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Oncology

Branch of medicine dealing with, or specializing in, cancer From Wikipedia, the free encyclopedia

Oncology
Not to be confused with Ontology.
For the journal, see Oncology (journal).
"Clinical oncology" redirects here. For the journal, see Clinical Oncology.

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

Quick Facts Focus, Subdivisions ...
Oncology
Thumb
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
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Quick Facts Occupation, Occupation type ...
Oncologist
Occupation
Occupation type
Specialty
Activity sectors
Medicine
Description
Fields of
employment
Hospitals, clinics, clinical research centers
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Oncology is focused on the diagnosis of cancer in a person, therapy (e.g., surgery, chemotherapy, radiotherapy and other modalities), monitoring of patients after treatment, palliative care of people with advanced-stage cancers, ethical questions surrounding cancer care, screening of patients, and the study of cancer treatments through clinical research.[1][3]

An oncologist typically focuses on a specialty area in cancer treatment, such as surgery, radiation, gynecologic oncology, geriatric oncology, pediatric oncology, and various organ-specific disciplines (breast, brain, liver, among others).[1][2]

The expertise of an oncologist is applied when cancer is suspected, is diagnosed with cancer, or undergoes cancer treatment.[1]

Diagnosis

Summarize
Perspective

Medical histories are still an important screening tool for an oncologist to assess the nature of concerns and nonspecific symptoms in a patient (such as fatigue, weight loss, unexplained anemia, fever of unknown origin, paraneoplastic phenomena and other signs) that may require further evaluation for malignancy.[3][4][5]

Diagnostic methods in oncology may include a biopsy or resection; these are methods used to remove suspicious neoplastic growths can be removed in part or in whole, and examined by a pathologist to assess for malignancy.[6] This is currently the gold standard for the diagnosis of cancer and is essential for determining the next step in the appropriate course of management (active surveillance, surgery, radiation therapy, chemotherapy, or a combination of these)[7]

Other diagnostic procedures may include an endoscopy, either upper or lower gastrointestinal, cystoscopy, bronchoscopy, or nasendoscopy to localize tissues suspicious for malignancy and biopsy,[8] mammograms, X-rays, CT scanning, MRI scanning, ultrasound and other radiological techniques to localize and guide biopsy.[4] Scintigraphy, single photon emission computed tomography (SPECT), positron emission tomography (PET) and other methods of nuclear medicine are imaging technologies used to identify areas suspicious of malignancy. Blood tests, including tumor markers, can assist diagnosis 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.

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.)

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.[9]

Therapy

Summarize
Perspective

Treament or palliative care depends on the cancer. Certain disorders (such as ALL or AML) will require immediate admission and chemotherapy. Others may be followed up with regular physical examination, medical imaging, 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, 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 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 several 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.

Monoclonal antibody treatments are widely used in oncology, with established therapies such as Rituximab for lymphoma and Trastuzumab for HER2-positive breast cancer, alongside newer agents targeting various cancers. Cancer vaccines and other immunotherapies, such as checkpoint inhibitors, CAR-T cell therapy, and cytokine therapies, remain active areas of research and clinical application.[3][10]

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 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:

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 chemotherapy treatment regimens and optimal palliative care and pain relief. Next-generation sequencing and whole-genome sequencing have completely changed the understanding of cancers. Identification of novel genetic/molecular markers will change the methods of diagnosis and treatment, paving 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),[11] Medical Research Council (MRC),[12] the European Organisation for Research and Treatment of Cancer (EORTC)[13] or the National Cancer Research Network (NCRN).

The most valued companies worldwide whose leading products are in Oncology include Pfizer (United States), Roche (Switzerland), Merck (United States), AstraZeneca (United Kingdom), Novartis (Switzerland) and Bristol-Myers Squibb (United States) who are active in the treatment areas Kinase inhibitors, Antibodies, Immuno-oncology and Radiopharmaceuticals.[14]

Specialties

See also

Organizations

References

Further reading

External links

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