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Oncology

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See cancer for the biology of the disease, as well as a list of malignant diseases.

Oncology is the branch of medicine dealing with tumors (cancer). A medical professional who practices oncology is an oncologist. The term originates from the Greek onkos (ονκος), meaning bulk, mass, or tumor, and the suffix -logy, meaning "study of".

Oncology is concerned with:

Contents

[edit] Diagnosis

The most important diagnostic tool remains the medical history: the character of the complaints and any specific symptoms (fatigue, weight loss, unexplained anemia, fever of unknown origin, paraneoplastic phenomena and other signs). Often a physical examination will reveal the location of a malignancy.

Diagnostic methods include:

Apart from in diagnosis, 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.

Generally, a "tissue diagnosis" (from a biopsy) is considered essential for the proper identification of cancer. When this is not possible, "empirical therapy" (without an exact diagnosis) may be given, based on the available evidence (e.g. history, x-rays and scans.)

Occasionally, a metastatic lump or pathological lymph node is found (typically in the neck) for which a primary tumor cannot be found. This situation is referred to as "carcinoma of unknown primary", and again, treatment is empirical based on past experience of the most likely origin.

[edit] Therapy

It depends completely on the nature of the tumor identified what kind of therapeutical intervention will be necessary. Certain disorders will require immediate admission and chemotherapy (such as ALL or AML), while others will be followed up with regular physical examination and blood tests. A detailed discussion of treatment options according to the type of cancer is at the National Cancer Institute website with sections on adult cancers, pediatric cancers, and supportive care. There is also a section on complementary and alternative methods of treatment.

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 up 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 and prolong life.

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.

The application of ultrasound in the form of HIFU to solid tumors is under investigation.

[edit] Follow-up

A large segment of the oncologist's workload is the following-up of cancer patients who have been successfully treated. For some cancers, early identification of recurrence, with prompt treatment, can lead to better survival and quality of life. It depends on the nature of the cancer whether the follow-up lasts a number of years or remains "life long". Some hospitals have cancer programs approved by the American College of Surgeons and must adhere to standards set forth by that organization. One of those standards requires annual followup of every patient entered into the Cancer Program's Registry for the remainder of the patient's life. This sort of long-term follow-up helps in analysis of long-term survival and recurrence of patients' cancers many years after initial successful treatment.

[edit] Palliative care

Approximately 50% of all cancer cases in the Western world can be cured 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 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.

[edit] 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, personal, and family life. The answers are rarely black and white. It requires a degree of sensitivity and very good communication on the part of the oncology team to address these problems properly.

[edit] Progress and research in oncology

There is a tremendous amount of research being conducted on all frontiers of oncology, ranging from cancer cell biology to chemotherapy treatment regimens and optimal palliative care and pain relief. This makes oncology a continuously changing field.

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)[1], Medical Research Council (MRC)[2], the European Organisation for Research and Treatment of Cancer (EORTC)[3] or the National Cancer Research Network (NCRN).[4]

[edit] Complementary and alternative therapies

Main article: Alternative medicine

Many cancer patients seek extra help from complementary and alternative therapies, which fall outside the scope of conventional medicine. Many complementary therapies do not have a firm scientific or evidential base.

Nonetheless, many aspects of the patients life that fall outside of the scope of conventional western medicine may be addressed very effectively by alternative means. Alternative means can help the patient and the patients family cope with the prospect of death, depression, anorexia, day to day emotions and functions such as sleeping and eating, and other palliative care.

Complementary therapies are diverse and multifaceted. They can range from free of charge to exorbitantly expensive, ineffective, to beneficial, to downright hazardous. As a general rule, complementary or alternative therapy is only as effective as one believes it to be.

[edit] Specialties

There are several sub-specialties within oncology. Moreover, oncologists often develop an interest and expertise in the management of particular types of cancer.

Oncologists may be divided on the basis of the type of treatment provided.[5]

In the United Kingdom and several other countries, oncologists may be either clinical or medical oncologists. The main difference is that clinical oncologists deliver radiotherapy, while medical oncologists do not. (This difference does not apply in North America: the terms, clinical oncologist and medical oncologist are used interchangeably.)

In most countries it is now common that patients are treated by a multidisciplinary team. These teams will meet on regular basis and discus the patients under their care. These teams consist of the medical oncologist , a clinical oncologist or radiotherapist, a surgeon (sometimes there is a second reconstructive surgeon), a radiologist, a pathologist, an organ specific specialist such as a gynaecologist or dermatologist, and sometimes the general practitioner is also involved. These disease oriented teams are sometimes in conflict with the general organisation and operation in hospitals. Historically hospitals are organised in an organ or technique specific manner. Multidisciplinary teams operate over these borders and it is sometimes difficult to define who is in charge.

In veterinary medicine, veterinary oncology is the sub-specialty that deals with cancer diagnosis and treatment in animals.

[edit] See also

[edit] References

 This article needs additional citations for verification.
Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (December 2007)
  1. ^ http://www.cancerresearchuk.org.uk
  2. ^ http://www.mrc.ac.uk
  3. ^ http://www.eortc.be
  4. ^ http://www.ncrn.org.uk
  5. ^ http://www.ascocancerfoundation.org/patient/ASCO+Resources/Find+an+Oncologist/Types+of+Oncologists
  6. ^ NCI Dictionary of Cancer terms

[edit] Further reading

  • Vickers, A., Banks, J., et al. Alternative Cancer Cures: "Unproven" or "Disproven"? CA Cancer J Clin 2004 54: 110-118. Full text online

[edit] External links


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