Oncology

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

Cancer survival has improved due to three main components including improved prevention efforts to reduce exposure to risk factors (e.g., tobacco smoking and alcohol consumption), improved screening of several cancers (allowing for earlier diagnosis), and improvements in treatment.

Cancers are often managed through discussion on multi-disciplinary cancer conferences where medical oncologists, surgical oncologists, radiation oncologists, pathologists, radiologists, and organ specific oncologists meet to find the best possible management for an individual patient considering the physical, social, psychological, emotional, and financial status of the patient. It is very important for oncologists to keep updated with respect to the latest advancements in oncology, as changes in management of cancer are quite common. All eligible patients in whom cancer progresses, and for whom no standard of care treatment options are available should be enrolled in a clinical trial.

Video Oncology

Risk factors

Tobacco

The leading cause of cancer, and death from cancer. Smoking is associated with increased risk of cancers of the lung, larynx, mouth, oesophagus, throat, bladder, kidney, liver, stomach, pancreas, colon, rectum, cervix and acute myeloid leukemia. Smokeless tobacco (snuff or chewing tobacco) is associated with increased risks of cancers of the mouth, oesophagus, and pancreas.

Alcohol

Can increase risk of cancer of the mouth, throat, oesophagus, larynx, liver, and breast. The risk of cancer is much higher for those who drink alcohol and also use tobacco.

Obesity

Obese individuals have an increased risk of cancer of the breast, colon, rectum, endometrium, oesophagus, kidney, pancreas, and gallbladder.

Age

Advanced age is a risk factor for many cancers. The median age of cancer diagnosis is 66 years.

Maps Oncology

Screening

Screening is recommended for cancers of breast, cervix, colon, and lung.

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Signs and symptoms

Signs and symptoms usually depend on the site and type of cancer.

Breast cancer

Lump in breast and axilla associated with or without ulceration or bloody nipple discharge.

Endometrial cancer

Bleeding per vagina.

Cervix cancer

Bleeding after sexual intercourse.

Ovarian cancer

Nonspecific symptoms such as abdominal distension, dyspepsia.

Lung cancer

Persistent cough, breathlessness, blood in the sputum, hoarseness of voice.

Head and neck cancer

Non-healing ulcer or growth, lump in the neck.

Brain cancer

Persistent headache, vomiting, loss of consciousness, double vision.

Thyroid cancer

Lump in the neck.

Oesophageal cancer

Painful swallowing predominantly with solid food, weight loss.

Stomach cancer

Vomiting, dyspepsia, weight loss.

Colon & rectal cancer

Bleeding per rectum, alteration of bowel habits.

Liver cancer

Jaundice, pain and mass in right upper abdomen.

Pancreatic cancer

Weight loss, jaundice.

Skin cancer

Non-healing ulcer or growth, mole with sudden increase in size or irregular border, induration, or pain.

Kidney cancer

Blood in urine, abdominal lump.

Bladder cancer

Blood in urine.

Prostate cancer

Urgency, hesitancy and frequency while passing urine, bony pain.

Testis cancer

Swelling of testis, back pain, dyspnoea.

Bone cancer

Pain and swelling of bones.

Lymphoma

Fever, weight loss more than 10% body weight in preceding 6 months and drenching night sweats which constitutes the B symptoms, lump in neck, axilla or groin.

Blood cancer

Bleeding manifestations including bleeding gums, bleeding from nose, blood in vomitus, blood in sputum, blood stained urine, black coloured stools, fever, lump in neck, axilla, or groin, lump in upper abdomen.

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Diagnosis and staging

Diagnostic and staging investigations depend on the site and type of malignancy.

Blood cancer

Blood investigations including hemoglobin, total leukocyte count, platelet count, peripheral smear, red cell indices.

Bone marrow studies including aspiration, flow cytometry, cytogenetics, fluorescent in situ hybridisation and molecular studies.

Lymphoma

Excision biopsy of lymph node for histopathological examination, immunohistochemistry, and molecular studies.

Blood investigations include lactate dehydrogenase (LDH), serum uric acid, and kidney function tests.

Imaging tests such as computerised tomography (CT), positron emission tomography (PET CT).

Bone marrow biopsy.

Solid tumors

Biopsy for histopathology and immunohistochemistry.

Imaging tests like X-ray, ultrasonography, computerised tomography (CT), magnetic resonance imaging (MRI) and PET CT.

Endoscopy including Naso-pharyngoscopy, Direct & Indirect Laryngoscopy, Upper Gastrointestinal Endoscopy, Colonoscopy, Cystoscopy.

Tumor markers including alphafetoprotein (AFP), Beta Human Chorionic Gonadotropin (HCG), Carcinoembionic Antigen (CEA), CA 125, Prostate specific antigen (PSA).

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Treatment

Treatment depends on the site and type of cancer.

Solid tumors

Breast cancer

Treatment options include surgery, radiation, chemotherapy, hormonal therapy, and targeted therapy (Her 2 neu inhibitors).

Cervix cancer

Treatment options include radiation, surgery and chemotherapy.

Endometrial cancer

Treatment options include surgery, radiation, and chemotherapy.

Ovary cancer

Treatment options include surgery, chemotherapy, and targeted therapy (VEGF inhibitors).

Lung cancer

Treatment options include surgery, radiation, chemotherapy, and targeted therapy (EGFR & ALK inhibitors).

Head & Neck Cancer

Treatment options include surgery, radiation, chemotherapy, and targeted therapy (EGFR inhibitors).

Brain cancer

Treatment options include surgery, radiation, chemotherapy, and targeted therapy (VEGF inhibitors).

Thyroid cancer

Treatment options include surgery and radioactive iodine.

Oesophageal cancer

Treatment options include radiation, chemotherapy, and surgery.

Stomach cancer

Treatment options include chemotherapy, surgery, radiation, and targeted therapy (Her 2 neu inhibitors).

Colon cancer

Treatment options include surgery, chemotherapy, and targeted therapy (EGFR & VEGF inhibitors).

Rectum cancer

Treatment options include chemotherapy, radiation, surgery.

Liver cancer

Treatment options include surgery, Trans-arterial chemotherapy (TACE), Radio-frequency ablation (RFA), and multi-kinase (Sorafenib).

Pancreas cancer

Treatment options include surgery, radiation, and chemotherapy.

Skin cancer

Treatment options include surgery, radiation, targeted therapy (BRAF & MEK inhibitors), Immunotherapy (CTLA 4 & PD 1 inhibitors, and chemotherapy.

Kidney cancer

Treatment options include surgery, multi-kinase inhibitors, and targeted therapy (mTOR & VEGF inhibitors).

Bladder cancer

Treatment options include surgery, radiation, and chemotherapy.

Prostate cancer

Treatment options include surgery, radiation, chemotherapy, anti-androgens, and immunotherapy.

Testis cancer

Treatment options include surgery, chemotherapy, and radiation.

Bone cancer

Treatment options include surgery, chemotherapy, and radiation.

Lymphoma

It includes Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL):

Hodgkin lymphoma (HL)

Chemotherapy with ABVD or BEACOPP regimen and Involved field radiation therapy (IFRT).

Non-Hodgkin lymphoma (NHL)

Chemo-immunotherapy (R-CHOP) for B cell lymphomas, and chemotherapy (CHOP) for T cell lymphomas.

Blood cancer

Includes acute and chronic leukemias. Acute leukemias includes acute lymphoblastic leukemia (ALL), and acute myeloid leukemia (AML). Chronic leukemias include chronic lymphocytic leukemia (CLL), and chronic myeloid leukemia (CML).

Acute lymphoblastic leukemia (ALL)

Intensive chemotherapy phase for initial 6 months and maintenance chemotherapy for 2 years. Prophylactic cranial and stem cell transplantation for high-risk patients.

Acute myeloid leukemia (AML)

Induction with chemotherapy (Daunorubicin + Cytarabine), followed by consolidation chemotherapy (High dose cytarabine). Stem cell transplantation for high-risk patients.

Chronic lymphocytic leukemia (CLL): Chemo-immunotherapy (FCR or BR regimen) for symptomatic patients.

Chronic myeloid leukemia (CML)

Targeted therapy with tyrosine kinase inhibitor (Imatinib) as first-line treatment.

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Specialties

• The three main divisions:
  • Medical oncology: focuses on treatment of cancer with chemotherapy, targeted therapy, immunotherapy, and hormonal therapy.
  • Surgical oncology: focuses on treatment of cancer with surgery.
  • Radiation oncology: focuses on treatment of cancer with radiation.
• Sub-specialties in Oncology:
  • Neuro-oncology: focuses on cancers of brain.
  • Ocular oncology: focuses on cancers of eye.
  • Head & Neck oncology: focuses on cancers of oral cavity, nasal cavity, oropharynx, hypopharyx and larynx.
  • Thoracic oncology: focuses on cancers of lung, mediastinum, oesophagus and pleura.
  • Breast oncology: focuses on cancers of breast
  • Gastrointestinal oncology: focuses on cancers of stomach, colon, rectum, anal canal, liver, gallbladder, pancreas.
  • Bone & Musculoskeletal oncology: focuses on cancers of bones and soft tissue.
  • Dermatological oncology: focuses on the medical and surgical treatment of skin, hair, sweat gland, and nail cancers
  • Genitourinary oncology: focuses on cancers of genital and urinary system.
  • Gynecologic oncology: focuses on cancers of the female reproductive system.
  • Pediatric oncology: concerned with the treatment of cancer in children.
  • Hemato oncology: focuses on cancers of blood and stem cell transplantation
  • Preventive oncology: focuses on epidemiology & prevention of cancer.
  • Geriatric oncology: focuses on cancers in elderly population.
  • Pain & Palliative oncology: focuses on treatment of end stage cancer to help alleviate pain and suffering.
  • Molecular oncology: focuses on molecular diagnostic methods in oncology.
  • Oncopathology: A specialty of Pathology that focuses on the histopathological diagnosis of cancer. As a significant portion of all general pathology practice is concerned with cancer, the practice of oncology is deeply tied to, and dependent upon, the work of both anatomical and clinical pathologists.
  • Nuclear medicine oncology: focuses on diagnosis and treatment of cancer with radiopharmaceuticals.
  • Psycho-oncology: focuses on psychosocial issues on diagnosis and treatment of cancer patients.
  • Veterinary oncology: focuses on treatment of cancer in animals.

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Progress and future

• Leukemia, Lymphoma, Germ cell tumors and early stage solid tumors which were once incurable have become curable malignancies now. Immunotherapies have already proven efficient in leukemia, bladder cancer and various skin cancer. For the future, research is promising in the field of physical oncology.
• Survival of cancer has significantly improved over the past years due to improved screening, diagnostic methods and treatment options with targeted therapy.
• Large multi-centric Phase III randomised controlled clinical trials by the National Surgical Adjuvant Breast & Bowel Project (NSABP) Medical Research Council (MRC), the European Organisation for Research and Treatment of Cancer (EORTC), and National Cancer Institute (NCI) have contributed significantly to the improvement in survival.

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See also

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References

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Bibliography

• Watson, Ian R.; Takahashi, Koichi; Futreal, P. Andrew; Chin, Lynda (2013). "Emerging patterns of somatic mutations in cancer". Nat Rev Genet. 14 (10): 703-718. doi:10.1038/nrg3539. PMC 4014352 . PMID 24022702. 
• Meyerson, Matthew; Gabriel, Stacey; Getz, Gad (2010). "Advances in understanding cancer genomes through second-generation sequencing". Nat Rev Genet. 11 (10): 685-696. doi:10.1038/nrg2841. PMID 20847746. 
• Katsanis, Sara Huston; Katsanis, Nicholas (2013). "Molecular genetic testing and the future of clinical genomics". Nat Rev Genet. 14 (6): 415-426. doi:10.1038/nrg3493. PMC 4461364 . PMID 23681062. 
• Mardis, Elaine R. (2012). "Applying next-generation sequencing to pancreatic cancer treatment". Nat Rev Gastroenterol Hepatol. 9 (8): 477-486. doi:10.1038/nrgastro.2012.126. PMID 22751458. 
• Mukherjee, Siddhartha (2011). The Emperor of All Maladies: A Biography of Cancer. Fourth Estate. ISBN 978-0-00-725092-9. 
• Vickers, Andrew (1 March 2004). "Alternative Cancer Cures: "Unproven" or "Disproven"?". CA: A Cancer Journal for Clinicians. 54 (2): 110-118. doi:10.3322/canjclin.54.2.110. PMID 15061600. 

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External links

• "Comprehensive Cancer Information". National Cancer Institute. Retrieved 2016-01-16. <
• "NCCN - Evidence-Based Cancer Guidelines, Oncology Drug Compendium, Oncology Continuing Medical Education". National Comprehensive Cancer Network. Retrieved 2016-01-16. 
• "European Society for Medical Oncology | ESMO". www.esmo.org. Retrieved 2016-01-16. 

Source of article : Wikipedia