Oncology
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CT scans, MRI |
Occupation | |
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Occupation type | Specialty |
Activity sectors | Medicine |
Description | |
Education required |
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Fields of employment | Hospitals, Clinics, Clinical research centers |
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:
- The diagnosis of any cancer in a person (pathology)
- Therapy (e.g. radiotherapyand other modalities)
- Follow-up of cancer patientsafter successful treatment
- Palliative care of patients with terminal malignancies
- Ethical questions surrounding cancer care
- Screening efforts:
- of populations, or
- of the relatives of patients (in types of cancer that are thought to have a hereditary basis, such as breast cancer)
Diagnosis
Medical histories remain an important screening tool: the character of the complaints and nonspecific symptoms (such as
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)[5]
- Endoscopy, either upper or lower gastrointestinal, cystoscopy, bronchoscopy, or nasendoscopy; to localise areas suspicious for malignancy and biopsy when necessary.[6]
- Mammograms, CT scanning, MRI scanning, ultrasoundand other radiological techniques to localise and guide biopsy.
- single photon emission computed tomography (SPECT), positron emission tomography (PET) and other methods of nuclear medicineto identify areas suspicious of malignancy.
- Blood tests, including tumor markers, which can increase the suspicion of certain types of cancers.
Apart from diagnoses, these modalities (especially imaging by
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 "malignancy of unknown primary", and again, treatment is empirically based on past experience of the most likely origin.[7]
Therapy
Depending upon the cancer identified, follow-up and palliative care will be administered at that time. Certain disorders (such as
Often,
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).
Vaccines 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
While many of these problems fall within the remit of the oncologist, palliative care has matured into a separate, closely allied specialty 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:
- What information to give the patient regarding disease extent/progression/prognosis.
- Entry into clinical trials, especially in the face of terminal illness.
- Withdrawal of active treatment.
- "Do Not Resuscitate" orders and other end-of-life issues.
These issues are closely related to the patient's 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, and radiation therapy to
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
The most valued companies worldwide whose leading products are in Oncology include
Specialties
- The four main divisions:
- Medical oncology: focuses on the treatment of cancer with chemotherapy, targeted therapy, immunotherapy, and hormonal therapy.[12]
- Surgical oncology: focuses on treatment of cancer with surgery.[13]
- Radiation oncology: focuses on treatment of cancer with radiation.[13]
- Clinical oncology: focuses on treatment of cancer with both systemic therapies and radiation.[14]
- Sub-specialties in Oncology:
- Neuro-oncology: focuses on cancers of brain.
- Ocular oncology: focuses on cancers of eye.[15]
- Head & Neck oncology: focuses on cancers of oral cavity, nasal cavity, oropharynx, hypopharynx and larynx.[16]
- Thoracic oncology: focuses on cancers of lung, mediastinum, oesophagus and pleura.[17]
- Breast oncology: focuses on cancers of breast.
- Gastrointestinal oncology: focuses on cancers of the stomach, colon, rectum, anal canal, liver, gallbladder, pancreas.[18]
- Bone & Musculoskeletal oncology: focuses on cancers of bones and soft tissue.[19]
- 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.[20]
- Gynecologic oncology: focuses on cancers of the female reproductive system.[21]
- Pediatric oncology: concerned with the treatment of cancer in children.[22]
- Adolescent and young adult (AYA) oncology.[23]
- Hemato oncology: focuses on cancers of blood and stem cell transplantation.
- Preventive oncology: focuses on epidemiology & prevention of cancer.[24]
- Geriatric oncology: focuses on cancers in elderly population.[25]
- Pain & Palliative oncology: focuses on treatment of end stage cancer to help alleviate pain and suffering.[26]
- Molecular oncology: focuses on molecular diagnostic methods in oncology.[27]
- 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.[28]
- Emerging specialties:
- Cardiooncology is a branch of cardiology that addresses the cardiovascular impact of cancer and its treatments.[29]
See also
- Organizations
References
- ^ Maureen McCutcheon. Where Have My Eyebrows Gone?. Cengage Learning, 2001. ISBN 0766839346. Page 5.
- ^ Types of Oncologists Archived 2017-07-26 at the Wayback Machine, American Society of Clinical Oncology (ASCO).
- ^ Alfred E. Chang & authors. Oncology: An Evidence-Based Approach. Springer Science & Business Media, 2007. ISBN 0387310568. Page 1488.
- ^ Alice Villalobos, Laurie Kaplan. Canine and Feline Geriatric Oncology: Honoring the Human-Animal Bond. John Wiley & Sons, 2008. ISBN 0470344075. Page 77.
- ^ "How biopsy procedures are used to diagnose cancer". Mayo Clinic. Archived from the original on 2023-06-13. Retrieved 2023-06-13.
- ^ "Endoscopy". British Medical Association Complete Family Health Encyclopedia. Dorling Kindersley Limited. 1990.
- 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.
- ^ "Cancer Research UK". Cancer Research UK. 10 May 2021. Archived from the original on 2022-12-30. Retrieved 2022-12-30.
- ^ "Home - Medical Research Council". Archived from the original on 2017-09-12. Retrieved 2004-03-29.
- ^ "European Organisation For Research And Treatment Of Cancer". EORTC. January 17, 2017. Archived from the original on October 28, 2022. Retrieved March 2, 2020.
- ^ "Top Global Pharmaceutical Company Report" (PDF). The Pharma 1000. November 2021. Archived (PDF) from the original on 2022-03-15. Retrieved 29 December 2022.
- PMID 9394841.
- ^ a b "Types of Oncologists". Cancer.Net : American Society of Clinical Oncology (ASCO). 2011-05-09. Archived from the original on 2013-06-01. Retrieved 25 May 2013.
- ^ "What is clinical oncology? | the Royal College of Radiologists". Archived from the original on 2021-08-11. Retrieved 2021-08-11.
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- S2CID 20700214.
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Further reading
- 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. 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. S2CID 2544266.
- Katsanis, Sara Huston; Katsanis, Nicholas (2013). "Molecular genetic testing and the future of clinical genomics". Nat Rev Genet. 14 (6): 415–426. PMID 23681062.
- Mardis, Elaine R. (2012). "Applying next-generation sequencing to pancreatic cancer treatment". Nat Rev Gastroenterol Hepatol. 9 (8): 477–486. S2CID 9981262.
- 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. S2CID 35124492.
External links
- "Comprehensive Cancer Information". National Cancer Institute. January 1980. 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.