Week 1 - Prerequisite Knowledge

Question 1

What is incidence in epidemiology?

Answer 1

New cases over a time period

Incidence rate adjusts for person-time (e.g., cases per 100,000 person-years).

Question 2

Define cumulative incidence/risk.

Answer 2

Probability of developing cancer in a set time (e.g., lifetime risk)

It reflects the likelihood of cancer occurrence over a specified duration.

Question 3

What does prevalence measure?

Answer 3

People living with cancer at a point/period

It reflects both incidence and survival and drives service demand.

Question 4

What is mortality in the context of cancer?

Answer 4

Deaths due to cancer in a period (rate per 100,000)

It can be tracked by tumor type, sex, age, and region.

Question 5

What is survival in cancer epidemiology?

Answer 5

Time from diagnosis to outcome (e.g., 5-year relative survival)

Influenced by stage at diagnosis and treatment access.

Question 6

What is age-standardisation?

Answer 6

Removes population age structure differences to allow fair comparisons

Useful for comparing states, countries, or time periods.

Question 7

What are key screening metrics?

Answer 7

Sensitivity, specificity, PPV/NPV; plus lead-time bias, length bias, and overdiagnosis

These metrics help counsel patients on benefits and harms.

Question 8

What is the nursing relevance of epidemiological data?

Answer 8

Triage and escalation (red flags), advocacy for screening eligibility, realistic education, and interpreting local data

Important for anticipating workload.

Question 9

What happens during the G₁ phase of the cell cycle?

Answer 9

Cell grows and checks environment; restriction point commits to division.

Question 10

What is the main event that occurs during the S phase of the cell cycle?

Answer 10

DNA replication

Target of antimetabolites like 5-FU and methotrexate.

Question 11

What occurs in the G₂ phase of the cell cycle?

Answer 11

Post-replication quality control; prepares for mitosis.

Question 12

What is the M phase in the cell cycle?

Answer 12

Mitosis

Microtubule poisons like taxanes and vinca alkaloids act here.

Question 13

What is the G₀ phase in the cell cycle?

Answer 13

Quiescent state; many normal cells and some tumor cells may sit here.

Question 14

What is the significance of phase-specific drugs in chemotherapy?

Answer 14

Scheduling matters; combining S-phase and M-phase agents affects toxicity windows.

Question 15

What is myelosuppression nadir?

Answer 15

Often ~7–14 days post-chemo (regimen dependent)

Important for infection risk education and monitoring.

Question 16

What is the role of proto-oncogenes?

Answer 16

Gain-of-function mutations lead to oncogenes

Examples include growth factors/receptors (EGFR/HER2), RAS/RAF/MEK signalling.

Question 17

What happens when tumor suppressor genes lose function?

Answer 17

Loss leads to survival of damaged cells

Example: p53 halts at G₁ and triggers DNA repair or apoptosis.

Question 18

What is the significance of the stages of carcinogenesis?

Answer 18

Initiation → promotion → progression: mutations → clonal expansion → malignant phenotype.

Question 19

Differentiate between differentiation and anaplasia.

Answer 19

Resemblance to cell of origin vs. poor differentiation typically worse prognosis.

Question 20

What does doubling time indicate in tumors?

Answer 20

Conceptual guide to tumor growth; informs why “early” can still be microscopic.

Question 21

What is the difference between in situ and invasive cancer?

Answer 21

Basement membrane intact vs. breached.

Question 22

Define invasion vs metastasis.

Answer 22

Local tissue spread vs. distant colonization.

Question 23

What is angiogenesis?

Answer 23

Formation of new vessels supporting growth and metastasis

Anti-angiogenic therapies target this process.

Question 24

What does the TNM staging system stand for?

Answer 24

T = primary tumor size/extent; N = regional nodes; M = distant metastasis.

Question 25

What is supportive care in oncology?

Answer 25

Needs-based services across the cancer continuum addressing various domains ## Footnote Includes physical, emotional, informational, spiritual, social, practical, and rehab support.

Question 26

What are the principles of supportive care?

Answer 26

Person- and family-centered, system-wide/team-based, workforce-supported, quality-monitored, population-planned.

Question 27

What typical team members are involved in supportive care?

Answer 27

Oncology/haem clinicians, CNC/CNS, GP, psycho-oncology, social work, dietetics, physio/OT, palliative care, spiritual care, peer/community organizations, volunteers.

Question 28

What triggers routine distress screening in cancer care?

Answer 28

Uncontrolled symptoms, financial/transport issues, caregiver strain, cultural/communication needs, sexual health/fertility concerns.

Question 29

What actions should nurses take in supportive care?

Answer 29

Normalize help-seeking, complete rapid screens, initiate referrals, document preferences, and use teach-back to confirm understanding.

Question 30

What is the purpose of age-standardisation in cancer stats?

Answer 30

To remove differences in population age structure so incidence/mortality can be fairly compared across places or time.

Question 31

Define cumulative incidence.

Answer 31

The probability of developing a disease over a specified period (e.g., lifetime risk).

Question 32

What denominator does an incidence rate use?

Answer 32

Person-time (e.g., cases per 100,000 person-years).

Question 33

What two factors drive prevalence?

Answer 33

* Incidence * Survival (people living with cancer)

Question 34

Why track mortality by tumour type/sex/age/region?

Answer 34

To identify inequities and guide resource allocation and planning.

Question 35

Define 5-year relative survival.

Answer 35

Survival compared with the expected survival of a similar cancer-free population over five years.

Question 36

Define sensitivity.

Answer 36

The proportion of people with disease who test positive (true positive rate).

Question 37

Define specificity.

Answer 37

The proportion of people without disease who test negative (true negative rate).

Question 38

Define positive predictive value (PPV).

Answer 38

The probability that a person with a positive test actually has the disease.

Question 39

Define negative predictive value (NPV).

Answer 39

The probability that a person with a negative test truly does not have the disease.

Question 40

What is lead-time bias in screening?

Answer 40

Earlier detection appears to lengthen survival time without actually changing the time of death.

Question 41

What is length bias in screening?

Answer 41

Screening over-detects slower-growing/less aggressive disease, making outcomes look better than they are.

Question 42

What is overdiagnosis?

Answer 42

Detection of cancers that would not have caused symptoms or death in a person’s lifetime.

Question 43

One nursing implication of screening metrics?

Answer 43

Provide balanced counselling on benefits/harms and ensure safety-netting for abnormal results.

Question 44

Why is G₀ relevant to chemotherapy?

Answer 44

Quiescent cells in G₀ may be less sensitive to phase-specific drugs → potential resistance between cycles.

Question 45

Typical window for chemo-related myelosuppression nadir?

Answer 45

Around 7–14 days post-chemotherapy (regimen dependent).

Question 46

Typical timing of mucositis peak after chemo?

Answer 46

About 1–2 weeks after many regimens.

Question 47

Effect of activating mutations in proto-oncogenes?

Answer 47

Gain-of-function → excessive growth/survival signalling and accelerated cycling.

Question 48

Differentiate initiation, promotion, and progression.

Answer 48

* Initiation: irreversible DNA damage * Promotion: clonal expansion via extrinsic stimuli * Progression: additional changes → malignant phenotype

Question 49

Differentiate differentiation vs anaplasia.

Answer 49

* Differentiation: resembles tissue of origin * Anaplasia: loss of normal features → more aggressive

Question 50

Define in situ vs invasive.

Answer 50

* In situ: confined by basement membrane * Invasive: basement membrane breached with potential for spread

Question 51

Differentiate invasion vs metastasis.

Answer 51

* Invasion: local tissue spread * Metastasis: colonisation of distant sites via blood/lymph

Question 52

What is angiogenesis and its common target?

Answer 52

New vessel formation (e.g., VEGF signalling); target of anti-angiogenic drugs.

Question 53

List TNM components and why they matter.

Answer 53

* T=primary tumour * N=regional nodes * M=distant mets Combined with grade/histology to guide prognosis and protocols.

Question 54

One supportive-care trigger nurses should screen for routinely?

Answer 54

Clinical distress, uncontrolled symptoms, financial/transport barriers, or cultural/communication needs (per service tools).

Question 55

Teach-back: what is it and why use it?

Answer 55

A method to confirm understanding by asking patients to restate information; improves safety and adherence.

Question 56

What is a neoplasm?

Answer 56

New uncontrolled growth (benign/malignant) ## Footnote Neoplasms can be classified into benign (non-cancerous) and malignant (cancerous) types.

Question 57

Define malignant.

Answer 57

Invasive, destructive, and capable of metastasis ## Footnote Malignant tumors can invade surrounding tissues and spread to other parts of the body.

Question 58

What does anaplasia refer to?

Answer 58

Loss of differentiation; cells look/act less like tissue of origin ## Footnote Anaplastic cells often indicate a more aggressive tumor.

Question 59

What is metastasis?

Answer 59

Spread to distant site via blood/lymph or seeding ## Footnote Metastasis is a key characteristic of malignant tumors.

Question 60

What does 'in situ' mean in cancer terminology?

Answer 60

Pre‑invasive, confined by basement membrane ## Footnote In situ cancers are localized and have not spread beyond their original site.

Question 61

What does the TNM system stand for?

Answer 61

Tumour (T), nodes (N), metastasis (M) ## Footnote The TNM system is used to stage cancer and describe the extent of disease.

Question 62

Define supportive care in the context of cancer.

Answer 62

Needs‑based services across the cancer continuum ## Footnote Supportive care addresses the physical, emotional, and social needs of cancer patients.

Question 63

What is clinical distress?

Answer 63

Multifactorial unpleasant emotional experience that may interfere with coping/ADLs; requires screening and intervention ## Footnote Clinical distress can affect a patient's quality of life and necessitates appropriate management.