Objectives	To describe the cellular components, molecular mechanisms, and alterations in basic cell biology involved in the development of cancer and apply these concepts as they relate to disease, modes of action of specific drugs, significance of biomarkers, and the basis for adverse effects and acquired resistance to treatment
Key Concepts	Describe the process of cell division and tissue regeneration starting from the precursor stem cell to progenitor cell and finally to differentiated cells and how this process is under tight intracellular control Summarise the concept of a cancer stem cell/cancer-initiating cell and how a cell capable of regeneration, resistance to cell death, and endless replication leads to tumour development, relapse, and metastasis and how this poses difficulty in tumour eradication Recognise the importance of increased and unchecked cell division in tumours as it relates to available anti-cancer therapeutics which target various aspects of this process Explain that each tissue is comprised of a heterogenous amalgam of cells undergoing cell division or apoptosis at various stages depending on innate cellular mechanisms and environmental stressors Determine that these environmental stressors can lead to aberrations in cell division oversight, resistance to apoptosis, and loss of function in tumour suppressor genes that provide an evolutionary advantage for clonal selection of tumour cells over normal cells Recognise that response to therapy, likelihood and pattern of metastasis, and aggressiveness of disease are related to both site of origin and tumour histology, among other factors Demonstrate an understanding that the tissue of origin of tumours is also important to pathologic identification of cancer and that there is overlap between shared normal cell surface and intracellular proteins between cancer cells and normal cells Determine that interactions between tumour cells and the surrounding tumour stroma (extracellular matrix, fibroblasts, fatty tissue, vasculature, and immune cells) are vital to tumour survival, resistance to treatment, and development of metastasis Distinguish that cell-cell interaction between tumour tissue and surrounding microenvironment (including immune cells) utilize natural existing mechanisms for cell survival, communication, and metabolism which makes targeting these features difficult and results in off target toxicity to treatment Recognise that epithelial to mesenchymal, as well as other trans-differentiation changes related to changes in cell surface receptor and cell adhesion expression can lead to tumour migration and metastasis and that the reverse of this process leads to tumour establishment in new locations Explain that selective pressure induced by tumour targeted strategies (chemotherapy, radiation therapy, immunotherapy) leads to selection of resistant clones within the heterogenous tumour leading to resistance and treatment failure
Skills	Demonstrate the ability to: Use information technology and data sets to understand the landscape of disease and patients' care Critically discuss mechanisms of pharmacologic interactions within the cell and the potential adverse effects based on intracellular pathways of signalling and metabolism Critically discuss the heterogeneous nature of tumours and selective environmental stress that results in tumour evolution, metastases, and therapy resistance