Oncology

Last updated
Oncology
Tumor Mesothelioma2 legend.jpg
A coronal CT scan showing a malignant mesothelioma, indicated by the asterisk and the arrows
Focus Cancerous tumor
SubdivisionsMedical oncology, radiation oncology, surgical oncology
Significant tests Tumor markers, TNM staging, CT scans, MRI
Oncologist
Occupation
Occupation type
 Specialty
Activity sectors
 Medicine
Description
Education required
Fields of
employment
 Hospitals, clinics

Oncology is a branch of medicine that deals with the prevention, diagnosis, and treatment of cancer. A medical professional who practices oncology is called an Oncologist. [1]

Contents

Cancer survival has improved due to three main components: improved prevention efforts to reduce exposure to risk factors (e.g., tobacco smoking and alcohol consumption), [2] improved screening of several cancers (allowing for earlier diagnosis), [3] and improvements in treatment. [4] [5]

Cancers are often managed through discussion on multi-disciplinary cancer conferences [6] 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. [7] It is very important for oncologists to keep up-to-date with the latest advancements in oncology, as changes in the management of cancer are quite common.

Because a cancer diagnosis can cause distress and anxiety, [8] clinicians may use a number of strategies such as SPIKES [9] for offering emotional support. [10]

Etymology

The name's etymological origin is the Greek word ὄγκος (óngkos), meaning 1. "burden, volume, mass" and 2. "barb", and the Greek word λόγος ( logos ), meaning "study". [11] The neoclassical term oncology was used from 1618, initially in neo-Greek, in cognizance of Galen's work on abnormal tumors, De tumoribus præter naturam (Περὶ τῶν παρὰ φύσιν ὄγκων). [12]

Risk factors

Tobacco
Tobacco exposure is the leading cause of cancer and death from it. [13] Smoking tobacco is associated with increased risk of death of over 15 varieties of cancer including lung, larynx, mouth, esophagus, throat, brain, bladder, kidney, liver, stomach, pancreas, colon, rectum, cervix, ovary, urinary bladder, prostate, head and neck, brain and blood. Smokeless tobacco (snuff or chewing tobacco) is associated with increased risks of cancers of the mouth, esophagus, and pancreas. [14]
Alcohol
Alcohol consumption increases risk of cancers of the mouth, throat, esophagus, larynx, liver, and breast. The risk of cancer is much higher for those who drink alcohol and also use tobacco. [15]
Obesity
Obese individuals have an increased risk of cancer of the breast, colon, rectum, endometrium, esophagus, kidney, pancreas, and gallbladder. [16]
Age
Advanced age is a risk factor for many cancers. The median age of cancer diagnosis is 66 years. [17]
Cancer-Causing Substances
Cancer is caused by changes to certain genes that alter the way our cells function. Some of them are the result of environmental exposures that damage DNA. These exposures may include substances, such as the chemicals in tobacco smoke, or radiation, such as ultraviolet rays from the sun and other carcinogens.
Infectious Agents
Certain infectious agents, including oncoviruses, bacteria, and parasites, can cause cancer.
Immunosuppression
The body's immune response plays a role in defending the body against cancer, a concept known mainly because certain cancers occur at a greatly increased prevalence among people with immunosuppression.

Screening

Cancer screening is recommended for cancers of breast, [18] cervix, [19] colon, [20] and lung. [21]

Signs and symptoms

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

Breast cancer
Lump in breast and axilla associated with or without ulceration or bloody nipple discharge. [22]
Endometrial cancer
Bleeding per vaginam. [23]
Cervix cancer
Bleeding after sexual intercourse. [24]
Ovarian cancer
Nonspecific symptoms such as abdominal distension, dyspepsia. [25]
Lung cancer
Persistent cough, breathlessness, blood in the sputum, hoarseness of voice. [26]
Head and neck cancer
Non-healing ulcer or growth, lump in the neck. [27]
Brain cancer
Persistent headache, vomiting, loss of consciousness, double vision. [28]
Thyroid cancer
Lump in the neck. [29]
Oesophageal cancer
Painful swallowing predominantly with solid food, weight loss. [30]
Stomach cancer
Vomiting, dyspepsia, weight loss. [31]
Colon & rectal cancer
Bleeding per rectum, alteration of bowel habits. [32]
Liver cancer
Jaundice, pain and mass in right upper abdomen. [33]
Pancreatic cancer
Weight loss, jaundice. [34]
Skin cancer
Non-healing ulcer or growth, mole with sudden increase in size or irregular border, induration, or pain. [35]
Kidney cancer
Blood in urine, abdominal lump. [36]
Bladder cancer
Blood in urine. [37]
Prostate cancer
Urgency, hesitancy and frequency while passing urine, bony pain. [38]
Testis cancer
Swelling of testis, back pain, dyspnoea. [39]
Bone cancer
Pain and swelling of bones. [40]
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. [41]
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. [26]

Diagnosis and staging

Diagnostic and staging investigations depend on the size 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, [42] cytogenetics, [43] fluorescent in situ hybridisation and molecular studies. [44]

Lymphoma

Excision biopsy of lymph node for histopathological examination, [45] immunohistochemistry, [46] and molecular studies. [47]

Blood investigations include lactate dehydrogenase (LDH), serum uric acid, and kidney function tests. [48]

Imaging tests such as computerised tomography (CT scan), positron emission tomography (PET CT). [49]

Bone marrow biopsy. [50]

Solid tumors

Biopsy for histopathology and immunohistochemistry. [51]

Imaging tests like X-ray, ultrasonography, computerised tomography (CT), magnetic resonance imaging (MRI) and PET CT. [52]

Endoscopy including Nasopharyngoscopy, Direct & Indirect Laryngoscopy, Upper Gastrointestinal Endoscopy, Colonoscopy, Cystoscopy.

Tumor markers including alphafetoprotein (AFP), [53] Beta Human Chorionic Gonadotropin (β-HCG), [53] Carcinoembionic Antigen (CEA), [54] CA 125, [55] Prostate specific antigen (PSA). [56]

Treatment

Treatment depends on the size and type of cancer.

Solid tumors

Breast cancer
Treatment options include surgery, radiation, chemotherapy, hormonal therapy, and targeted therapy (Her 2 neu inhibitors). [57]
Cervix cancer
Treatment options include radiation, surgery and chemotherapy. [58]
Endometrial cancer
Treatment options include surgery, radiation, and chemotherapy. [59]
Ovary cancer
Treatment options include surgery, chemotherapy, and targeted therapy (VEGF inhibitors). [60]
Lung cancer
Treatment options include surgery and robot-assisted surgery, radiation, chemotherapy, and targeted therapy (EGFR & ALK inhibitors). [61]
Head & Neck Cancer
Treatment options include surgery, radiosurgery, radiation, chemotherapy, and targeted therapy (EGFR inhibitors). [62]
Brain cancer
Treatment options include surgery, radiosurgery with the Cyberknife System, radiation, chemotherapy, and targeted therapy (VEGF inhibitors).[ citation needed ]
Thyroid cancer
Treatment options include surgery and radioactive iodine. [63]
Oesophageal cancer
Treatment options include radiation, chemotherapy, and surgery. [64]
Stomach cancer
Treatment options include chemotherapy, surgery, radiation, and targeted therapy (Her 2 neu inhibitors). [65] [66]
Colon cancer
Treatment options include surgery, chemotherapy, and targeted therapy (EGFR & VEGF inhibitors). [67]
Rectum cancer
Treatment options include chemotherapy, radiation, surgery. [68]
Liver cancer
Treatment options include surgery, Trans-arterial chemotherapy (TACE), Radio-frequency ablation (RFA), and multi-kinase (Sorafenib). [69]
Pancreas cancer
Treatment options include surgery, radiation, and chemotherapy. [70]
Skin cancer
Treatment options include surgery, radiation, targeted therapy (BRAF & MEK inhibitors), Immunotherapy (CTLA 4 & PD 1 inhibitors, and chemotherapy. [71]
Kidney cancer
Treatment options include surgery, multi-kinase inhibitors, and targeted therapy (mTOR & VEGF inhibitors). [72]
Bladder cancer
Treatment options include surgery, radiation, and chemotherapy. [73]
Prostate cancer
Treatment options include surgery, radiation, chemotherapy, anti-androgens, and immunotherapy. [74]
Testis cancer
Treatment options include surgery, chemotherapy, and radiation. [75]
Bone cancer
Treatment options include surgery, chemotherapy, and radiation. [76]

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). [77]
Non-Hodgkin lymphoma (NHL)
Chemo-immunotherapy (R-CHOP) for B cell lymphomas, and chemotherapy (CHOP) for T cell lymphomas. [78]

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. [79]
Acute myeloid leukemia (AML)
Induction with chemotherapy (Daunorubicin + Cytarabine), followed by consolidation chemotherapy (High dose cytarabine). Stem cell transplantation for high-risk patients. [80]
Chronic lymphocytic leukemia (CLL)
Chemo-immunotherapy (FCR or BR regimen) for symptomatic patients. [81]
Chronic myeloid leukemia (CML)
Targeted therapy with tyrosine kinase inhibitor (Imatinib) as first-line treatment. [82]

Specialties

Research and progress

See also

Related Research Articles

Leukemia Group of blood cancers that usually begin in the bone marrow

Leukemia is a group of blood cancers that usually begin in the bone marrow and result in high numbers of abnormal blood cells. These blood cells are not fully developed and are called blasts or leukemia cells. Symptoms may include bleeding and bruising, bone pain, fatigue, fever, and an increased risk of infections. These symptoms occur due to a lack of normal blood cells. Diagnosis is typically made by blood tests or bone marrow biopsy.

Non-Hodgkin lymphoma Type of cancer of lymph nodes

Non-Hodgkin lymphoma (NHL) is a group of blood cancers that includes all types of lymphomas except Hodgkin lymphomas. Symptoms include enlarged lymph nodes, fever, night sweats, weight loss and tiredness. Other symptoms may include bone pain, chest pain or itchiness. Some forms are slow-growing, while others are fast-growing.

Lymphoma Hematologic cancer that affects lymphocytes

Lymphoma is a group of blood and lymph tumors that develop from lymphocytes. In current usage the name usually refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include enlarged lymph nodes, fever, drenching sweats, unintended weight loss, itching, and constantly feeling tired. The enlarged lymph nodes are usually painless. The sweats are most common at night.

Testicular cancer Medical condition

Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system. Symptoms may include a lump in the testicle, or swelling or pain in the scrotum. Treatment may result in infertility.

Chronic lymphocytic leukemia Medical condition

Chronic lymphocytic leukemia (CLL) is a type of cancer in which the bone marrow makes too many lymphocytes. Early on there are typically no symptoms. Later non-painful lymph node swelling, feeling tired, fever, night sweats, or weight loss for no clear reason may occur. Enlargement of the spleen and low red blood cells (anemia) may also occur. It typically worsens gradually over years.

Anal cancer Medical condition

Anal cancer is a cancer which arises from the anus, the distal opening of the gastrointestinal tract. Symptoms may include bleeding from the anus or a lump near the anus. Other symptoms may include pain, itchiness, or discharge from the anus. A change in bowel movements may also occur.

Tumor lysis syndrome is a group of metabolic abnormalities that can occur as a complication from the treatment of cancer, where large amounts of tumor cells are killed off (lysed) from the treatment, releasing their contents into the bloodstream. This occurs most commonly after the treatment of lymphomas and leukemias and in particular when treating non-Hodgkin's lymphoma (NHL), acute myeloid leukemia (AML), and acute lymphoblastic leukemia (ALL). This is a potentially fatal complication and patients at increased risk for TLS should be closely monitored while receiving chemotherapy and should receive preventive measures and treatments as necessary. TLS can also occur on its own although this is less common.

Proton therapy Medical Procedure

In the field of medical treatment, proton therapy, or proton radiotherapy, is a type of particle therapy that uses a beam of protons to irradiate diseased tissue, most often to treat cancer. The chief advantage of proton therapy over other types of external beam radiotherapy is that the dose of protons is deposited over a narrow range of depth, which results in minimal entry, exit, or scattered radiation dose to healthy nearby tissues.

Adult T-cell leukemia/lymphoma Human disease

Adult T-cell leukemia/lymphoma is a rare cancer of the immune system's T-cells caused by human T cell leukemia/lymphotropic virus type 1 (HTLV-1). All ATL cells contain integrated HTLV-1 provirus further supporting that causal role of the virus in the cause of the neoplasm. A small amount of HTLV-1 individuals progress to develop ATL with a long latency period between infection and ATL development. ATL is categorized into 4 subtypes: acute, smoldering, lymphoma-type, chronic. Acute and Lymphoma-type are known to particularity be aggressive with poorer prognosis.

Acute promyelocytic leukemia Subtype of acute myeloid leukaemia characterised by accumulation of promyelocytes

Acute promyelocytic leukemia is a subtype of acute myeloid leukemia (AML), a cancer of the white blood cells. In APL, there is an abnormal accumulation of immature granulocytes called promyelocytes. The disease is characterized by a chromosomal translocation involving the retinoic acid receptor alpha gene and is distinguished from other forms of AML by its responsiveness to all-trans retinoic acid therapy. Acute promyelocytic leukemia was first characterized in 1957 by French and Norwegian physicians as a hyperacute fatal illness, with a median survival time of less than a week. Today, prognoses have drastically improved; 10-year survival rates are estimated to be approximately 80-90% according to one study.

Nasopharyngeal carcinoma Medical condition

Nasopharyngeal carcinoma (NPC), or nasopharynx cancer, is the most common cancer originating in the nasopharynx, most commonly in the postero-lateral nasopharynx or pharyngeal recess, accounting for 50% of cases. NPC occurs in children and adults. NPC differs significantly from other cancers of the head and neck in its occurrence, causes, clinical behavior, and treatment. It is vastly more common in certain regions of East Asia and Africa than elsewhere, with viral, dietary and genetic factors implicated in its causation. It is most common in males. It is a squamous cell carcinoma of an undifferentiated type. Squamous epithelial cells are a flat type of cell found in the skin and the membranes that line some body cavities. Differentiation means how different the cancer cells are from normal cells. Undifferentiated cells are cells that do not have their mature features or functions.

Cancer and Leukemia Group B U.S. research cooperative group

Cancer and Leukemia Group B is a cancer research cooperative group in the United States.

Gynecologic oncology is a specialized field of medicine that focuses on cancers of the female reproductive system, including ovarian cancer, uterine cancer, vaginal cancer, cervical cancer, and vulvar cancer. As specialists, they have extensive training in the diagnosis and treatment of these cancers.

Endoscopic nasopharyngectomy is a form of endoscopic surgery to treat nasopharyngeal carcinoma. This type of cancer is commonly treated with radiation therapy and chemotherapy, but endoscopic operation offers an alternative treatment especially when the radiation therapy fails.

Hodgkin lymphoma Type of blood and immune-system cancer

Hodgkin lymphoma (HL) is a type of lymphoma, in which cancer originates from a specific type of white blood cell called lymphocytes, where multinucleated Reed–Sternberg cells are present in the patient's lymph nodes. The condition was named after the English physician Thomas Hodgkin, who first described it in 1832. Symptoms may include fever, night sweats, and weight loss. Often, nonpainful enlarged lymph nodes occur in the neck, under the arm, or in the groin. Those affected may feel tired or be itchy.

Treatment of cancer Overview of various treatment possibilities for cancer

Cancer can be treated by surgery, chemotherapy, radiation therapy, hormonal therapy, targeted therapy and synthetic lethality, most commonly as a series of separate treatments. The choice of therapy depends upon the location and grade of the tumor and the stage of the disease, as well as the general state of the patient. Cancer genome sequencing helps in determining which cancer the patient exactly has for determining the best therapy for the cancer. A number of experimental cancer treatments are also under development. Under current estimates, two in five people will have cancer at some point in their lifetime.

Childhood leukemia Medical condition

Childhood leukemia is leukemia that occurs in a child and is a type of childhood cancer. Childhood leukemia is the most common childhood cancer, accounting for 29% of cancers in children aged 0–14 in 2018. There are multiple forms of leukemia that occur in children, the most common being acute lymphoblastic leukemia (ALL) followed by acute myeloid leukemia (AML). Survival rates vary depending on the type of leukemia, but may be as high as 90% in ALL.

Cancer in adolescents and young adults is cancer which occurs in those between the ages of 15 and 39. This occurs in about 70,000 people a year in the United States—accounting for about 5 percent of cancers. This is about six times the number of cancers diagnosed in children ages 0–14. Globally, nearly 1 million young adults between the ages of 20 and 39 were diagnosed with cancer in 2012, and more than 350,000 people in this age range died from cancer.

A central nervous system tumor is an abnormal growth of cells from the tissues of the brain or spinal cord. CNS tumor is a generic term encompassing over 120 distinct tumor types. Common symptoms of CNS tumors include vomiting, headache, changes in vision, nausea, and seizures. A CNS tumor can be detected and classified via neurological examination, medical imaging, such as x-ray imaging, magnetic resonance imaging (MRI) or computed tomography (CT), or after analysis of a biopsy.

Indolent lymphoma Medical condition

Indolent lymphoma, also known as low-grade lymphoma, is a group of slow-growing non-Hodgkin lymphomas (NHLs). Because they spread slowly, they tend to have fewer signs and symptoms when first diagnosed and may not require immediate treatment. Symptoms can include swollen but painless lymph nodes, unexplained fever, and unintended weight loss.

References

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