Oncology

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Oncology
Tumor Mesothelioma2 legend.jpg
A coronal CT scan showing a malignant mesothelioma, indicated by the asterisk and the arrows
FocusCancerous tumor
SubdivisionsMedical oncology, radiation oncology, surgical oncology
Significant testsTumor markers, TNM staging, CT scans, MRI
Oncologist
Occupation
Occupation type
Specialty
Activity sectors
Medicine
Description
Education required
Fields of
employment
Hospitals, clinics

Oncology is a branch of medicine that deals with the study, treatment, diagnosis and prevention of cancer. A medical professional who practices oncology is an oncologist.[1] The name's etymological origin is the Greek word ὄγκος (ónkos), meaning "tumor", "volume" or "mass".[2] Oncology is concerned with:

Diagnosis

Medical histories remain an important screening tool: the character of the complaints and nonspecific symptoms (such as fatigue, weight loss,[3] unexplained anemia,[4] fever of unknown origin, paraneoplastic phenomena and other signs) may warrant further investigation for malignancy. Occasionally, a physical examination may find the location of a malignancy.

Diagnostic methods include:

  • Biopsy or resection; these are methods by which suspicious neoplastic growths can be removed in part or in whole, and evaluated by a pathologist to determine malignancy. This is currently the gold standard for the diagnosis of cancer and is crucial in guiding the next step in management (active surveillance, surgery, radiation therapy, chemotherapy or a combination of these)
  • Endoscopy, either upper or lower gastrointestinal, cystoscopy, bronchoscopy, or nasendoscopy; to localise areas suspicious for malignancy and biopsy when necessary.
  • X-rays, CT scanning, MRI scanning, ultrasound and other radiological techniques to localise and guide biopsy.
  • Scintigraphy, single photon emission computed tomography (SPECT), positron emission tomography (PET) and other methods of nuclear medicine to identify areas suspicious for malignancy.
  • Blood tests, including tumor markers, which can increase the suspicion of certain types of cancers.

Apart from diagnoses, these modalities (especially imaging by CT scanning) are often used to determine operability, i.e. whether it is surgically possible to remove a tumor in its entirety.

Currently, a tissue diagnosis (from a biopsy) by a pathologist is essential for the proper classification of cancer and to guide the next step of treatment. On extremely rare instances when this is not possible, "empirical therapy" (without an exact diagnosis) may be considered, based on the available evidence (e.g. history, x-rays and scans.)

On very rare occasions, a metastatic lump or pathological lymph node is found (typically in the neck) for which a primary tumor cannot be found. However, immunohistochemical markers often give a strong indication of the primary malignancy. This situation is referred to as "malignacy of unknown primary", and again, treatment is empirical based on past experience of the most likely origin.[5]

Therapy

Depending upon the cancer identified, followup and palliative care will be administered at that time. Certain disorders (such as ALL or AML) will require immediate admission and chemotherapy, while others will be followed up with regular physical examination and blood tests.

Often, surgery is attempted to remove a tumor entirely. This is only feasible when there is some degree of certainty that the tumor can in fact be removed. When it is certain that parts will remain, curative surgery is often impossible, e.g. when there are metastases elsewhere, or when the tumor has invaded a structure that cannot be operated upon without risking the patient's life. Occasionally surgery can improve survival even if not all tumour tissue has been removed; the procedure is referred to as "debulking" (i.e. reducing the overall amount of tumour tissue). Surgery is also used for the palliative treatment of some of cancers, e.g. to relieve biliary obstruction, or to relieve the problems associated with some cerebral tumors. The risks of surgery must be weighed against the benefits.

Chemotherapy and radiotherapy are used as a first-line radical therapy in a number of malignancies. They are also used for adjuvant therapy, i.e. when the macroscopic tumor has already been completely removed surgically but there is a reasonable statistical risk that it will recur. Chemotherapy and radiotherapy are commonly used for palliation, where disease is clearly incurable: in this situation the aim is to improve the quality of life and to prolong it

Hormone manipulation is well established, particularly in the treatment of breast and prostate cancer.

There is currently a rapid expansion in the use of monoclonal antibody treatments, notably for lymphoma (Rituximab) and breast cancer (Trastuzumab).

Vaccine and other immunotherapies are the subject of intensive research.

Palliative care

Approximately 50% of all cancer cases in the Western world can be treated to remission with radical treatment. For pediatric patients, that number is much higher. A large number of cancer patients will die from the disease, and a significant proportion of patients with incurable cancer will die of other causes. There may be ongoing issues with symptom control associated with progressive cancer, and also with the treatment of the disease. These problems may include pain, nausea, anorexia, fatigue, immobility, and depression. Not all issues are strictly physical: personal dignity may be affected. Moral and spiritual issues are also important.

While many of these problems fall within the remit of the oncologist, palliative care has matured into a separate, closely allied speciality to address the problems associated with advanced disease. Palliative care is an essential part of the multidisciplinary cancer care team. Palliative care services may be less hospital-based than oncology, with nurses and doctors who are able to visit the patient at home.

Ethical issues

There are a number of recurring ethical questions and dilemmas in oncological practice. These include:

These issues are closely related to the patients' personality, religion, culture, and family life. Though these issues are complex and emotional, the answers are often achieved by the patient seeking counsel from trusted personal friends and advisors. It requires a degree of sensitivity and very good communication on the part of the oncology team to address these problems properly.

Progress and research

There is a tremendous amount of research being conducted on all frontiers of oncology, ranging from cancer cell biology, radiation therapy to chemotherapy treatment regimens and optimal palliative care and pain relief. In the past decade, the advent of next-generation sequencing and whole-genome sequencing has completely changed our understanding of cancers. Identification of novel genetic/molecular markers will dramatically change how we diagnose and treat cancer, which will pave the way for personalized medicine.

Therapeutic trials often involve patients from many different hospitals in a particular region. In the UK, patients are often enrolled in large studies coordinated by Cancer Research UK (CRUK),[6] Medical Research Council (MRC),[7] the European Organisation for Research and Treatment of Cancer (EORTC)[8] or the National Cancer Research Network (NCRN).

Specialties

See also

Organizations

References

  1. ^ Maureen McCutcheon. Where Have My Eyebrows Gone?. Cengage Learning, 2001. ISBN 0766839346. Page 5.
  2. ^ Types of Oncologists, American Society of Clinical Oncology (ASCO).
  3. ^ Alfred E. Chang & authors. Oncology: An Evidence-Based Approach. Springer Science & Business Media, 2007. ISBN 0387310568. Page 1488.
  4. ^ Alice Villalobos, Laurie Kaplan. Canine and Feline Geriatric Oncology: Honoring the Human-Animal Bond. John Wiley & Sons, 2008. ISBN 0470344075. Page 77.
  5. ^ National Institute for Health and Clinical Excellence. Clinical guideline 104: Metastatic malignant disease of unknown primary origin: Diagnosis and management of metastatic malignant disease of unknown primary origin. London, 2010.
  6. ^ Cancer Research UK
  7. ^ Home - Medical Research Council
  8. ^ EORTC
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  10. ^ a b "Types of Oncologists". Cancer.Net : American Society of Clinical Oncology (ASCO). 2011-05-09. Retrieved 25 May 2013.
  11. ^ "What is clinical oncology? | the Royal College of Radiologists".
  12. ^ Natarajan, Sundaram (2015-02-01). "Ocular oncology – A multidisciplinary specialty". Indian Journal of Ophthalmology. 63 (2): 91. doi:10.4103/0301-4738.154364. ISSN 0301-4738. PMC 4399140. PMID 25827536.
  13. ^ Manganaris, Argyris; Black, Myles; Balfour, Alistair; Hartley, Christopher; Jeannon, Jean-Pierre; Simo, Ricard (2009-07-01). "Sub-specialty training in head and neck surgical oncology in the European Union". European Archives of Oto-Rhino-Laryngology. 266 (7): 1005–1010. doi:10.1007/s00405-008-0832-4. ISSN 1434-4726. PMID 19015865. S2CID 20700214.
  14. ^ Harish, Krishnamachar; Kirthi Koushik, Agrahara Sreenivasa (2015-05-01). "Multidisciplinary teams in thoracic oncology-from tragic to strategic". Annals of Translational Medicine. 3 (7): 89. doi:10.3978/j.issn.2305-5839.2015.01.31. ISSN 2305-5839. PMC 4430737. PMID 26015931.
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  16. ^ Weber, Kristy L.; Gebhardt, Mark C. (2003-04-01). "What's new in musculoskeletal oncology". The Journal of Bone and Joint Surgery. American Volume. 85-A (4): 761–767. doi:10.2106/00004623-200304000-00029. ISSN 0021-9355. PMID 12672857.
  17. ^ Bukowski, Ronald M. (2011-10-10). "Genitourinary Oncology: Current Status and Future Challenges". Frontiers in Oncology. 1: 32. doi:10.3389/fonc.2011.00032. ISSN 2234-943X. PMC 3355990. PMID 22649760.
  18. ^ Benedetti-Panici, P.; Angioli, R. (2004-01-01). "Gynecologic oncology specialty". European Journal of Gynaecological Oncology. 25 (1): 25–26. ISSN 0392-2936. PMID 15053057.
  19. ^ Wolff, J. A. (1991-06-01). "History of pediatric oncology". Pediatric Hematology and Oncology. 8 (2): 89–91. doi:10.3109/08880019109033436. ISSN 0888-0018. PMID 1863546.
  20. ^ Shaw, Peter H.; Reed, Damon R.; Yeager, Nicholas; Zebrack, Bradley; Castellino, Sharon M.; Bleyer, Archie (April 2015). "Adolescent and Young Adult (AYA) Oncology in the United States: A Specialty in Its Late Adolescence". Journal of Pediatric Hematology/Oncology. 37 (3): 161–169. doi:10.1097/MPH.0000000000000318. ISSN 1536-3678. PMID 25757020. S2CID 27695404.
  21. ^ Mkrtchyan, L. N. (2010-06-01). "On a new strategy of preventive oncology". Neurochemical Research. 35 (6): 868–874. doi:10.1007/s11064-009-0110-x. ISSN 1573-6903. PMID 20119639. S2CID 582313.
  22. ^ Vijaykumar, D. K.; Anupama, R.; Gorasia, Tejal Kishor; Beegum, T. R. Haleema; Gangadharan, P. (2012-01-01). "Geriatric oncology: The need for a separate subspecialty". Indian Journal of Medical and Paediatric Oncology. 33 (2): 134–136. doi:10.4103/0971-5851.99755. ISSN 0971-5851. PMC 3439792. PMID 22988358.
  23. ^ Epstein, A. S.; Morrison, R. S. (2012-04-01). "Palliative oncology: identity, progress, and the path ahead". Annals of Oncology. 23 Suppl 3: 43–48. doi:10.1093/annonc/mds087. ISSN 1569-8041. PMC 3493143. PMID 22628415.
  24. ^ Jenkins, Robert (2001-04-01). "Principles of Molecular Oncology". American Journal of Human Genetics. 68 (4): 1068. doi:10.1086/319526. ISSN 0002-9297. PMC 1275628.
  25. ^ Breen, Matthew (2009-08-01). "Update on genomics in veterinary oncology". Topics in Companion Animal Medicine. 24 (3): 113–121. doi:10.1053/j.tcam.2009.03.002. ISSN 1938-9736. PMC 2754151. PMID 19732729.
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Further reading

External links