maintained in neoplastic cells, this correlates with increased expression levels of telomerase
Term
Which gene is the "guardian of the genome"?
Definition
p53
Term
What two things can p53 do and how does it do them?
Definition
It can inhibit cell proliferation (by transactivation of p21) or it can promote apoptosis (by activation of BAX)
Term
Which genes in the p family inhibit kinases?
Definition
p16-19, p21, p27, p57
Term
In which tumor is p53 imprinting a major factor?
Definition
Wilm's tumor
Term
Where does DNA methylation occur most frequently?
Definition
5 methyl cytosine
Term
What do miRNAs do?
Definition
encoded in cells, antisense to mRNA target, results in destruction of mRNA message so protein product is not produced, some cancers associated with specific miRNAs
Term
The cell cycle
Definition
G1 -> R -> S -> G2 -> M -> G1
Term
Examples of biochemical changes in transformed cells
Definition
Increase in glucose uptake, cell agglutination in presence of lectin, changes in cytoskeleton, production of growth factors
Term
3 main components of cytoskeleton (in order from smallest to largest)
Definition
Microfilaments, intermediate filaments, microtubules
Term
Three types of cellular secretion
Definition
autocrine, paracrine, endocrine
Term
What were biochemical changes accompanying transformation initially studied with?
Definition
Chick embryo fibroblasts that have been infected with a transforming virus (Rous sarcoma virus or SV40)
Term
SV40 transformed cells treated with plant lectins (concanavalin A) caused cells to do what?
Definition
Aggregate/clump
Term
What do lectins bind to?
Definition
Sugar
Term
Why did aggregation of SV40 treated cells exposed to plant lectins most likely occur?
Definition
Changes in surface glycoproteins and lectin receptors
Term
What are microfilaments made of?
Definition
Actin
Term
What are microtubules made of?
Definition
Tubulin
Term
What are intermediate filaments made of?
Definition
Cell type specific (collagen, keratins)
Term
Examples of growth factors
Definition
EGF/TGFα, TGFβ
Term
What is the usual signal transduction cascade look like?
Definition
GF secreted into extracellular space; bind specific cellular receptors, causing dimerization; dimerization often leads to activation of kinase domain (exception is JAK/STAT pathway); phosphorylation of subsequent cellular proteins leads to changes in gene expression
Term
What is cachexia?
Definition
Extreme weight loss and body wasting in cancer patients
Term
Common characteristics of patient with Cachexia
Definition
weight loss, very high energy expenditure, and lose muscle protein
Term
Does a patient with high weight loss have a better or worse prognosis than a patient without the weight loss?
Definition
Worse prognosis
Term
Why does cancer cause a patient to lose muscle protein?
Definition
Neoplasms metabolize glucose to lactate in an inefficient way
Term
Which three factors mediate Cachexia?
Definition
LMF (lipid mobilizing factor), PIF (proteolysis-inducing factor), and TNF-α => all of which are secreted by neoplasms
Term
How does Lipid Mobilizing factor create a gluconeogenic substrate?
Definition
releases fatty acids from tissue (degrades fat)
Term

How does Proteolysis-inducing factor create a gluconeogenic substrate?

Definition
causes muscle degradation
Term

How does Tumor Necrosis factor-alpha create a gluconeogenic substrate?

Definition
inflammatory cytokine, stimulates catabolism
Term
What are two important regulators involved in hypercalcemia?
Definition
PTH and PTHRP
Term
How does energy expenditure differ between starvation and cachexia? Skeletal muscle? Liver?
Definition
In starvation energy expenditure goes down, which in cachexia it goes up; in starvation there is no change in skeletal muscle, while in cachexia it goes down; in starvation the liver atrophies, while in cachexia it increases in size
Term
Is high blood Ca2+ a good or bad prognosis?
Definition
Bad
Term
What are two different actions of TNF-α?
Definition

activates TNFR1 (apoptosis)

activates TNFR2 (NF-κB activation)

also involved in invasion

Term
How is sensitivity calculated?
Definition
True positive/ (True positive + False negative)
Term
How is specificity calculated?
Definition
True negatives / (true negatives + False positives)
Term
What does a high sensitivity detect?
Definition
Disease
Term
What does a high specificity detect?
Definition
Normal
Term
What is a common biomarker?
Definition
Serum AFP (low in normal, high in cancer)
Term
Why is PSA not a great biomarker for prostate cancer?
Definition
Sensitivity not good
Term
In order for hormones produced by the host to influence the neoplasm, the neoplasm must express what?
Definition
Receptors for that hormone
Term
Properties of dependent stage neoplasm
Definition
Preneoplastic lesion arising from a spontaneously initiated cell is still completely dependent on promoting agent
Term
Properties of Responsive stage neoplasm
Definition
Has a cellular population that can survive in the absence of hormone but grows relatively slowly in the stage of progression
Term
Properties of an Autonomous stage neoplasm
Definition
Malignant neoplasm in the stage of progression
Term
What fraction of breast cancers depend on estrogens for their growth?
Definition
2/3
Term
What are SERMs and which hormone did they have similar effects to?
Definition
Selective Estrogen Receptor Modulators; estrogen
Term
What are the Anatomic prognostic factors of early stage breast cancer?
Definition
Size of tumor; lymph node involvement (most powerful prognostic factor)
Term
What are the histologic prognostic factors for early stage breast cancer?
Definition
Tumor grade
Term
What are the molecular prognostic factors for early stage breast cancers
Definition
Estrogen receptor/Progesterone receptor; HER2/neu; 21-gene recurrence score
Term
If a patient lacks both estrogen receptors and progesterone receptors, is their odds response high or low?
Definition
Low
Term

If a patient has both estrogen receptors and progesterone receptors, is their odds response high or low?

Definition
High
Term
What are Tamoxifen and Toremifene?
Definition
SERMs
Term
What is exemestane?
Definition
A steroidal aromatase inhibitor
Term
What are anastrozole and letrozole?
Definition
Non-steroidal aromatase inhibitors
Term
What do beta cells in Islets of Langerhans produce?  What percentage of cells in Islets of Langerhans are beta cells?
Definition
Insulin and amylin (65-80%)
Term

What do alpha cells in Islets of Langerhans produce?  What percentage of cells in Islets of Langerhans are alpha cells?

Definition
Glucagon (15-20%)
Term

What do delta cells in Islets of Langerhans produce?  What percentage of cells in Islets of Langerhans are delta cells?

Definition
Somatostatin (3-10%)
Term
What causes ectopic hormone production by neoplasms?
Definition
Evolving karyoptypic instability
Term
What does AID stand for?
Definition
Activation-induced deaminase
Term
What are the three ways for normal self antigens to become tumor antigens?
Definition

Mutant epitope expressed (not recognized as self)

Too much epitope expressed (due to gene amplifications or overexpression)

Epitope is modified (i.e. glycosylated = masking)

Term
Examples of common TSAs
Definition
MAGE-1, MAGE-3, BAGE, GAGE, bcr-abl
Term
Why are oncofetal antigens expressed on tumors?
Definition
Evolving karyotypic instability
Term
What are the two ways in which the immune system responds to cancer cells?
Definition

By reacting against TSAs (molecules that are unique to cancer cells-> mutations of cellular genes, viral antigens, overexpression, modification)

By reacting against tumor-associated antigens (molecules that are expressed differently by cancer cells and normal cells)

Term
7 Ways in which neoplasms evade host immune response
Definition

Expression of HLA-G

Defects in antigen processing

T-cell deletion

Modulation

Masking

Immunosuppression

Sneaking Through

Term
Function of HLA-G
Definition
Repels NK cell function
Term
What is the treatment for downregulated MHC?
Definition
IFN-γ, upregulates MHC expression
Term
Three major types of defects in antigen processing molecules
Definition

1. antigen is not expressed-> B2M loss (total loss of MHC)

2. antigen is not generated-> proteosome

3. antigen is not transported-> TAP

Term
What is the hallmark of invasive cancers?
Definition
Loss of HLA molecules
Term
Two ways tumors cause clonal deletion of T-cells
Definition
Superantigens and expression of fas ligand
Term
Properties of modulation
Definition
"hiding" of the antigen from antibodies that then don't destroy the cell
Term
Properties of masking
Definition

Blocking factors in the serum of patients coat the surface of tumor cells

Glycosylated molecules that are produced at high levels in tumor cells can surround the tumor antigen so that it is inaccessible to the immune system

Term
Which cytokines do neoplasms secrete that serve to act as immunosuppressors?
Definition
TGF-β, IL-10, VEGF
Term
What is the optimum number of cells for "sneaking through"?
Definition
100 to 500 cells
Term
How does "sneaking through" work?
Definition
Tumor cells stimulate T-suppressor cells via cytokines and growth factors
Term
Which chemical is used to prevent "sneaking through"?
Definition
Cyclophosphamide
Term
Why is UV radiation immunosuppressive?
Definition

It kills dendritic and Langerhan cells-> no adaptive immune response

Also T-suppressor cells are not killed by UVR

Term
Why are there breaks in between rounds of chemo?
Definition
Drug scheduling allows time for normal dividing cells to recover from toxicity
Term
What must a chemotherapeutic drug do in order to be useful?
Definition
Kill more neoplastic cells than normal cells
Term
What does the therapeutic index equal?
Definition
TD-05/ED-50
Term
Is a higher or lower therapeutic index desirable?
Definition
Lower
Term
How does chemotherapeutic resistance developed?
Definition

Karyotypic instability:

-mutations

-chromosomal abnormalities

-gene amplification

-alternative metabolic pathways

Term

What class is Bevacizumab and what is its target?

How does this affect the neoplasm?

Definition
Monoclonal antibody protein kinase inhibitor; VEGFR; prevents angiogenesis
Term
What class of drug is BIBW 2993 and what is its target?  How does this affect the neoplasm?
Definition
Small molecule protein kinase inhibitor; EGFR and HER2/neu; blocks growth of neoplasm
Term

What class of drug is Cetuximab and what is its target?  How does this affect the neoplasm?

Definition
Monoclonal antibody protein kinase inhibitor; ERbB1; blocks growth of neoplasm
Term

What class of drug is Imatinib and what is its target?  How does this affect the neoplasm?

Definition
Small molecule protein kinase inhibitor; Bcr-abl; prevents growth of neoplasm
Term

What class of drug is Trastuzaumab and what is its target?  How does this affect the neoplasm?

Definition
Monoclonal antibody; HER2/neu; blocks growth of neoplasm
Term

What class of drug is Gefitinib and what is its target?  How does this affect the neoplasm?

Definition
Small molecule protein kinase inhibitor; EGFR, blocks growth of neoplasm
Term

What class of drug is Ranibizumab and what is its target?  How does this affect the neoplasm?

Definition
Monoclonal antibody protein kinase inhibitor; VEGFR; blocks angiogenesis
Term

What class of drug is Erlotinib and what is its target?  How does this affect the neoplasm?

Definition
Small molecule protein kinase inhibitor; ErbB1; blocks growth of neoplasm
Term
What are protein kinase inhibitors designed to inhibit?
Definition
A specific receptor (or downstream player) to block the overactive growth factor signaling pathway
Term
How does radiation therapy often work?
Definition
Disrupting DNA; ionizing radiation creates free radicals which lead to "mitotic death," which means that the cells cannot divide; can also lead to apoptosis
Term
Where in the cell cycle is radiation therapy most effective?
Definition
G2/M
Term
Consequences for a cell due to radiation damage (3)
Definition

Repair-> viable cell

Misrepair-> mutation -> cancer or cell death

Not repaired ->cell death

Term
Is repair from ionizing radiation more or less efficient in cancer cells?
Definition
less efficient
Term
Which types of cancers are especially prevalent in children?
Definition
Leukemias and sarcomas
Term
How would you know if your child had cancer?
Definition

Feel lump

Tumors can secrete things that cause symptoms (ie hormones)

Organ function can be disrupted

Term
Is radiation or chemo preferred for cancers that have metastasized?
Definition
chemo
Term

Is radiation or chemo preferred for localized cancers?

Definition
radiation
Term
Why are patients who are in bed >50% of day not often treated with chemo?
Definition
normal cells are not able to recover between rounds of chemo
Term
Two possibilities for tumor resistance to treatment
Definition

1. Evolving karyotypic instability causes resistance

2. Core population of resistant cells that regrow into a new tumor after the non-resistant cells have been killed off

Term
What do antimetabolites target?
Definition
DNA synthesis
Term
What do alkylating agents target?
Definition
DNA
Term
What do intercalating agents target?
Definition
DNA transcription and duplication
Term
What do spindle poisons target?
Definition
Mitosis
Term
Common effects of chemotherapy toxicity
Definition

Myelosuppresion of all bone marrow products: WBCs, RBCs, and platelets

GI: diarrhea, taste alteration, anorexia

Alopecia (loss of hair)

Neuropathy

Fatigue

Nausea, vomiting

Term
What does Sunitinib block?
Definition
PDGFR and VEGFR
Term
Which specific gene does smoking cause mutations in?
Definition
p53
Term
Properties of the Ames test
Definition

Utilizes bacterial cells that are deficient in DNA repair and dependent on histidine for growth

If you incubate cells with a mutagenic compound, you would expect a mutation would occur that would allow them to make their own histidine

 

Term
Why are liver microsomes added to Ames test medium?
Definition
Bacteria differ in their metabolic capabilities compared to mammals, and we want the drug-metabolizing ability of the bacteria to be comparable to human metabolism
Term
What do the Ames test and the lacZ test test for?
Definition
Mutagenesis
Term
What is the next step if the Ames test comes up negative?
Definition
Do Lac Operon test
Term
Properties of Lac Operon
Definition
Lactose (sugar) is the inducer for the lac operon.  Its presence results in the removal of a repressor so enzymes can be made to cleave lactose into glucose and galactose for the cell to use for energy (IPTG can also remove the repressor for the same end result)
Term
If the lacI gene has been mutated, what will happen?
Definition
It will not prevent the transcription of the lacZ gene, and b-gal will be constitutively transcribed and translated (even in absence of lactose or IPTG)
Term
What happens if the lacO gene is mutated?
Definition
The repressor won't recognize it, and you'll get constitutive operon expression in this case
Term
After a positive Ames test and Lac Operon E. coli test, what is next?
Definition
Transgenic mouse experiment
Term
Properties of transgenic mouse experiment
Definition

*Transgenic mouse has lac operon integrated into its DNA

*Expose mouse to carcinogen, allow mouse to replicate DNA, then extract the DNA from the mouse's tissues

*You then package your DNA into a virus that is only capable of infecting bacteria (phage virus)

*Plate bacteria on selective media to determine if DNA has been mutated

Term
What does the selective media for the transgenic mouse experiment contain?
Definition
x-gal which can be cleaved by β-galactosidase; when teh compound is cleaved, the colony turns blue
Term
If the selective media for the transgenic mouse experiment turns blue, what does this mean?
Definition
The lac operon is not repressed (mutagenesis occurred)
Term
How do you test for strand breaks?
Definition
Stain DNA, apply carcinogen, and then look at chromosomes and look for peculiarities
Term
What carcinogenesis model are federal regulations based on and what is the problem with this model?
Definition
MKV multihit model of carcinogenesis, problem is in the model all stages are irreversible
Term
Properties of transformation of cells in culture
Definition

-Digested hamster embryos into little bits (essentially single layer cells) and dispersed the cells onto "feeder layers" of cells (i.e. cells whose growth has been arrested by irradiation or chemical means)

-The hamster embryo cells attached and began to grow

-Cells were then exposed to carcinogen (chemicals added to the culture media or direct irradiation)

-cells were allowed to grow, then examined under the microscope

-morphological changes were observed

Term
Main characteristics of neoplastic transformation in vivo
Definition

inoculation of 10^6 or fewer cells in vivo gives tumors

growth in soft agar

agglutination by lectins

alterations in cytoskeleton

karyotypic changes

Term
Which agents usually inhibit cell communication through gap junctions?
Definition
Promoting agents
Term
What effect allows cells to "talk" to each other?
Definition
Bystander effect
Term
Bystander effect
Definition
Neoplastic cells close off gap junctions with normal cells but secrete substances to communicate with normal cells and tell them to grow
Term
What do Adenoma of the islet cells in the pancreas do?
Definition
Stimulates insulin production, leading to insulin shock and death
Term
How can lung tumors cause Cushing's Syndrome?
Definition
lung tumors secrete ATCH which leads to overproduction of cortisol which leads to Cushing's syndrome
Term
Example of non-hormonal paraneoplastic syndrome
Definition
multiple myeloma of the B-cells can lead to an overproduction of antibodies to various organs -> renal failure; autoimmunity
Term
What are stromal reactions?
Definition
Metastases can stimulate the production of fibrous tissue
Term
What is the maximum size a tumor can grow without angiogenesis?
Definition
2 mm
Term
When does angiogenesis occur in neoplasms?
Definition
Progression
Term
active modes of cancer prevention:definition and examples
Definition
being proactive in preventing cancer; eg vaccination against oncogenic viruses, dietary modifications, antihormones
Term
passive means of preventing cancer: definition and examples
Definition
changing lifestyle to prevent cancer, eg smoking cessation, alcohol and sex habits
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