Welcome to the COH/VA Cancer Genomics in Practice course!

Instruction 3 Learning Modules

Time 2.5 Hours

Tasks 3 Quizzes

Basic Genetics Primer, Part 1

• Define the basic principles of gene structure, function, and regulation.
• Appreciate the nature and consequences of major types of gene mutations.

Basic Genetics Primer, Part 2

• Outline the principles of Mendelian inheritance.
• Identify the features of incomplete penetrance and variable expressivity.
• Recognize how genetic mechanisms such as de novo mutations, mosaicism and imprinting can affect the pattern of cancer in a family.

The Basic Science of Cancer Genetics

• Distinguish the differences between somatic and germline mutations.
• Describe the roles of oncogenes and tumor suppressor genes in signal transduction and cell cycle control.
• Review the mechanisms of DNA damage

Instruction 3 Learning Modules

Time 2.25 Hours

Tasks 3 Quizzes

The Fundamentals of GCRA

• Describe fundamentals of the genetic cancer risk assessment (GCRA) process.
• Take a comprehensive cancer family history.
• Explain the importance of and strategies for confirming key cancers.
• Identify sporadic, familial, and hereditary cancer patterns.

Documenting the Cancer Family History

• Recognize the importance of eliciting, documenting and verifying the patient family history.
• Collect family history information, focusing on details and questions relevant to cancer history documentation.
• Identify questionable or incomplete information that will need further verification to assess cancer risk in the family.
  
• Draw a 3-4 generation pedigree using standard pedigree nomenclature and symbols.
• Demonstrate skills associated with proficiency in collecting and documenting the family history of cancers.

Reading the Pathology Report through the Genomics Lens

• Apply reading and interpreting pathology reports to define cancer stage and extract information on histology/molecular features.
• Describe the roles of other diagnostic data (imaging, CT scans, blood markers).

Instruction 4 Learning Modules & 1 Elective Module

Time 3.75 Hours

Tasks 3 Quizzes

Laboratory Methods for Inherited Cancer Susceptibilities

• Identify the methods, benefits, and limitations of different types of NGS cancer panels.
  
• Recognize approaches to variant interpretation and reporting.
• Apply different types of genetic tests to clinical vignettes.

Characterization and Clinical Interpretation of Germline Genomic Variants

• Review types of genetic variants.
  
• Outline the categories of variant classification established by the ACMG.
• Describe the methods, resources, and tools used to classify variants.
• Discuss approaches to re-classifying variants of uncertain significance (VUS).

Mutation Nomenclature: Reading and Interpreting Genetic Test Results

• Recognize and describe various types of mutations.
• Distinguish between different types of mutation nomenclature.
• Interpret a genetic test report

Instruction 2 Learning Modules

Time 2.25 Hours

Tasks 2 Quizzes

Tumor/Germline Analysis in GCRA Practice, Part 1

Objectives

• Describe the differences between a high, moderate, and low penetrance cancer susceptibility gene.
• Counsel a patient about moderate and low penetrance cancer susceptibility genes found on routine clinical testing.
• Identify that moderate and low penetrance cancer susceptibility genes may not track with the family history of cancer.
• Recognize that cancer susceptibility genes on clinical panels are not always actionable.

Tumor/Germline Analysis in GCRA Practice, Part 2

Objectives

• Compare the benefits and challenges of somatic panel, germline panel and paired somatic/germline sequencing.
• Identify issues related to incidental findings in cancer sequencing.
• Discriminate strategies used to interpret genomic data.
• Examine ways that genomic data are changing cancer treatment paradigms.
• Discuss some of the patient, provider, and system-level challenges to genomic test integration.

Navigating Complex Genetic Test Results - Clonal Hematopoiesis

Objectives

• Review the various possible mechanisms of both germline and somatic mosaicism.
• Identify the various mechanisms that can be associated with an altered allelic fraction in a germline genetic test.
• Discuss approaches to interpreting, further evaluating and following up on genetic test results reporting low allelic fractions.

Instruction 4 Learning Modules & 4 Elective Modules

Time 4.5 Hours

Tasks 3 Quizzes & 1 Case Scenario Assignment

Hereditary Breast and Ovarian Cancer Syndromes

• Recognize features of high-penetrance hereditary breast/breast and ovarian cancer syndromes.
• Describe the established and emerging genetic etiologies of breast and ovarian cancer.
• Review the impact of founder mutations associated with BRCA 1 & 2 hereditary breast and ovarian cancer.
• Examine the benefits and limitations of genetic analysis and risk management for hereditary breast/breast ovarian cancer.

Hereditary Breast and Ovarian Cancer Syndromes: Moderate Risk Genes

• Describe the differences between high, moderate, and low penetrance cancer susceptibility genes.
• Recognize that cancer susceptibility genes on clinical panels are not always actionable.
• Identify the benefits and limitations in moderate and low penetrance cancer susceptibility genes in clinical multi gene testing panels.

Hereditary Breast/Ovarian Cancer Risk Assessment

• Apply mutation probability and empiric risk assessment models for breast cancer.
• Formulate an evaluation & management plan.

Elective: Clinical Management of Hereditary Breast & Ovarian Cancers, Part 1

• Describe the methods and efficacy of breast and ovarian cancer screening tools.
• Describe the methods and efficacy of breast and ovarian cancer surgical risk reduction.
• Review the NCCN guidelines for high-risk cancer screening and management.
• Recognize the timing of GCRA and impact on surgical decisions.
• Discuss targeted treatment options for patients with germline HRD mutations.

Elective: Clinical Management of Hereditary Breast & Ovarian Cancers, Part 2: Chemoprevention

• Identify tools and strategies for personalized on-surgical breast cancer risk reduction.
• Describe the benefits and risks of chemopreventive risk reduction strategies and appropriateness for age, life phase and risk level.
• Review evidence related to lifestyle interventions to reduce breast cancer risk (diet, exercise, etc.).
• Recognize approaches for testing new interventions for breast cancer risk reduction.

Instruction 4 Learning Modules & 3 Elective Modules

Time 5.00 Hours

Tasks 4 Quizzes & 1 Case Scenario Assignment

Hereditary Gastrointestinal Cancer Syndromes, Part 1: Lynch Syndrome

Objectives

• Recognize the features of hereditary gastrointestinal and other cancers associated with Lynch Syndrome.
• Discuss the methods and limitations of tumor screening for Lynch syndrome.
• Identify the features and mode of inheritance of Constitutional Mismatch Repair Deficiency (CMMRD).
• Recognize the characteristics of Familial Colorectal Cancer (CRC) Type X.

Significance and Practical Applications for Tumor Phenotyping (IHC/MSI) in Hereditary Cancer Risk Assessment

Objectives

• Determine which cases of CRC have defective mismatch repair.
• Screen for Lynch Syndrome among newly diagnosed CRC & endometrial cancer (EC) patients.
• Discuss Ohio State University clinical experience doing IHC on all newly diagnosed CRC & EC patients.
• Review evaluation of genomic applications in practice and prevention (EGAPP) recommendations.

Hereditary Gastrointestinal Cancer Syndromes, Part 2: Polyposis

Objectives

• Identify the features distinguishing different hereditary polyposis syndromes.
• Recognize the association between polyp histology and potential germline genetic predisposition to a polyposis syndrome.
• Discern the features of different polyposis syndromes, including: Familial adenomatous polyposis; MutYH-associated polyposis; Hamartomatous polyposis syndromes; Serrated polyposis syndrome.

Hereditary Gastrointestinal Cancer Syndromes, Part 3: Gastric Pancreatic

Objectives

• Recognize the features of hereditary gastric cancers.
• Recognize the features of hereditary pancreatic cancers.
• Apply appropriate germline genetic testing strategies for hereditary gastrointestinal syndromes.

Instruction 2 Learning Modules & 1 Elective Modules

Time 2.50 Hours

Tasks 2 Quizzes & 1 Case Scenario Assignment

Genitourinary Cancer Syndromes

Objectives

• Recognize rare inherited urologic malignant disorders associated with kidney cancer.
• Identify appropriate kidney cancer patients for genetic counseling / testing.
• Verbalize general statements about the genetic basis of prostate and testicular cancer.
• Distinguish renal tumor pathologies associated with several inherited kidney cancer syndromes.

Hereditary Prostate Cancer

Objectives

• Discuss current genetic testing guidelines for prostate cancer.
• Assess clinical genetic evaluation of men with or at-risk for prostate cancer.
• Identify recommendations based on test results.

Instruction 2 Learning Modules & 1 Elective Module

Time 3.00 Hours

Tasks 2 Quizzes

Navigating Complex Genetic Test Results - Clonal Hematopoiesis

Objectives

• Review the various possible mechanisms of both germline and somatic mosaicism.
• Identify the various mechanisms that can be associated with an altered allelic fraction in a germline genetic test.
• Discuss approaches to interpreting, further evaluating and following up on genetic test results reporting low allelic fractions.

Hereditary Hematologic Cancer Syndromes

Objectives

• Recognize the basics of hematologic malignancies.
• Identify the currently known hereditary hematologic malignancy syndromes.
• Distinguish the unique needs for genetic testing in the setting of hematologic malignancies.

Instruction 3 Learning Modules & 2 Elective Modules

Time 2.00 Hours

Tasks 3 Quizzes

Hereditary Endocrine Neoplasias

Objectives

• Recognize clinical features of hereditary endocrine neoplasia syndromes
• Appreciate risks, benefits, and limitations of genetic testing
• Identify resources to inform risk management for individuals with hereditary endocrine neoplasias

Hereditary Genodermatoses

Objectives

• Define disease characteristics of hereditary syndromes classified as genodermatoses.
• Identify the genes associated with hereditary syndromes that have cutaneous manifestations.
• Recognize cancer risks associated with hereditary genodermatoses syndromes.

Hereditary Melanoma

Objectives

• Identify characteristics of hereditary melanoma and when to consider genetic testing.
• Recognize the genes associated with hereditary melanoma.
• Discuss clinical characteristics associated with CDKN2A gene and management recommendations.

Elective: Pediatric Cancer Syndromes

Objectives

• Recognize clinical features of hereditary cancer syndromes with pediatric manifestations.
• Recognize the conditions under which a pediatric cancer patient should be referred to Clinical Genetics.
• Provide education on hereditary cancer syndromes with pediatric manifestations to parents, patients and providers in age appropriate manner.

Elective: Pediatric Cancer Syndromes: Counseling Issues

Objectives

• Identify genetic counseling and testing issues associated with pediatric hereditary cancer syndromes.
• Apply appropriate germline genetic testing strategies for hereditary pediatric cancer syndromes.

Instruction 1 Learning Modules, 1 Elective Module, & Many Mock Counseling Samples

Time 1.00 Hours

Tasks 1 Quiz

Ethical, Legal, and Social Issues in Cancer Genetics

• Recognize ethical, legal and social issues relevant to cancer genetics counseling and testing.
• Apply bioethical principles to counseling challenges.
• Identify emerging legislation protecting against genetic discrimination.

Elective: Pyscho-social and Family Dynamics of Hereditary Cancers

• Recognize key psychological principles and how they generalize across hereditary cancer syndromes.
• Discuss  how psychological factors may interact with specific features of hereditary risk.
• Review how these processes may effect emotional adjustment, decision-making, quality of life.
• Identify family- and individual-level challenges commonly encountered in working with familial risk patients.
• Review brief assessments and tools that can be incorporated into cancer risk consultations.
• Identify red flags that indicate consideration of referral for psychological support.

Elective: Mock Counseling Session, Mock Counseling Case Vignettes

• Observe the application of cancer risk assessment and counseling skills in the setting of mock initial and follow up genetic cancer risk assessment (GCRA) consultation sessions.
• Recognize the key elements of a comprehensive GCRA counseling process.
• Review the essential components of the informed consent process for genetic testing.
• Identify how to address ethical, legal and social issues with patients and families.
• Recognize key issues related to genetic test results interpretation, disclosure and communication of personalized risk management recommendations.

GCRA Case-based Webinars

COH/VA Genetic Cancer Risk Assessment (GCRA) Case-based Webinars are a central source of practice-centered skills development for participants in the COH/VA Cancer Genomics in Practice course. During case-based webinars inter-professional faculty present, discuss, and apply evidence-based resources to guide genetically informed patient care and address real-world challenges related to diverse cases from GCRA practices. Case-based webinars in the City of Hope program have been demonstrated to generate new learning, reinforce existing knowledge, and help participants identify and address individual learning and skills deficits. Participants seeking a Final Certificate of Completion for the course are required to engage in four live or recorded case-based webinars and complete a post-webinar feedback evaluation form for all four sessions while engaged in the course.

Objectives

• Observe the process of genetic cancer risk assessment (GCRA) in a collaborative inter-professional case conference setting
• Apply mutation probability and empiric cancer risk models to actual clinical cases
• Discern the characteristics of personal/patient history to develop differential diagnoses
• Develop appropriate genetic testing strategies for patients and at-risk family members
• Identify strategies to address patient and family communication, ethical, legal, psychosocial, and insurance issues
• Demonstrate the ability to interpret genetic test results
• Incorporate evidence-based guidelines and resources to develop personalized cancer risk management plans for patients
• Recognize key tumor and germline signatures indicating candidacy for targeted treatments by cancer type
• Identify strategies to address patient and family communication, ethical, legal, psychosocial, and insurance issue