Oncology is dedicated to the study and treatment of cancer, whose development is related to environmental factors and life habits, being 10% hereditary. The multidisciplinary treatment, focusing on prevention, diagnosis and treatment, is fundamental. The national cancer institute estimates 600,000 new cases of cancer in the biennium 2018-2019 in Brazil. With the exception of non-melanoma skin cancer, the most incident cancers in men will be prostate, lung, intestine, stomach and oral cavity, and in women, cancers of the breast, intestine, cervix, lung and thyroid. Despite great advances in the knowledge of the etiopathogenesis of cancer, it continues to take millions of lives every year, being the second cause of death in Brazil. 90% of these tumors could be cured if they were diagnosed early and treated properly. Although this pathology is quite complex in its mechanisms of development and responses to therapeutic application, few medical schools have a specific oncology discipline in their curriculum. The diagnosis and treatment of different types of tumor has progressed in the last 15 years. Imaging methods allowed the identification of increasingly smaller tumors and biomarkers allowed the diagnoses to be more accurate. The inclusion of molecular and cellular biology has resulted in the identification of potential therapeutic targets and risk markers for tumor development. However, knowledge about cancer is extremely dynamic. The challenges for establishing more specific treatments with fewer side effects and drug resistance are currently present. Thus, the improvement and exchange of knowledge of the molecular and cellular mechanisms of cancer, the search for new biomarkers and antitumor therapies, and the care for patients and their relatives are fundamental. Unifesp is a center of excellence in research, teaching and clinical care and needs to develop a broad and multidisciplinary vision in the field of oncology with the training of highly qualified human resources. In addition, it needs to stimulate the formation of international research networks in order to improve the quality of the academic production linked to the postgraduate study on the subject.
- Molecular and Cellular Mechanisms of Cancer
Early and accurate diagnosis of cancer is essential for its proper treatment. Knowledge of the molecular and cellular mechanisms of hereditary and sporadic tumors will allow individualized diagnosis that will result in follow-up and personalized treatment. The constant replication of tumor cells requires a lot of energy and to sustain this process, the neoplastic cell needs to adjust its metabolism, which leads to cellular energy deregulation. In addition, the neoplastic cell must acquire the ability to evade the immune response, i.e., to exit the surveillance mechanisms and acquire resistance to the effector mechanisms of the immune system. Having established, tumor needs nutrients and oxygen. Then, there will be important interaction with the circulatory system through the induction of angiogenesis. Finally, disease progresses by invading and metastasizing. This capability is one of the most lethal of cancer since, despite advances in science and medicine, the treatment of metastatic disease in most cases is not successful. All these processes are being studied by researchers from different UNIFESP disciplines. It is fundamental to improve the knowledge of these mechanisms and to develop new methodologies, recently available in international centers of excellence in the oncology area. Among the tools available are: new generation sequencing (NGS) and the development of pipeline analysis (Bioinformatics). Once the events are identified, it is necessary to distinguish the genes associated with cancer (drivers) from those that do not play a fundamental role in genesis and progression. In addition to enhancing our knowledge of 3D cell culture and other biological and biochemical assays, CRISPR-Cas9 technology-based gene editing tools need to be deployed in our labs. To obtain the biological material, technical improvement projects in minimally invasive surgery need to be developed at UNIFESP. The discovery of new immunotherapeutics and drugs for the treatment of cancer will depend on the molecular and cellular characterization of the different cancers, but mainly on pre-clinical studies and well-designed clinical trials for patients characterized by its molecular profile.
- Biomarkers and Antitumor Therapy
Biological markers are molecules present in the tumor or biological fluids whose appearance and / or changes in concentration are related to the genesis and growth of tumor cells. In some cases, the biomarker may be produced by healthy individuals, but high levels indicate deregulation and thus the presence of a tumor. There is a huge variety of biomarkers, which can be enzymes, cell membrane receptors or antibodies, nucleic acids, small peptides, among others. These markers can assist the physician in the diagnosis, staging, and evaluation of therapeutic response, relapse and prognosis. They also contribute to the development of new modalities of treatment and/or evaluation of drug pharmacokinetics. One of the major challenges is the development of target- specific drugs that do not damage normal cells, or can be used in combination with conventional therapies. Treatments that target the tumor microenvironment and tissue resistance factors also need to be better explored. The identification of biomarkers is now favored by the use of techniques, such as large-scale sequencing, gene expression profiles and mass spectroscopy. The large amount of data generated using these techniques means that special attention should be paid to the design of the study and data analysis in order to minimize associations that are subsequently determined to be false-positive. UNIFESP has multi user devices for “omics” technologies and laboratories from different areas of knowledge have been developing techniques of molecular and cellular biology, biochemistry and in vivo studies in the search for new targets. We are in the era of translational research development, where clinical studies are coupled with the search for predictive markers of response; development of personalized treatment directed against specific molecular targets; identification of mutations in genes and other changes predisposing to cancer, which can be markers for prevention and early detection of the disease. Collaboration with international researchers to exchange knowledge and improve them will be extremely important for the advancement of our scientific research and the training of highly qualified human resources.
- Assistance to cancer patients and their families: actions to improve quality of life and safety
Cancer is a worldwide public health problem. In Brazil, mortality represents 16.2%. Treatment approaches involve a variety of care settings and aggregate numerous professionals to provide the necessary conditions for their prevention, diagnosis and treatment, routinely dealing with technological and therapeutic advances. Understanding the role of each individual in these settings is essential for quality care for cancer patients and their families. In Brazil, oncological care policies have favored the therapeutic arsenal and stimulated the multiplication of service centers with high resolution. The State of São Paulo concentrates a complex network of services for oncological patients, users of the Unified Health System (SUS), but despite the increase in diagnostic and therapeutic offerings, there is still mixed statistics on mortality, since in most cases the patient is at advanced stages of the disease. In this way, cancer generates social, economic, ethnic and educational fragilities and vulnerabilities in individuals, both for their prevention and aggression of the pathology as for the treatment, palliative care and care at the end of life. Adverse events in cancer patients are a source of concern in all areas of care, including nursing. In addition to providing care, the oncologist nurse has the educational role, guiding patient and their family members during treatment. It is paramount to develop competencies, both in teaching and in professional practice, to make effective oncology care effective and effective. According to the recent National Patient Safety Program, they are needed to improve care processes, which are systematically addressed by the World Health Organization. International cooperation will provide: - broadening discussions on risk management and adverse events; costs of non-quality; quality strategy associated with clinical practice; Quality management; development of indicators; participation of the patient in their own safety; social and economic impacts of quality management; training of human resources: leadership; Communication; teamwork; advocate in favor of the patient; risk management; emotional intelligence; decision-making, and security-focused planning and management