Clinical Oncology and Radiotherapy
A.Y. 2023/2024
Learning objectives
The course is designed with a multidisciplinary approach integrating clinical oncology, chemotherapy, radiotherapy and psychology to address clical approach to oncologic patients. During the course students will -acquire the clinical "vocabulary" of clinical oncology, in order for students, whether as future general practioners or as non-cancer specialists, to be able to discuss cancer clinical cases with an oncology team on a multidisciplinary basis and/or to be proactive in counseling patients on treatment options in collaboration with an oncology team; - to advise patients on their lifestyles supporting behavioral change motivation, and early diagnosis choices, to properly refer patients when suspected or diagnosed with cancer or cancer risk, to share patient follow-up and surveillance with cancer institutions; - to be able to appreciate and start managing cancer-related emergencies and to share management of patients major complications from cancer and/or cancer treatment. - to acquire knowledge on the role of Molecular Pathology in oncology, spanning from implication of cancer molecular and morphological heterogeneity in acquired resistance to targeted therapies, to precision medicine, liquid biopsy, and basic principles of cancer genomics including an overview of the latest techniques and experimental models used in Pathology Divisions. - to acquire knowledge on the role of radiotherapy (RT) in the management of cancer: biological basis of RT, indications, combination with other cancer therapies (multimodality approach, multidisciplinary treatment), basic technical issues (modern high-precision RT: intensity modulated RT IMRT, image-guided RT IGRT, stereotactic RT SRT, intraoperative RT IORT, brachytherapy etc.), fractionation, dose and volume concept, acute and late toxicity, management of RT-induced toxicity, tumor response evaluation, role of RT in 4 big killers (lung, prostate, breast, colon-rectum). Imaging in oncology and in particular in radiation oncology.
Expected learning outcomes
At the end of the course students are expected to know: Basic knowledge about epidemiology of cancer, etiology and pathogenesis of thoracic and gastrointestinal malignancies.
Lesson period: Second semester
Assessment methods: Esame
Assessment result: voto verbalizzato in trentesimi
Single course
This course cannot be attended as a single course. Please check our list of single courses to find the ones available for enrolment.
Course syllabus and organization
Single session
Responsible
Prerequisites for admission
To take the Clinical Oncology and Radiotherapy exam, students must have already passed all the exams of the first and second year (Fundamentals of Basic Sciences, Cells, Molecules and Genes 1 and 2, Human Body, Functions and Mechanisms of Diseases).
Assessment methods and Criteria
The examination is based on a multiple-choice test (56 questions, each one with only one correct answer). Test duration: 90 minutes. Each correct answer corresponds to 0.55 points (no penalties will be given to missing or wrong answers). The final mark is the sum of the points obtained in each question.
The exam is deemed to be passed successfully if the final grade is equal to or higher than 18/30. If the number of correct questions exceeds 54, honors (lode) is granted.
Attendance is required to be allowed to take the exam. Unexcused absence is tolerated up to 34% of the course activities. University policy regarding excused illness is followed.
Registration through SIFA is mandatory.
The exam is deemed to be passed successfully if the final grade is equal to or higher than 18/30. If the number of correct questions exceeds 54, honors (lode) is granted.
Attendance is required to be allowed to take the exam. Unexcused absence is tolerated up to 34% of the course activities. University policy regarding excused illness is followed.
Registration through SIFA is mandatory.
Medical oncology
Course syllabus
MODULE Pharmacology:
Targeted Therapies: Tyrosine Kinase Inhibitors, Monoclonal Antibodies, and Cytokines
Natural Products in Cancer Chemotherapy: Hormones and Related Agents
Immunotherapy of Cancer
MODULE Pathology:
Molecular pathology and immunopathology in clinical practice
Biomarkers for precision medicine 1: lung cancer
Biomarkers for precision medicine 2: breast cancer
Biomarkers for precision medicine 3: cancers of the female genital tract
Biomarkers for precision medicine 4: melanoma and head and neck cancer
Biomarkers for precision medicine 5: gastrointestinal cancers
MODULE Medical Oncology:
Clinical biology" of cancer
Clinical methodology in Oncology
Principles of multidisciplinary cancer treatment
Principles of medical cancer treatment
Evidence building and state of the art on Oncology
Complications of cancer treatment
Complications of cancer disease
Lung cancer as a clinical model
Colorectal cancer as a clinical model
Breast cancer as a clinical model
Prostate cancer as a clinical model
Rare versus frequent cancers
Application of molecular pathology to cancer treatment
Unknown primary cancers
MODULE Radiology and Radiotherapy:
Role of Nuclear Medicine: imaging and therapy
Radiologic evaluation
Radiobiology and radioprotection
Radiotherapy: indications, combinations with other modalities, techniques, side effects (prevention and management)
Radiotherapy alone and in combination with other modalities for big killers: breast and lung cancers
Radiotherapy alone and in combination with other modalities for big killers: prostate and GI tumors
MODULE General Psychology:
The psychological models in cancer care
Principal of communication skills in cancer care
PROGRAM:
Lecture 1. ONCOLOGY: Clinical methodology in Oncology
Principles of cancer clinical diagnosis (including early diagnosis)
Principles of cancer pathologic diagnosis
Principles of cancer staging
Organization of multidisciplinary decision-making
Outcome assessment
Principles of follow-up and surveillance; the concept of survivorship
Lecture 2. ONCOLOGY: "Clinical biology" of cancer
The epidemiological scope of cancer
Risk factors and lifestyles
Clinical implications of cancer hallmarks
Major molecular assessments of cancer
Lecture 3. PATHOLOGY: Molecular pathology and immunopathology in clinical practice
Biomarkers: definition and overview
Molecular diagnostics: testing methods, companion diagnostics, complementary diagnostics
Somatic mutations: driver vs. passengers, clinical actionability
Liquid biopsy and circulating biomarkers.
Immunoediting and immunopathology biomarkers
Lecture 4. PATHOLOGY: Biomarkers for precision medicine 1: lung cancer
Molecular profiling and classification of lung adenocarcinomas and squamous cell carcinomas
Testing methods for diagnosis, prognostication, and prediction
Molecular targets in NSCLC
Immune-checkpoint inhibition
Lecture 5. PATHOLOGY: Biomarkers for precision medicine 2: breast cancer
Histologic vs. molecular subtypes
Morphologic and molecular heterogeneity: inter-tumor, intra-tumor, tumor-to-metastasis, metastasis-to-metastasis
ER positivity spectra and their clinical relevance
HER2 positivity spectra and their clinical relevance
Tumor infiltrating lymphocytes
BRCA
Actionability of the PIK3CA/Akt pathway
Lecture 6. PATHOLOGY: Biomarkers for precision medicine 3: cancers of the female genital tract
Dualistic (Bokhman) and histologic classifications vs. molecular classification (TCGA) of endometrial cancer
POLE-ultramutated endometrial tumors
Microsatellite instability and mismatch repair deficiency
Copy number alteration and recurrent mutations in ovarian cancer
BRCA and synthetic lethality
FOXL2 in granulosa cell tumors
SMARCA4 in small cell carcinoma
Lecture 7. PATHOLOGY: Biomarkers for precision medicine 4: melanoma and head and neck cancer
Molecular taxonomy
Tumor immune microenvironment
Mutational load
Molecular targets
Biomarkers for immunotherapy
Lecture 8. PATHOLOGY: Biomarkers for precision medicine 5: gastrointestinal cancers
Therapeutic targets
HER2 in cancers of the digestive system
Sporadic vs. familial forms
Histologic and molecular subtypes of esophageal cancer
Histologic and molecular subtypes of gastric cancer
EBV infection and gastric cancer
Histologic and molecular subtypes of colorectal cancer
Lecture 9. ONCOLOGY: Principles of multidisciplinary cancer treatment
Objectives and principles of cancer surgery, radiation therapy and medical treatment
The multidisciplinary integration of cancer treatment modalities
Lecture 10. ONCOLOGY: Principles of medical cancer treatment
Principles of cytotoxic chemotherapy
Principles of hormonal therapy
Principles of molecular targeted therapy
Principles of immune treatment
The multidisciplinary integration of cancer treatment modalities
Lecture 11. PHARMACOLOGY: Cytotoxic Agents
Structure-Activity Relationships.
Pharmacological Actions
Mechanisms of Resistance
Clinical Pharmacology
Lecture 12. PHARMACOLOGY: Targeted Therapies: Tyrosine Kinase Inhibitors, Monoclonal Antibodies, and Cytokines
Structure-Activity Relationships.
Pharmacological Actions
Mechanisms of Resistance
Clinical Pharmacology
Lecture 13. PHARMACOLOGY: Natural Products in Cancer Chemotherapy: Hormones and Related Agents
Pharmacology
Clinical Pharmacology
Lecture 14: PHARMACOLOGY: Immunotherapy of Cancer
Pharmacological Actions
Clinical Pharmacology
Lecture 15. ONCOLOGY: Evidence building and state of the art on Oncology
Clinical studies in Oncology and their end-points
Statistical significance and magnitude of clinical benefit
Clinical practice guidelines and access to resources
Principles of resource allocation, sustainability and ethical implications
Lecture 16. PSYCHOLOGY: The psychological models in cancer care
Behavioral Change Theories
Practical implications and strategies
Lecture 17. ONCOLOGY: Complications of cancer treatment
Approach to infections
Principles of transfusional support
Approach to nausea and vomiting and mucositis
Major complications of targeted and immune therapies
Lecture 18. ONCOLOGY: Complications of cancer disease
Principles of pain therapy
Approach to main obstructive, neurological and metabolic complications
Approach to paraneoplastic syndromes
Lecture 19. PSYCHOLOGY: Psychological complications of cancer disease
Approaching psychological disorders in cancer patients
Cognitive and psychological components of physical disorders
Lecture 20. PSYCHOLOGY: Principal of communication skills in cancer car
Principal models for communicating with cancer patients across the life span and illness trajectory
Lecture 21. ONCOLOGY: Lung cancer as a clinical model
Epidemiology and screening
Diagnosis and staging
Principles of treatment
Lecture 22. ONCOLOGY: Colorectal cancer as a clinical model
Epidemiology and screening
Diagnosis and staging
Principles of treatment
Lecture 23. ONCOLOGY: Breast cancer as a clinical model
Epidemiology and screening
Diagnosis and staging
Principles of treatment
Lecture 24. ONCOLOGY: Prostate cancer as a clinical model
Epidemiology and screening
Diagnosis and staging
Principles of treatment
Lecture 25. ONCOLOGY: Application of molecular pathology to cancer treatment
Molecular Tumor Boards and precision oncology
Tissue-agnostic cancer treatment
Lecture 26. ONCOLOGY: Rare versus frequent cancers
The problem of rare diseases and rare cancers
Rare subtypes of frequent cancers and methodological difficulties of research
Lecture 27. ONCOLOGY: Unknown primary cancers
Typical presentations
A rational approach to unknown primary tumors
Lesson 28. RADIOLOGY AND RADIOTHERAPY: Role of Nuclear Medicine: imaging and therapy
Understand advantages and limitations of PET with fluorodeoxyglucose
Describe the role of other radiopharmaceuticals
Understand the role of Nuclear Medicine in the treatment of cancer
Lecture 29. RADIOLOGY AND RADIOTHERAPY: Radiologic evaluation
Role of imaging in evaluating solid tumor response to therapy
Role of imaging and its integration with metabolic studies in evaluating response of lymphoma to therapy
Lecture 30. RADIOLOGY AND RADIOTHERAPY: Radiobiology and radioprotection
Lecture 31. RADIOLOGY AND RADIOTHERAPY: Radiotherapy: indications, combinations with other modalities, techniques, side effects (prevention and management)
Lecture 32 RADIOLOGY AND RADIOTHERAPY: Radiotherapy alone and in combination with other modalities for big killers: breast and lung cancers
Lecture 33. RADIOLOGY AND RADIOTHERAPY: Radiotherapy alone and in combination with other modalities for big killers: prostate and GI tumors.
Targeted Therapies: Tyrosine Kinase Inhibitors, Monoclonal Antibodies, and Cytokines
Natural Products in Cancer Chemotherapy: Hormones and Related Agents
Immunotherapy of Cancer
MODULE Pathology:
Molecular pathology and immunopathology in clinical practice
Biomarkers for precision medicine 1: lung cancer
Biomarkers for precision medicine 2: breast cancer
Biomarkers for precision medicine 3: cancers of the female genital tract
Biomarkers for precision medicine 4: melanoma and head and neck cancer
Biomarkers for precision medicine 5: gastrointestinal cancers
MODULE Medical Oncology:
Clinical biology" of cancer
Clinical methodology in Oncology
Principles of multidisciplinary cancer treatment
Principles of medical cancer treatment
Evidence building and state of the art on Oncology
Complications of cancer treatment
Complications of cancer disease
Lung cancer as a clinical model
Colorectal cancer as a clinical model
Breast cancer as a clinical model
Prostate cancer as a clinical model
Rare versus frequent cancers
Application of molecular pathology to cancer treatment
Unknown primary cancers
MODULE Radiology and Radiotherapy:
Role of Nuclear Medicine: imaging and therapy
Radiologic evaluation
Radiobiology and radioprotection
Radiotherapy: indications, combinations with other modalities, techniques, side effects (prevention and management)
Radiotherapy alone and in combination with other modalities for big killers: breast and lung cancers
Radiotherapy alone and in combination with other modalities for big killers: prostate and GI tumors
MODULE General Psychology:
The psychological models in cancer care
Principal of communication skills in cancer care
PROGRAM:
Lecture 1. ONCOLOGY: Clinical methodology in Oncology
Principles of cancer clinical diagnosis (including early diagnosis)
Principles of cancer pathologic diagnosis
Principles of cancer staging
Organization of multidisciplinary decision-making
Outcome assessment
Principles of follow-up and surveillance; the concept of survivorship
Lecture 2. ONCOLOGY: "Clinical biology" of cancer
The epidemiological scope of cancer
Risk factors and lifestyles
Clinical implications of cancer hallmarks
Major molecular assessments of cancer
Lecture 3. PATHOLOGY: Molecular pathology and immunopathology in clinical practice
Biomarkers: definition and overview
Molecular diagnostics: testing methods, companion diagnostics, complementary diagnostics
Somatic mutations: driver vs. passengers, clinical actionability
Liquid biopsy and circulating biomarkers.
Immunoediting and immunopathology biomarkers
Lecture 4. PATHOLOGY: Biomarkers for precision medicine 1: lung cancer
Molecular profiling and classification of lung adenocarcinomas and squamous cell carcinomas
Testing methods for diagnosis, prognostication, and prediction
Molecular targets in NSCLC
Immune-checkpoint inhibition
Lecture 5. PATHOLOGY: Biomarkers for precision medicine 2: breast cancer
Histologic vs. molecular subtypes
Morphologic and molecular heterogeneity: inter-tumor, intra-tumor, tumor-to-metastasis, metastasis-to-metastasis
ER positivity spectra and their clinical relevance
HER2 positivity spectra and their clinical relevance
Tumor infiltrating lymphocytes
BRCA
Actionability of the PIK3CA/Akt pathway
Lecture 6. PATHOLOGY: Biomarkers for precision medicine 3: cancers of the female genital tract
Dualistic (Bokhman) and histologic classifications vs. molecular classification (TCGA) of endometrial cancer
POLE-ultramutated endometrial tumors
Microsatellite instability and mismatch repair deficiency
Copy number alteration and recurrent mutations in ovarian cancer
BRCA and synthetic lethality
FOXL2 in granulosa cell tumors
SMARCA4 in small cell carcinoma
Lecture 7. PATHOLOGY: Biomarkers for precision medicine 4: melanoma and head and neck cancer
Molecular taxonomy
Tumor immune microenvironment
Mutational load
Molecular targets
Biomarkers for immunotherapy
Lecture 8. PATHOLOGY: Biomarkers for precision medicine 5: gastrointestinal cancers
Therapeutic targets
HER2 in cancers of the digestive system
Sporadic vs. familial forms
Histologic and molecular subtypes of esophageal cancer
Histologic and molecular subtypes of gastric cancer
EBV infection and gastric cancer
Histologic and molecular subtypes of colorectal cancer
Lecture 9. ONCOLOGY: Principles of multidisciplinary cancer treatment
Objectives and principles of cancer surgery, radiation therapy and medical treatment
The multidisciplinary integration of cancer treatment modalities
Lecture 10. ONCOLOGY: Principles of medical cancer treatment
Principles of cytotoxic chemotherapy
Principles of hormonal therapy
Principles of molecular targeted therapy
Principles of immune treatment
The multidisciplinary integration of cancer treatment modalities
Lecture 11. PHARMACOLOGY: Cytotoxic Agents
Structure-Activity Relationships.
Pharmacological Actions
Mechanisms of Resistance
Clinical Pharmacology
Lecture 12. PHARMACOLOGY: Targeted Therapies: Tyrosine Kinase Inhibitors, Monoclonal Antibodies, and Cytokines
Structure-Activity Relationships.
Pharmacological Actions
Mechanisms of Resistance
Clinical Pharmacology
Lecture 13. PHARMACOLOGY: Natural Products in Cancer Chemotherapy: Hormones and Related Agents
Pharmacology
Clinical Pharmacology
Lecture 14: PHARMACOLOGY: Immunotherapy of Cancer
Pharmacological Actions
Clinical Pharmacology
Lecture 15. ONCOLOGY: Evidence building and state of the art on Oncology
Clinical studies in Oncology and their end-points
Statistical significance and magnitude of clinical benefit
Clinical practice guidelines and access to resources
Principles of resource allocation, sustainability and ethical implications
Lecture 16. PSYCHOLOGY: The psychological models in cancer care
Behavioral Change Theories
Practical implications and strategies
Lecture 17. ONCOLOGY: Complications of cancer treatment
Approach to infections
Principles of transfusional support
Approach to nausea and vomiting and mucositis
Major complications of targeted and immune therapies
Lecture 18. ONCOLOGY: Complications of cancer disease
Principles of pain therapy
Approach to main obstructive, neurological and metabolic complications
Approach to paraneoplastic syndromes
Lecture 19. PSYCHOLOGY: Psychological complications of cancer disease
Approaching psychological disorders in cancer patients
Cognitive and psychological components of physical disorders
Lecture 20. PSYCHOLOGY: Principal of communication skills in cancer car
Principal models for communicating with cancer patients across the life span and illness trajectory
Lecture 21. ONCOLOGY: Lung cancer as a clinical model
Epidemiology and screening
Diagnosis and staging
Principles of treatment
Lecture 22. ONCOLOGY: Colorectal cancer as a clinical model
Epidemiology and screening
Diagnosis and staging
Principles of treatment
Lecture 23. ONCOLOGY: Breast cancer as a clinical model
Epidemiology and screening
Diagnosis and staging
Principles of treatment
Lecture 24. ONCOLOGY: Prostate cancer as a clinical model
Epidemiology and screening
Diagnosis and staging
Principles of treatment
Lecture 25. ONCOLOGY: Application of molecular pathology to cancer treatment
Molecular Tumor Boards and precision oncology
Tissue-agnostic cancer treatment
Lecture 26. ONCOLOGY: Rare versus frequent cancers
The problem of rare diseases and rare cancers
Rare subtypes of frequent cancers and methodological difficulties of research
Lecture 27. ONCOLOGY: Unknown primary cancers
Typical presentations
A rational approach to unknown primary tumors
Lesson 28. RADIOLOGY AND RADIOTHERAPY: Role of Nuclear Medicine: imaging and therapy
Understand advantages and limitations of PET with fluorodeoxyglucose
Describe the role of other radiopharmaceuticals
Understand the role of Nuclear Medicine in the treatment of cancer
Lecture 29. RADIOLOGY AND RADIOTHERAPY: Radiologic evaluation
Role of imaging in evaluating solid tumor response to therapy
Role of imaging and its integration with metabolic studies in evaluating response of lymphoma to therapy
Lecture 30. RADIOLOGY AND RADIOTHERAPY: Radiobiology and radioprotection
Lecture 31. RADIOLOGY AND RADIOTHERAPY: Radiotherapy: indications, combinations with other modalities, techniques, side effects (prevention and management)
Lecture 32 RADIOLOGY AND RADIOTHERAPY: Radiotherapy alone and in combination with other modalities for big killers: breast and lung cancers
Lecture 33. RADIOLOGY AND RADIOTHERAPY: Radiotherapy alone and in combination with other modalities for big killers: prostate and GI tumors.
Teaching methods
Lectures will be provided favoring an interactive climate.
Synchronous and asynchronous activités will be scheduled.
Synchronous and asynchronous activités will be scheduled.
Teaching Resources
Harrison's Principles of Internal Medicine, McGraw Hill 19th Edition, chapters: # 3, 4, 10, 15, 17, 18, 91, 99, 100, 101, 102, 103, 104, 120, 121, 122, 125 (also available as ebook in the digital library of the University of Milano http://www.sba.unimi.it/)
Papadakis MA et al Current Medical Diagnosis & Treatment, McGraw Hill chapter on the 2017 Edition: # 9
Papadakis MA et al Current Medical Diagnosis & Treatment, McGraw Hill chapter on the 2017 Edition: # 9
Radiology and radiotherapy
Course syllabus
The course is based on a strong integration of different disciplines, thus the program of the single disciplines must be considered embedded in the program of the whole course which is reported in module Medical Oncology.
Teaching methods
Lectures will be provided favoring an interactive climate.
Synchronous and asynchronous activités will be scheduled.
Synchronous and asynchronous activités will be scheduled.
Teaching Resources
Harrison's Principles of Internal Medicine, McGraw Hill 19th Edition, chapters: # 3, 4, 10, 15, 17, 18, 91, 99, 100, 101, 102, 103, 104, 120, 121, 122, 125 (also available as ebook in the digital library of the University of Milano http://www.sba.unimi.it/)
Papadakis MA et al Current Medical Diagnosis & Treatment, McGraw Hill chapter on the 2017 Edition: # 9
Papadakis MA et al Current Medical Diagnosis & Treatment, McGraw Hill chapter on the 2017 Edition: # 9
Pharmacology
Course syllabus
The course is based on a strong integration of different disciplines, thus the program of the single disciplines must be considered embedded in the program of the whole course which is reported in module Medical Oncology.
Teaching methods
Lectures will be provided favoring an interactive climate.
Synchronous and asynchronous activités will be scheduled.
Synchronous and asynchronous activités will be scheduled.
Teaching Resources
Goodman & Gilman's. "The pharmacological basis of therapeutics". 12th Edition. The McGraw-Hill companies
Slides and scientific material provided during lectures
Slides and scientific material provided during lectures
General psychology
Course syllabus
The course is based on a strong integration of different disciplines, thus the program of the single disciplines must be considered embedded in the program of the whole course which is reported in module Medical Oncology.
Teaching methods
Lectures will be provided favoring an interactive climate.
Synchronous and asynchronous activités will be scheduled.
Synchronous and asynchronous activités will be scheduled.
Teaching Resources
Slides and scientific material provided during lectures
Pathology
Course syllabus
The course is based on a strong integration of different disciplines, thus the program of the single disciplines must be considered embedded in the program of the whole course which is reported in module Medical Oncology.
Teaching methods
Lectures will be provided favoring an interactive climate.
Synchronous and asynchronous activités will be scheduled.
Synchronous and asynchronous activités will be scheduled.
Teaching Resources
Robbins and Cotran. Pathologic basis of Disease (9th Edition)
General psychology
M-PSI/01 - GENERAL PSYCHOLOGY - University credits: 1
Lessons: 8 hours
: 4 hours
: 4 hours
Professors:
Mazzocco Ketti, Pravettoni Gabriella
Medical oncology
MED/06 - MEDICAL ONCOLOGY - University credits: 3
Lessons: 24 hours
: 12 hours
: 12 hours
Professors:
Casali Paolo Giovanni, Curigliano Giuseppe, De Braud Filippo Guglielmo Maria, Licitra Lisa Francesca Linda, Sartore Bianchi Andrea, Siena Salvatore
Pathology
MED/08 - PATHOLOGY - University credits: 1
Lessons: 8 hours
: 4 hours
: 4 hours
Professor:
Guerini Rocco Elena
Pharmacology
BIO/14 - PHARMACOLOGY - University credits: 1
Lessons: 12 hours
Professor:
Danesi Romano
Radiology and radiotherapy
MED/36 - IMAGING AND RADIOTHERAPY - University credits: 1
Lessons: 10 hours
: 2 hours
: 2 hours
Professor(s)
Reception:
upon appointment via email
Fondazione IRCCS Istituto Nazionale Tumori, Milan
Reception:
To be arranged by email
ASST Grande Ospedale Metropolitano Niguarda, Blocco Sud
Reception:
by appointment +39 02 6444.2291
Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3,Milano