To develop in students an understanding of the biological mechanisms underpinning cancer and its treatment.

To expose the students to the two major types of cancer (carcinoma and leukaemia/lymphoma), with in-depth analysis of selected examples of research excellence within the University of Liverpool (Haemato-oncology, Head and Neck Cancer and Pancreatic Cancer). This will provide students insight into the factors contributing to the pathogenesis and progression of these diseases.

To provide the students with an opportunity to explore and discuss the principles involved in cancer detection, diagnosis and therapy.

To match environmental DNA damage, DNA repair, viral infection and altered oncogene/tumour suppressor gene function to the pathological consequences for the patients.

To critically appraise discovery pathways for new diagnostic and prognostic cancer biomarkers

To analyse biochemical pathways likely to become novel therapeutic targets in the near future, with particular attention to enzyme inhibitors.

Lecture - Lectures to introduce key topics

Lectures are grouped organised by themes and delivered by experts actively researching and/or practising in each field. Reading materials and learning objectives will be provided in advance of each lecture. At the end of each thematic group, the lecturers that have participated will lead a questions and answers session.

Case Based Learning - Workshop

A workshop on cancer epidemiology with practical problems related to the acceptance of novel cancer diagnosis and treatment options. The workshops relies on unscheduled directed student learning, which will be organised as follows: At the start of the module, to direct their learning, the students will be provided with: 1) two short reviews to read on current problems in cancer diagnosis and treatment; 2) three problem scenarios with 3-5 specific questions each; 3) the bibliography to cover the required statistics to tackle the problem cases. With these directing materials, students will, in their own time (unscheduled) prepare for the 2-hour scheduled Case-Based Learning workshop in their own time. In the workshop (run twice, splitting the cohort in two groups) students will form discussion groups and will present their responses to the problems.

The module is structured into four lecture-based topics and one Case-Based Learning session (workshop). The cancer-specific topics have been selected partly on the basis of the expertise of the Department of Molecular and Clinical Cancer Medicine but especially on their cap acity to illustrate the modern views that fundamental research, the pharmaceutical industry and the translational and clinical research are taking towards the problem of cancer.

Topic 1: Hallmarks of cancer.

The topic reviews biochemical pathways relevant to the biology of cancer cells, focusing on alterations in the normal function of these pathways, such as mutations, epigenetic changes and viral infection. It covers the following fundamental concepts of cancer biology:

·         Cell cycle regulation

·         Escape from cell cycle by arrest

·         Apoptosi s and senescence

·         Nature and roles of oncogenes and tumour suppressor genes

·         Inheritance (familial vs. sporadic cancers)

·         Tumour microenvironment and role of the immune response against tumour cells.

The therapeutic opportunities brought about by the metabolic alterations of cancer cells are also discussed here in a general overview.

Topic 2: Haematological malignancies.

This topic is usually of great interest of students as it covers child leukaemias. Blood cancers are an excellent paradigm of malignancies were chromosomal translocations are significant and where the acute and chronic presentations figure prominently in the disease progression. They are also an excellent model to introduce students to therapeutic approaches based on kinase inhibitors, which informs (and feeds) their interest in this fast developing area of the pharmaceutical industry. The topic covers:

·         Blood cell types and function

·         Blood cell differentiation and the correlation of these phenotypes with types of leukaemia/lymphoma

·         Genetic/chromosomal changes and their diagnostic values

·         Bases of novel inhibitor-based as well as antibody-based therapeutic approaches (for example, the biochemical action of imatinib, ibrutinib, idelalisib, bortezomib and rituximab).

Topic 3: Head and Neck Cancer.

These malignancies illustrate the role of viral infection and risk factors on the incidence of cancer, as well as representing an ideal model for the understanding of modern approaches to radiotherapy. The topic covers both the molecular basis of head a nd neck cancer and the therapeutic approaches to it:

·         The role of HPV infection

·         Tissue specific carcinogens (alcohol and tobacco smoke)

·         Mutational profiles and tumour variability

·         Epigenetic changes, with especial focus on their diagnostic potential and clinically viable techniques for their exploitation

·         Radiobiology, focusing on radiation effects on DNA and the use of radiation to treat cancers.

·         Cell-matrix interactions, including mechanisms of invasion, epithelial mesenchymal transition (EMT) and the role of the cancer-associated host cells in treatment resistance.

Thus, the Head and Neck cancer topic serves to illustrate subjects (viruses, carcinogen s, radiobiology, EMT) common to many other cancers.

Topic 4: Pancreatic cancer.

This is a cancer model that optimally illustrates the problems of late presentation, differential diagnosis and tumour accessibility to chemotherapy. For students interested in the pharmaceutical industry, this is the topic that presents clinical trials for diagnosis and treatment. The following subjects, most of them common to many cancers, are specifically addressed in this topic:

·         The main biochemical changes occurring in pancreatic cancer, with particular attention to KRAS.

·         Screening and diagnosis: due to the problem of late diagnosis, epidemiologically, pancreatic cancer is a very rich model. Here, attention is given to the basis of cancer screening, sensitivity and specificity of diagnostic procedures, and the search for biomarkers for diagnosis.

·         The tumour microenvironment: revised here because of crucial role it plays in therapy efficacy, it is studied from the point of view of invasion, disease progression, role of macrophages and effect on treatment.

·         Treatment options: discussed here with attention to clinical trials and biomarkers for predicting response to treatment.< /span>

Case-based Workshop

The workshop focuses on decision making problems in relation to the incorporation of novel diagnostic and therapeutic procedures. The students are asked to take the views of the pharmaceutical industry, the health authorities and patients'' groups and analyse cost-benefit and ethical problems exemplified mainly, but not exclusively, by breast cancer. The students will be directed towards the reading resources that will complement their statistics knowledge in order to be able to discuss epidemiological problems such as trial design (e.g. randomised controlled trials vs. case-control stu dies), risk assessment (absolute and relative risk, odds ratio, numbers needed to treat) significance levels, etc.

The reading list has been designed to provide reading material relevant to each of the four topics described in the content section.