Oncology is a branch of
medicine
Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pr ...
that deals with the study, treatment, diagnosis and prevention of
cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
. 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". Oncology is concerned with:
* The
diagnosis
Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems engin ...
of any cancer in a person (pathology)
* Therapy (e.g.
surgery
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pa ...
,
chemotherapy
Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemother ...
,
radiotherapy and other modalities)
* Follow-up of
cancer patients after successful treatment
*
Palliative care of patients with terminal malignancies
*
Ethical questions surrounding cancer care
*
Screening
Screening may refer to:
* Screening cultures, a type a medical test that is done to find an infection
* Screening (economics), a strategy of combating adverse selection (includes sorting resumes to select employees)
* Screening (environmental), ...
efforts:
** of populations, or
** of the relatives of patients (in types of cancer that are thought to have a hereditary basis, such as
breast cancer
Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or ...
)
Diagnosis
Medical histories remain an important screening tool: the character of the complaints and nonspecific symptoms (such as
fatigue,
weight loss, unexplained
anemia,
fever of unknown origin,
paraneoplastic phenomena
A paraneoplastic syndrome is a syndrome (a set of signs and symptoms) that is the consequence of a tumor in the body (usually a cancerous one), specifically due to the production of chemical signaling molecules (such as hormones or cytokines) by ...
and other signs) may warrant further investigation for malignancy. Occasionally, a physical examination may find the location of a
malignancy.
Diagnostic methods include:
*
Biopsy or
resection; these are methods by which suspicious neoplastic growths can be removed in part or in whole, and evaluated by a pathologist to determine malignancy. This is currently the gold standard for the diagnosis of cancer and is crucial in guiding the next step in management (active surveillance, surgery, radiation therapy, chemotherapy or a combination of these)
*
Endoscopy, either upper or lower gastrointestinal, cystoscopy, bronchoscopy, or nasendoscopy; to localise areas suspicious for malignancy and biopsy when necessary.
*
X-rays,
CT scanning,
MRI scanning,
ultrasound and other radiological techniques to localise and guide biopsy.
*
Scintigraphy
Scintigraphy (from Latin ''scintilla'', "spark"), also known as a gamma scan, is a diagnostic test in nuclear medicine, where radioisotopes attached to drugs that travel to a specific organ or tissue ( radiopharmaceuticals) are taken internally an ...
,
single photon emission computed tomography (SPECT),
positron emission tomography (PET) and other methods of
nuclear medicine
Nuclear medicine or nucleology is a medical specialty involving the application of radioactive substances in the diagnosis and treatment of disease. Nuclear imaging, in a sense, is " radiology done inside out" because it records radiation emi ...
to identify areas suspicious for malignancy.
*
Blood tests, including
tumor markers, which can increase the suspicion 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.
Currently, a tissue diagnosis (from a
biopsy) by a pathologist is essential for the proper classification of
cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
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.)
On very rare occasions, a metastatic lump or pathological lymph node is found (typically in the neck) for which a primary tumor cannot be found. However, immunohistochemical markers often give a strong indication of the primary malignancy. This situation is referred to as "
malignacy of unknown primary", and again, treatment is empirical based on past experience of the most likely origin.
Therapy
Depending upon the cancer identified, followup and palliative care will be administered at that time. Certain disorders (such as
ALL
All or ALL may refer to:
Language
* All, an indefinite pronoun in English
* All, one of the English determiners
* Allar language (ISO 639-3 code)
* Allative case (abbreviated ALL)
Music
* All (band), an American punk rock band
* ''All'' (All ...
or
AML) will require immediate admission and
chemotherapy
Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemother ...
, while others will be followed up with regular physical examination and
blood tests.
Often,
surgery
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pa ...
is attempted to remove a
tumor
A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
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
Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, the ...
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 against the benefits.
Chemotherapy
Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemother ...
and
radiotherapy are used as a first-line radical therapy in a number of malignancies. They are also used for
adjuvant In pharmacology, an adjuvant is a drug or other substance, or a combination of substances, that is used to increase the efficacy or potency of certain drugs. Specifically, the term can refer to:
* Adjuvant therapy in cancer management
* Analgesi ...
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
A hormone (from the Greek participle , "setting in motion") is a class of signaling molecules in multicellular organisms that are sent to distant organs by complex biological processes to regulate physiology and behavior. Hormones are required ...
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
Lymphoma is a group of blood and lymph tumors that develop from lymphocytes (a type of white blood cell). In current usage the name usually refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include en ...
(
Rituximab) and
breast cancer
Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or ...
(
Trastuzumab
Trastuzumab, sold under the brand name Herceptin among others, is a monoclonal antibody used to treat breast cancer and stomach cancer. It is specifically used for cancer that is HER2 receptor positive. It may be used by itself or together wi ...
).
Vaccine and other
immunotherapies are the subject of intensive research.
Palliative care
Approximately 50% of all cancer cases in the Western world can be treated to
remission
Remission often refers to:
*Forgiveness
Remission may also refer to:
Healthcare and science
*Remission (medicine), the state of absence of disease activity in patients with a chronic illness, with the possibility of return of disease activity
*R ...
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 speciality 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:
* What information to give the patient regarding disease extent/progression/
prognosis.
* Entry into
clinical trials, especially in the face of
terminal illness.
* Withdrawal of active treatment.
* "
Do Not Resuscitate" orders and other end of life issues.
These issues are closely related to the patients' 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, radiation therapy to
chemotherapy
Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemother ...
treatment regimens and optimal
palliative care and
pain relief
Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia, pain control) in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professional ...
. In the past decade, the advent of next-generation sequencing and whole-genome sequencing has completely changed our understanding of cancers. Identification of novel genetic/molecular markers will dramatically change how we diagnose and treat cancer, which will pave 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),
Medical Research Council (MRC), the
European Organisation for Research and Treatment of Cancer
The European Organisation for Research and Treatment of Cancer (EORTC) is a unique pan-European non-profit clinical cancer research organisation established in 1962 operating as an international association under Belgium law. It develops, conduc ...
(EORTC) or the
National Cancer Research Network
The National Cancer Research Network (NCRN) is a UK based government funding utility created to provide infrastructure to the UK's National Health Service (NHS) and increase funding for clinical trials.
History
NCRN was created in April 2001 by t ...
(NCRN).
Specialties
* The four main divisions:
** Medical oncology: focuses on treatment of cancer with
chemotherapy
Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemother ...
,
targeted therapy,
immunotherapy, and
hormonal therapy.
**
Surgical oncology: focuses on treatment of cancer with surgery.
**
Radiation oncology: focuses on treatment of cancer with radiation.
** Clinical oncology: focuses on treatment of cancer with both systemic therapies and radiation.
* Sub-specialties in Oncology:
**
Neuro-oncology
Neuro-oncology is the study of brain and spinal cord neoplasms, many of which are (at least eventually) very dangerous and life-threatening (astrocytoma, glioma, glioblastoma multiforme, ependymoma, pontine glioma, and brain stem tumors are ...
: focuses on cancers of brain.
**
Ocular oncology: focuses on cancers of eye.
**
Head & Neck oncology: focuses on cancers of oral cavity, nasal cavity, oropharynx, hypopharynx and larynx.
**
Thoracic oncology: focuses on cancers of lung, mediastinum, oesophagus and pleura.
**
Breast oncology: focuses on cancers of breast
**
Gastrointestinal oncology: focuses on cancers of stomach, colon, rectum, anal canal, liver, gallbladder, pancreas.
**
Bone
A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...
& Musculoskeletal oncology: focuses on cancers of bones and soft tissue.
**
Dermatological oncology: focuses on the medical and surgical treatment of skin, hair, sweat gland, and nail cancers
** Genitourinary oncology: focuses on cancers of genital and urinary system.
**
Gynecologic oncology
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 ...
: focuses on cancers of the female reproductive system.
**
Pediatric oncology
Childhood cancer is cancer in a child. About 80% of childhood cancer cases can be successfully treated thanks to modern medical treatments and optimal patient care. However, only about 10% of children diagnosed with cancer reside in high-income co ...
: concerned with the treatment of cancer in children.
**
Adolescent and young adult (AYA) oncology.
**
Hemato oncology: focuses on cancers of blood and stem cell transplantation
**
Preventive oncology: focuses on epidemiology & prevention of cancer.
**
Geriatric oncology: focuses on cancers in elderly population.
** Pain & Palliative oncology: focuses on treatment of end stage cancer to help alleviate pain and suffering.
**
Molecular oncology
Molecular oncology is an interdisciplinary medical specialty at the interface of medicinal chemistry and oncology that refers to the investigation of the chemistry of cancer and tumors at the molecular scale. Also the development and application ...
: focuses on molecular diagnostic methods in oncology.
** 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.
* Emerging specialties:
**
Cardiooncology is a branch of cardiology that addresses the cardiovascular impact of cancer and its treaments
See also
*
Cancer research
Cancer research is research into cancer to identify causes and develop strategies for prevention, diagnosis, treatment, and cure.
Cancer research ranges from epidemiology, molecular bioscience to the performance of clinical trials to evaluate an ...
*
Comparative oncology
*
Oncometabolism
*
Tumour heterogeneity
*
Warburg effect (oncology)
;Organizations
*
American Cancer Society
*
American Cancer Society Cancer Action Network
*
American Cancer Society Center
The American Cancer Society Center is a large convention center and office building in downtown Atlanta, adjacent to Centennial Olympic Park. The building contains about , including a partially underground parking garage and loading area. The ...
*
American Society of Clinical Oncology
The American Society of Clinical Oncology (ASCO) is a professional organization representing physicians of all oncology sub-specialties who care for people with cancer. Founded in 1964 by Fred Ansfield, Harry Bisel, Herman Freckman, Arnoldus Go ...
*
Canadian Cancer Society
The Canadian Cancer Society (french: Société canadienne du cancer) is Canada's largest national cancer charity and the largest national charitable funder of cancer research in Canada.
History
The idea to form the Canadian Cancer Society origin ...
*
Cancer Research UK
*
National Cancer Institute
The National Cancer Institute (NCI) coordinates the United States National Cancer Program and is part of the National Institutes of Health (NIH), which is one of eleven agencies that are part of the U.S. Department of Health and Human Services. T ...
*
National Comprehensive Cancer Network
National Comprehensive Cancer Network (NCCN) is an alliance of 32 cancer centers in the United States, most of which are designated by the National Cancer Institute (one of the U.S. National Institutes of Health) as comprehensive cancer centers. ...
*
Programme of Action for Cancer Therapy
References
Further reading
*
*
*
*
*
*
External links
*
*
*
{{Authority control