Oncology

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Oncology - The study of Cancer cells
Tumor Mesothelioma2 legend.jpg
A coronal CT scan showing a malignant mesothelioma, indicated by the asterisk and the arrows
Focus Cancerous tumor
Subdivisions Medical oncology, radiation oncology, surgical oncology
Significant tests Tumor markers, TNM staging, CT scans, MRI
Specialist Oncologist

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.[1] The name's etymological origin is the Greek word ὄνκος (ónkos), meaning "tumor", "volume" or "mass".[2]

The three components which have improved survival in cancer are:

1. Prevention - This is by reduction of risk factors like tobacco & alcohol consumption[3]

2. Early diagnosis - Screening of common cancers[4] and comprehensive diagnosis and staging

3. Treatment - Multimodality management[5] by discussion in tumour board and treatment in a comprehensive cancer centre[6]

Cancers are best managed by discussing in multi-disciplinary tumour boards[7] where medical oncologist, surgical oncology, radiation oncology, pathologist, radiologist 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 patients. It is very important for oncologists to keep updated of the latest advancements in oncology as changes in management of cancer are quite common. All fit patients whose cancer progresses and no standard of care treatment options are available should be enrolled in a clinical trial.

Risk factors

Tobacco - It is the leading cause of cancer diagnosis and death from cancer. Smoking is associated with increased risk of cancers of 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.[8]

Alcohol - It can increase your 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.[9]

Obesity - Obese individuals have an increased risk of cancers of breast, colon, rectum, endometrium, oesophagus, kidney, pancreas, and gallbladder.[10]

Age - Advanced age is a risk factor for many cancers. The median age of cancer diagnosis is 66 years.[11]

Screening

Screening is recommended for cancers of breast,[12] cervix,[13] colon[14] and lung.[15]

Symptoms

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[16]

Endometrial cancer - Bleeding per vagina[17]

Cervix cancer - Bleeding after sexual intercourse[18]

Ovary cancer - Nonspecific symptoms like abdominal distension, dyspepsia[19]

Lung cancer - Persistent cough, breathlessness, blood in the sputum, hoarseness of voice[20]

Head & neck cancer - Non healing ulcer or growth, lump in the neck[21]

Brain cancer- Persistent headache, vomiting, loss of consciousness, double vision[22]

Thyroid cancer - Lump in the neck[23]

Oesophagus cancer- Painful swallowing predominantly to solid food, weight loss[24]

Stomach cancer- Vomiting, dyspepsia, weight loss[25]

Colon & rectum cancer - Bleeding per rectum, alteration of bowel habits[26]

Liver cancer - Jaundice, pain and mass in right upper abdomen[27]

Carcinoma Pancreas - Weight loss, jaundice[28]

Skin carcinoma - Non healing ulcer or growth, mole with sudden increase in size,irregular border, induration or pain[29]

Kidney cancer - Blood in urine, abdominal lump[30]

Bladder cancer - Blood in urine[31]

Prostate cancer - Urgency, hesitancy and frequency while passing urine, bony pain[32]

Testis cancer - Swelling of testis, back pain, dyspnoea[33]

Bone cancer - Pain and swelling of bones[34]

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[35]

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[20]

Diagnosis and staging

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

Blood cancer

Blood investigations including Haemoglobin, Total leucocyte count, Platelet count, Peripheral Smear, Red cell indices

Bone marrow studies including aspiration, Flow-cytometry,[36] Cytogenetics,[37] Fluorescent in situ hybridisation and molecular studies[38]

Lymphoma

Excision biopsy of lymph node for Histopathological Examination (HPE),[39] Immuno-histochemistry (IHC)[40] and molecular studies.[41]

Blood investigations including Lactate dehydrogenase (LDH), Serum Uric Acid, Renal Functions.[42]

Imaging tests like Computerised Tomography (CT), Positron emission tomography (PET CT).[43]

Bone marrow biopsy[44]

Solid tumours

Biopsy for histopathology & IHC[45]

Imaging tests like Roentgenogram (X-ray), Ultrasonography, Computerised tomography (CT), Magnetic Resonance Imaging (MRI) and PET CT.[46]

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

Tumour markers including alphafetoprotein (AFP),[47] Beta Human Chorionic Gonadotropin (HCG),[47] Carcinoembionic Antigen (CEA),[48] CA 125,[49] Prostate specific antigen (PSA).[50]

Treatment

Treatment depends on the site and type of cancer.

Solid tumours

Breast Cancer - Treatment options includes surgery, radiation, chemotherapy, hormonal therapy and targeted therapy (Her 2 neu inhibitors)[51]

Cervix Cancer - Treatment options includes radiation, surgery and chemotherapy[52]

Endometrial Cancer - Treatment options includes surgery, radiation and chemotherapy[53]

Ovary Cancer - Treatment options includes surgery, chemotherapy and targeted therapy (VEGF inhibitors)[54]

Lung Cancer - Treatment options includes surgery, radiation, chemotherapy and targeted therapy (EGFR & ALK inhibitors)[55]

Head & Neck Cancer - Treatment options includes surgery, radiation, chemotherapy and targeted therapy (EGFR inhibitors)[56]

Brain Cancer - Treatment options includes surgery, radiation, chemotherapy and targeted therapy (VEGF inhibitors)[51]

Thyroid Cancer - Treatment options includes surgery and radioactive iodine[57]

Oesophageal Cancer - Treatment options includes radiation, chemotherapy and surgery[58]

Stomach Cancer - Treatment options includes chemotherapy, surgery, radiation and targeted therapy (Her 2 neu inhibitors)[59]

Colon Cancer - Treatment options includes surgery, chemotherapy and targeted therapy (EGFR & VEGF inhibitors)[60]

Rectum Cancer - Treatment options includes chemotherapy, radiation, surgery[61]

Liver Cancer - Treatment options includes surgery, Trans-arterial chemotherapy (TACE), Radio-frequency abalation (RFA) and multi-kinase (Sorafenib)[62]

Pancreas Cancer - Treatment options includes surgery, radiation and chemotherapy[63]

Skin Cancer - Treatment options includes surgery, radiation, targeted therapy (BRAF & MEK inhibitors), Immunotherapy (CTLA 4 & PD 1 inhibitors) and chemotherapy[64]

Kidney Cancer - Treatment options includes surgery, multi-kinase inhibitors and targeted therapy (mTOR & VEGF inhibitors)[65]

Bladder Cancer - Treatment options includes surgery, radiation and chemotherapy[66]

Prostate Cancer - Treatment options includes surgery, radiation, chemotherapy, anti-androgens and immunotherapy[67]

Testis Cancer - Treatment options includes surgery, chemotherapy and radiation[68]

Bone Cancer - Treatment options includes surgery, chemotherapy and radiation[69]

Lymphoma

It includes Hodgkin Lymphoma (HL) and Non Hodgkin Lymphoma (NHL)

HL - Chemotherapy with ABVD or BEACOPP regimen and Involved field radiation therapy (IFRT)[70]

NHL - Chemo-immunotherapy (R-CHOP) for B cell lymphomas and chemotherapy (CHOP) for T cell lymphomas[71]

Blood cancer

It include Acute Leukemias 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).

ALL - Intensive chemotherapy phase for initial 6 months and maintenance chemotherapy for 2 years. Prophylactic cranial and stem cell transplantation for high risk patients.[72]

AML - Induction with chemotherapy (Daunorubicin + Cytarabine) followed by consolidation chemotherapy (High dose cytarabine). Stem cell transplantation for high risk patients.[73]

CLL - Chemo-immunotherapy (FCR or BR regimen) for symptomatic patients.[74]

CML - Targeted therapy with tyrosine kinase inhibitor (Imatinib) as first line treatment.[75]

Specialties

  • The three main division includes
  • Sub-specialities in Oncology:
    • Neuro-oncology: focuses on cancers of brain.[78]
    • Ocular oncology: focuses on cancers of eye.[79]
    • Head & Neck oncology: focuses on cancers of oral cavity, nasal cavity, oropharynx, hypopharyx and larynx.[80]
    • Thoracic oncology: focuses on cancers of lung, mediastinum, oesophagus and pleura.[81]
    • Breast oncology: focuses on cancers of breast
    • Gastrointestinal oncology: focuses on cancers of stomach, colon, rectum, anal canal, liver, gallbladder, pancreas.[82]
    • Bone & Musculoskeletal oncology: focuses on cancers of bones and soft tissue.[83]
    • Genitourinary oncology: focuses on cancers of genital and urinary system.[84]
    • Gynecologic oncology: focuses on cancers of the female reproductive system.[85]
    • Pediatric oncology: concerned with the treatment of cancer in children.[86]
    • Hemato oncology: focuses on cancers of blood and stem cell transplantation
    • Preventive oncology: focuses on epidemiology & prevention of cancer.[87]
    • Geriatric oncology: focuses on cancers in elderly population.[88]
    • Pain & Palliative oncology: focuses on treatment of end stage cancer to alleviate the suffering.[89]
    • Molecular oncology: focuses on molecular diagnostic methods in oncology.[90]
    • Oncopathology: focuses on histopathological diagnosis of cancer
    • 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.[91]

Progress and future

References

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  97. EORTC

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External links

  • National Institute of Health - National Cancer Institute [1]
  • National Comprehensive Cancer Network [2]
  • European Society of Medical Oncology[3]
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  3. "European Society for Medical Oncology | ESMO". www.esmo.org. Retrieved 2016-01-16.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>