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

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 ὄγκος (óngkos), meaning 1. "burden, volume, mass" and 2. "barb", and the Greek word λόγος ( logos ), meaning "study". [2]

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), [3] improved screening of several cancers (allowing for earlier diagnosis), [4] and improvements in treatment. [5] [6]

Cancers are often managed through discussion on multi-disciplinary cancer conferences [7] 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. [8] It is very important for oncologists to keep updated with respect to the latest advancements in oncology, as changes in management of cancer are quite common.

Because a cancer diagnosis can cause distress and anxiety, [9] clinicians may use a number of strategies such as SPIKES [10] for delivering the bad news. [11]

Risk factors

Tobacco
The leading cause of cancer, and death from cancer. [12] Smoking is associated with increased risk of cancers of the lung, larynx, mouth, oesophagus, throat, brain, 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. [13]
Alcohol
Can increase 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. [14]
Obesity
Obese individuals have an increased risk of cancer of the breast, colon, rectum, endometrium, oesophagus, kidney, pancreas, and gallbladder. [15]
Age
Advanced age is a risk factor for many cancers. The median age of cancer diagnosis is 66 years. [16]
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, [17] cervix, [18] colon, [19] and lung. [20]

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. [21]
Endometrial cancer
Bleeding per vagina. [22]
Cervix cancer
Bleeding after sexual intercourse. [23]
Ovarian cancer
Nonspecific symptoms such as abdominal distension, dyspepsia. [24]
Lung cancer
Persistent cough, breathlessness, blood in the sputum, hoarseness of voice. [25]
Head and neck cancer
Non-healing ulcer or growth, lump in the neck. [26]
Brain cancer
Persistent headache, vomiting, loss of consciousness, double vision. [27]
Thyroid cancer
Lump in the neck. [28]
Oesophageal cancer
Painful swallowing predominantly with solid food, weight loss. [29]
Stomach cancer
Vomiting, dyspepsia, weight loss. [30]
Colon & rectal cancer
Bleeding per rectum, alteration of bowel habits. [31]
Liver cancer
Jaundice, pain and mass in right upper abdomen. [32]
Pancreatic cancer
Weight loss, jaundice. [33]
Skin cancer
Non-healing ulcer or growth, mole with sudden increase in size or irregular border, induration, or pain. [34]
Kidney cancer
Blood in urine, abdominal lump. [35]
Bladder cancer
Blood in urine. [36]
Prostate cancer
Urgency, hesitancy and frequency while passing urine, bony pain. [37]
Testis cancer
Swelling of testis, back pain, dyspnoea. [38]
Bone cancer
Pain and swelling of bones. [39]
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. [40]
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. [25]

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, [41] cytogenetics, [42] fluorescent in situ hybridisation and molecular studies. [43]

Lymphoma

Excision biopsy of lymph node for histopathological examination, [44] immunohistochemistry, [45] and molecular studies. [46]

Blood investigations include lactate dehydrogenase (LDH), serum uric acid, and kidney function tests. [47]

Imaging tests such as computerised tomography (CT scan), positron emission tomography (PET CT). [48]

Bone marrow biopsy. [49]

Solid tumors

Biopsy for histopathology and immunohistochemistry. [50]

Imaging tests like X-ray, ultrasonography, computerised tomography (CT), magnetic resonance imaging (MRI) and PET CT. [51]

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

Tumor markers including alphafetoprotein (AFP), [52] Beta Human Chorionic Gonadotropin (HCG), [52] Carcinoembionic Antigen (CEA), [53] CA 125, [54] Prostate specific antigen (PSA). [55]

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). [56]
Cervix cancer
Treatment options include radiation, surgery and chemotherapy. [57]
Endometrial cancer
Treatment options include surgery, radiation, and chemotherapy. [58]
Ovary cancer
Treatment options include surgery, chemotherapy, and targeted therapy (VEGF inhibitors). [59]
Lung cancer
Treatment options include surgery and robot-assisted surgery, radiation, chemotherapy, and targeted therapy (EGFR & ALK inhibitors). [60]
Head & Neck Cancer
Treatment options include surgery, radiosurgery, radiation, chemotherapy, and targeted therapy (EGFR inhibitors). [61]
Brain cancer
Treatment options include surgery, radiosurgery with the Cyberknife System, radiation, chemotherapy, and targeted therapy (VEGF inhibitors). [56]
Thyroid cancer
Treatment options include surgery and radioactive iodine. [62]
Oesophageal cancer
Treatment options include radiation, chemotherapy, and surgery. [63]
Stomach cancer
Treatment options include chemotherapy, surgery, radiation, and targeted therapy (Her 2 neu inhibitors). [64] [65]
Colon cancer
Treatment options include surgery, chemotherapy, and targeted therapy (EGFR & VEGF inhibitors). [66]
Rectum cancer
Treatment options include chemotherapy, radiation, surgery. [67]
Liver cancer
Treatment options include surgery, Trans-arterial chemotherapy (TACE), Radio-frequency ablation (RFA), and multi-kinase (Sorafenib). [68]
Pancreas cancer
Treatment options include surgery, radiation, and chemotherapy. [69]
Skin cancer
Treatment options include surgery, radiation, targeted therapy (BRAF & MEK inhibitors), Immunotherapy (CTLA 4 & PD 1 inhibitors, and chemotherapy. [70]
Kidney cancer
Treatment options include surgery, multi-kinase inhibitors, and targeted therapy (mTOR & VEGF inhibitors). [71]
Bladder cancer
Treatment options include surgery, radiation, and chemotherapy. [72]
Prostate cancer
Treatment options include surgery, radiation, chemotherapy, anti-androgens, and immunotherapy. [73]
Testis cancer
Treatment options include surgery, chemotherapy, and radiation. [74]
Bone cancer
Treatment options include surgery, chemotherapy, and radiation. [75]

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). [76]
Non-Hodgkin lymphoma (NHL)
Chemo-immunotherapy (R-CHOP) for B cell lymphomas, and chemotherapy (CHOP) for T cell lymphomas. [77]

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. [78]
Acute myeloid leukemia (AML)
Induction with chemotherapy (Daunorubicin + Cytarabine), followed by consolidation chemotherapy (High dose cytarabine). Stem cell transplantation for high-risk patients. [79]
Chronic lymphocytic leukemia (CLL): Chemo-immunotherapy (FCR or BR regimen) for symptomatic patients. [80]
Chronic myeloid leukemia (CML)
Targeted therapy with tyrosine kinase inhibitor (Imatinib) as first-line treatment. [81]

Specialties

Research and progress

See also

Related Research Articles

Non-Hodgkin lymphoma A 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 that reside in the lymphatic system and in blood-forming organs

Lymphoma is a group of blood malignancies that develop from lymphocytes. The name often 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 male sex reproductive system cancer that is located in the testicles

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.

Kidney cancer urinary system cancer that is located in the kidney

Kidney cancer, also known as renal cancer, is a group of cancers that starts in the kidney. Symptoms may include blood in the urine, lump in the abdomen, or back pain. Fever, weight loss, and tiredness may also occur. Complications can include spread to the lungs or brain.

Rhabdomyosarcoma skeletal muscle cancer that arise from skeletal muscle progenitors

Rhabdomyosarcoma, or RMS, is an aggressive and highly malignant form of cancer that develops from skeletal (striated) muscle cells that have failed to fully differentiate. It is generally considered to be a disease of childhood, as the vast majority of cases occur in those below the age of 18. It is commonly described as one of the "small, round, blue cell tumours of childhood" due to its appearance on an H&E stain. Despite being a relatively rare cancer, it accounts for approximately 40% of all recorded soft tissue sarcomas.

Anal cancer large intestine cancer that is located in the anus

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 during the treatment of cancer, where large amounts of tumor cells are killed off (lysed) at the same time by the treatment, releasing their contents into the bloodstream. This occurs most commonly after the treatment of lymphomas and leukemias. In oncology and hematology, this is a potentially fatal complication, and patients at increased risk for TLS should be closely monitored before, during, and after their course of chemotherapy.

Spinal tumors are neoplasms located in either the vertebral column or the spinal cord. There are three main types of spinal tumors classified based on their location: extradural and intradural. Extradural tumors are located outside the dura mater lining and are most commonly metastatic. Intradural tumors are located inside the dura mater lining and are further subdivided into intramedullary and extramedullary tumors. Intradural-intramedullary tumors are located within the dura and spinal cord parenchyma, while intradural-extramedullary tumors are located within the dura but outside the spinal cord parenchyma. The most common presenting symptom of spinal tumors is nocturnal back pain. Other common symptoms include muscle weakness, sensory loss, and difficulty walking. Loss of bowel and bladder control may occur during the later stages of the disease.

Adjuvant therapy, also known as adjunct therapy, add-on therapy, and adjuvant care, is therapy that is given in addition to the primary or initial therapy to maximize its effectiveness. The surgeries and complex treatment regimens used in cancer therapy have led the term to be used mainly to describe adjuvant cancer treatments. An example of such adjuvant therapy is the additional treatment usually given after surgery where all detectable disease has been removed, but where there remains a statistical risk of relapse due to the presence of undetected disease. If known disease is left behind following surgery, then further treatment is not technically adjuvant. An adjuvant agent modifies the effect of another agent, so adjuvant therapy modifies other therapy.

Acute myeloid leukemia Cancer of the myeloid line of blood cells

Acute myeloid leukemia (AML) is a cancer of the myeloid line of blood cells, characterized by the rapid growth of abnormal cells that build up in the bone marrow and blood and interfere with normal blood cell production. Symptoms may include feeling tired, shortness of breath, easy bruising and bleeding, and increased risk of infection. Occasionally, spread may occur to the brain, skin, or gums. As an acute leukemia, AML progresses rapidly and is typically fatal within weeks or months if left untreated.

Nasopharyngeal carcinoma common cancer originating in the nasopharynx

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

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

Breast cancer chemotherapy

Breast cancer chemotherapy refers to the use of cytotoxic drugs (chemotherapy) in the treatment of breast cancer.

Nodular lymphocyte predominant Hodgkin lymphoma

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is an indolent CD20(+) form of lymphoma.

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 cells called lymphocytes. Symptoms may include fever, night sweats, and weight loss. Often there will be non-painful enlarged lymph nodes in the neck, under the arm, or in the groin. Those affected may feel tired or be itchy.

Treatment of cancer different types of therapy to treat cancer

Cancer can be treated by surgery, chemotherapy, radiation therapy, hormonal therapy, targeted therapy and synthetic lethality. 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 leukemia that occurs in children

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.

Paul Hendrick Sugarbaker is an American surgeon at the Washington Cancer Institute. He is known for developments in surgical oncology of the abdomen, including cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy, or HIPEC, a treatment alternately referred to as the Sugarbaker Procedure.

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

Indolent lymphoma, also known as low-grade lymphoma, is a group of slow growing non-Hodgkin Lymphoma (NHL). Because indolent lymphoma is usually very slow growing and slow to spread, it tends to have fewer signs and symptoms when first diagnosed and may not require treatment straight away. Possible symptoms include one or more swollen but painless lymph nodes, unexplained fever and unintended weight loss.

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