Oncology

Not to be confused with ontology, ontogeny, or odontology.
See cancer for the biology of the disease, as well as a list of malignant diseases.
Oncology

A coronal CT scan showing a malignant mesothelioma, indicated by the asterisk and the arrows
Focus Cancerous tumor
Subdivisions Medical oncology, radiation oncology, surgical oncology
Significant tests Tumor markers, TNM staging, CT scans, MRI
Specialist Oncologist

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 ὄνκος (ónkos), meaning "tumor", "volume" or "mass".[2]

The three components which have improved survival in cancer are:

1. Prevention - This is by reduction of risk factors like tobacco & alcohol consumption[3]

2. Early diagnosis - Screening of common cancers[4] and comprehensive diagnosis and staging

3. Treatment - Multimodality management[5] by discussion in tumour board and treatment in a comprehensive cancer centre[6]

Cancers are best managed by discussing in multi-disciplinary tumour boards[7] where medical oncologist, surgical oncology, radiation oncology, pathologist, radiologist 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 patients. It is very important for oncologists to keep updated of the latest advancements in oncology as changes in management of cancer are quite common. All fit patients whose cancer progresses and no standard of care treatment options are available should be enrolled in a clinical trial.

Risk factors

Tobacco - It is the leading cause of cancer diagnosis and death from cancer. Smoking is associate with increased risk of cancers of lung, larynx, mouth, oesophagus, throat, 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.[8]

Alcohol - It can increase your 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.[9]

Obesity - Obese individuals have an increased risk of cancers of breast, colon, rectum, endometrium, oesophagus, kidney, pancreas, and gallbladder.[10]

Age - Advanced age is a risk factor for many cancers. The median age of cancer diagnosis is 66 years.[11]

Screening

Screening is recommended for cancers of breast,[12] cervix,[13] colon[14] and lung.[15]

Symptoms

Symptoms usually depend on the site and type of cancer.

Breast cancer - Lump in breast and axilla associated with or without ulceration or bloody nipple discharge[16]

Endometrial cancer - Bleeding per vagina[17]

Cervix cancer - Bleeding after sexual intercourse[18]

Ovary cancer - Nonspecific symptoms like abdominal distension, dyspepsia[19]

Lung cancer - Persistent cough, breathlessness, blood in the sputum, hoarseness of voice[20]

Head & neck cancer - Non healing ulcer or growth, lump in the neck[21]

Brain cancer- Persistent headache, vomiting, loss of consciousness, double vision[22]

Thyroid cancer - Lump in the neck[23]

Oesophagus cancer- Painful swallowing predominantly to solid food, weight loss[24]

Stomach cancer- Vomiting, dyspepsia, weight loss[25]

Colon & rectum cancer - Bleeding per rectum, alteration of bowel habits[26]

Liver cancer - Jaundice, pain and mass in right upper abdomen[27]

Carcinoma Pancreas - Weight loss, jaundice[28]

Skin carcinoma - Non healing ulcer or growth, mole with sudden increase in size,irregular border, induration or pain[29]

Kidney cancer - Blood in urine, abdominal lump[30]

Bladder cancer - Blood in urine[31]

Prostate cancer - Urgency, hesitancy and frequency while passing urine, bony pain[32]

Testis cancer - Swelling of testis, back pain, dyspnoea[33]

Bone cancer - Pain and swelling of bones[34]

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[35]

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[20]

Diagnosis and staging

Diagnostic and staging investigations depend on the site and type of malignancy

Blood cancer

Blood investigations including Haemoglobin, Total leucocyte count, Platelet count, Peripheral Smear, Red cell indices

Bone marrow studies including aspiration, Flow-cytometry,[36] Cytogenetics,[37] Fluorescent in situ hybridisation and molecular studies[38]

Lymphoma

Excision biopsy of lymph node for Histopathological Examination (HPE),[39] Immuno-histochemistry (IHC)[40] and molecular studies.[41]

Blood investigations including Lactate dehydrogenase (LDH), Serum Uric Acid, Renal Functions.[42]

Imaging tests like Computerised Tomography (CT), Positron emission tomography (PET CT).[43]

Bone marrow biopsy[44]

Solid tumours

Biopsy for histopathology & IHC[45]

Imaging tests like Roentgenogram (X-ray), Ultrasonography, Computerised tomography (CT), Magnetic Resonance Imaging (MRI) and PET CT.[46]

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

Tumour markers including alphafetoprotein (AFP),[47] Beta Human Chorionic Gonadotropin (HCG),[47] Carcinoembionic Antigen (CEA),[48] CA 125,[49] Prostate specific antigen (PSA).[50]

Treatment

Treatment depends on the site and type of cancer.

Solid tumours

Breast Cancer - Treatment options includes surgery, radiation, chemotherapy, hormonal therapy and targeted therapy (Her 2 neu inhibitors)[51]

Cervix Cancer - Treatment options includes radiation, surgery and chemotherapy[52]

Endometrial Cancer - Treatment options includes surgery, radiation and chemotherapy[53]

Ovary Cancer - Treatment options includes surgery, chemotherapy and targeted therapy (VEGF inhibitors)[54]

Lung Cancer - Treatment options includes surgery, radiation, chemotherapy and targeted therapy (EGFR & ALK inhibitors)[55]

Head & Neck Cancer - Treatment options includes surgery, radiation, chemotherapy and targeted therapy (EGFR inhibitors)[56]

Brain Cancer - Treatment options includes surgery, radiation, chemotherapy and targeted therapy (VEGF inhibitors)[51]

Thyroid Cancer - Treatment options includes surgery and radioactive iodine[57]

Oesophageal Cancer - Treatment options includes radiation, chemotherapy and surgery[58]

Stomach Cancer - Treatment options includes chemotherapy, surgery, radiation and targeted therapy (Her 2 neu inhibitors)[59]

Colon Cancer - Treatment options includes surgery, chemotherapy and targeted therapy (EGFR & VEGF inhibitors)[60]

Rectum Cancer - Treatment options includes chemotherapy, radiation, surgery[61]

Liver Cancer - Treatment options includes surgery, Trans-arterial chemotherapy (TACE), Radio-frequency abalation (RFA) and multi-kinase (Sorafenib)[62]

Pancreas Cancer - Treatment options includes surgery, radiation and chemotherapy[63]

Skin Cancer - Treatment options includes surgery, radiation, targeted therapy (BRAF & MEK inhibitors), Immunotherapy (CTLA 4 & PD 1 inhibitors) and chemotherapy[64]

Kidney Cancer - Treatment options includes surgery, multi-kinase inhibitors and targeted therapy (mTOR & VEGF inhibitors)[65]

Bladder Cancer - Treatment options includes surgery, radiation and chemotherapy[66]

Prostate Cancer - Treatment options includes surgery, radiation, chemotherapy, anti-androgens and immunotherapy[67]

Testis Cancer - Treatment options includes surgery, chemotherapy and radiation[68]

Bone Cancer - Treatment options includes surgery, chemotherapy and radiation[69]

Lymphoma

It includes Hodgkin Lymphoma (HL) and Non Hodgkin Lymphoma (NHL)

HL - Chemotherapy with ABVD or BEACOPP regimen and Involved field radiation therapy (IFRT)[70]

NHL - Chemo-immunotherapy (R-CHOP) for B cell lymphomas and chemotherapy (CHOP) for T cell lymphomas[71]

Blood cancer

It include Acute Leukemias 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).

ALL - Intensive chemotherapy phase for initial 6 months and maintenance chemotherapy for 2 years. Prophylactic cranial and stem cell transplantation for high risk patients.[72]

AML - Induction with chemotherapy (Daunorubicin + Cytarabine) followed by consolidation chemotherapy (High dose cytarabine). Stem cell transplantation for high risk patients.[73]

CLL - Chemo-immunotherapy (FCR or BR regimen) for symptomatic patients.[74]

CML - Targeted therapy with tyrosine kinase inhibitor (Imatinib) as first line treatment.[75]

Specialties

Progress and future

References

  1. ↑ Maureen McCutcheon. Where Have My Eyebrows Gone?. Cengage Learning, 2001. ISBN 0766839346. Page 5.
  2. ↑ Types of Oncologists, American Society of Clinical Oncology (ASCO).
  3. ↑ Stein, C. J.; Colditz, G. A. (2004-01-26). "Modifiable risk factors for cancer". British Journal of Cancer 90 (2): 299–303. doi:10.1038/sj.bjc.6601509. ISSN 0007-0920. PMC 2410150. PMID 14735167.
  4. ↑ Hristova, L.; Hakama, M. (1997-01-01). "Effect of screening for cancer in the Nordic countries on deaths, cost and quality of life up to the year 2017". Acta Oncologica (Stockholm, Sweden). 36 Suppl 9: 1–60. ISSN 0284-186X. PMID 9143316.
  5. ↑ Forbes, J. F. (1982-08-01). "Multimodality treatment of cancer". The Australian and New Zealand Journal of Surgery 52 (4): 341–346. ISSN 0004-8682. PMID 6956307.
  6. ↑ Bristow, Robert E.; Chang, Jenny; Ziogas, Argyrios; Campos, Belinda; Chavez, Leo R.; Anton-Culver, Hoda (2015-05-01). "Impact of National Cancer Institute Comprehensive Cancer Centers on ovarian cancer treatment and survival". Journal of the American College of Surgeons 220 (5): 940–950. doi:10.1016/j.jamcollsurg.2015.01.056. ISSN 1879-1190. PMID 25840536.
  7. ↑ Croke, J.M.; El-Sayed, S. (2012-08-01). "Multidisciplinary management of cancer patients: chasing a shadow or real value? An overview of the literature". Current Oncology 19 (4): e232–e238. doi:10.3747/co.19.944. ISSN 1198-0052. PMC 3410834. PMID 22876151.
  8. ↑ "Tobacco". National Cancer Institute. Retrieved 2016-01-18.
  9. ↑ "Alcohol". National Cancer Institute. Retrieved 2016-01-18.
  10. ↑ "Obesity". National Cancer Institute. Retrieved 2016-01-18.
  11. ↑ "Age". National Cancer Institute. Retrieved 2016-01-18.
  12. ↑ Gøtzsche, Peter C.; Jørgensen, Karsten Juhl (2013-01-01). "Screening for breast cancer with mammography". The Cochrane Database of Systematic Reviews 6: CD001877. doi:10.1002/14651858.CD001877.pub5. ISSN 1469-493X. PMID 23737396.
  13. ↑ Behtash, Nadereh; Mehrdad, Nili (2006-12-01). "Cervical cancer: screening and prevention". Asian Pacific Journal of Cancer Prevention 7 (4): 683–686. ISSN 1513-7368. PMID 17250453.
  14. ↑ Winawer, Sidney; Fletcher, Robert; Rex, Douglas; Bond, John; Burt, Randall; Ferrucci, Joseph; Ganiats, Theodore; Levin, Theodore; Woolf, Steven (2003-02-01). "Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence". Gastroenterology 124 (2): 544–560. doi:10.1053/gast.2003.50044. ISSN 0016-5085. PMID 12557158.
  15. ↑ Humphrey, Linda L.; Deffebach, Mark; Pappas, Miranda; Baumann, Christina; Artis, Kathryn; Mitchell, Jennifer Priest; Zakher, Bernadette; Fu, Rongwei; Slatore, Christopher G. (2013-09-17). "Screening for lung cancer with low-dose computed tomography: a systematic review to update the US Preventive services task force recommendation". Annals of Internal Medicine 159 (6): 411–420. doi:10.7326/0003-4819-159-6-201309170-00690. ISSN 1539-3704. PMID 23897166.
  16. ↑ "Symptoms of Breast Cancer | Breastcancer.org". Breastcancer.org. Retrieved 2016-01-17.
  17. ↑ Information, National Center for Biotechnology; Pike, U. S. National Library of Medicine 8600 Rockville; MD, Bethesda; Usa, 20894. "Endometrial Cancer: Symptoms - National Library of Medicine". PubMed Health. Retrieved 2016-01-17.
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  19. ↑ Olson, S. H.; Mignone, L.; Nakraseive, C.; Caputo, T. A.; Barakat, R. R.; Harlap, S. (2001-08-01). "Symptoms of ovarian cancer". Obstetrics and Gynecology 98 (2): 212–217. ISSN 0029-7844. PMID 11506835.
  20. 1 2 Information, National Center for Biotechnology; Pike, U. S. National Library of Medicine 8600 Rockville; MD, Bethesda; Usa, 20894. "Lung Cancer: Symptoms - National Library of Medicine". PubMed Health. Retrieved 2016-01-17.
  21. ↑ Mehanna, H.; Paleri, V.; West, C. M. L.; Nutting, C. (2010-01-01). "Head and neck cancer--Part 1: Epidemiology, presentation, and prevention". BMJ (Clinical research ed.) 341: c4684. ISSN 1756-1833. PMID 20855405.
  22. ↑ Snyder, H.; Robinson, K.; Shah, D.; Brennan, R.; Handrigan, M. (1993-06-01). "Signs and symptoms of patients with brain tumors presenting to the emergency department". The Journal of Emergency Medicine 11 (3): 253–258. ISSN 0736-4679. PMID 8340578.
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  28. ↑ Holly, Elizabeth A.; Chaliha, Indranushi; Bracci, Paige M.; Gautam, Manjushree (2004-06-01). "Signs and symptoms of pancreatic cancer: a population-based case-control study in the San Francisco Bay area". Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association 2 (6): 510–517. ISSN 1542-3565. PMID 15181621.
  29. ↑ Information, National Center for Biotechnology; Pike, U. S. National Library of Medicine 8600 Rockville; MD, Bethesda; Usa, 20894. "Nonmelanoma Skin Cancer: Symptoms - National Library of Medicine". PubMed Health. Retrieved 2016-01-17.
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  39. ↑ Eberle, Franziska C.; Mani, Haresh; Jaffe, Elaine S. (2009-04-01). "Histopathology of Hodgkin's lymphoma". Cancer Journal (Sudbury, Mass.) 15 (2): 129–137. doi:10.1097/PPO.0b013e31819e31cf. ISSN 1528-9117. PMID 19390308.
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  47. 1 2 Bassetto, M. A.; Franceschi, T.; Lenotti, M.; Parise, G.; Pancheri, F.; Sabbioni, R.; Zaninelli, M.; Cetto, G. L. (1994-01-01). "AFP and HCG in germ cell tumors". The International Journal of Biological Markers 9 (1): 29–32. ISSN 0393-6155. PMID 7519651.
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  49. ↑ Scholler, Nathalie; Urban, Nicole (2007-12-01). "CA125 in Ovarian Cancer". Biomarkers in medicine 1 (4): 513–523. doi:10.2217/17520363.1.4.513. ISSN 1752-0363. PMC 2872496. PMID 20477371.
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  51. 1 2 Breast Cancer Treatment (PDQ®): Patient Version. Bethesda (MD): National Cancer Institute (US). 2002-01-01. PMID 26389406.
  52. ↑ Cervical Cancer Treatment (PDQ®): Health Professional Version. Bethesda (MD): National Cancer Institute (US). 2002-01-01. PMID 26389493.
  53. ↑ Endometrial Cancer Treatment (PDQ®): Patient Version. Bethesda (MD): National Cancer Institute (US). 2002-01-01. PMID 26389334.
  54. ↑ Aletti, Giovanni D.; Gallenberg, Mary M.; Cliby, William A.; Jatoi, Aminah; Hartmann, Lynn C. (2007-06-01). "Current management strategies for ovarian cancer". Mayo Clinic Proceedings 82 (6): 751–770. doi:10.4065/82.6.751. ISSN 0025-6196. PMID 17550756.
  55. ↑ Non-Small Cell Lung Cancer Treatment (PDQ®): Patient Version. Bethesda (MD): National Cancer Institute (US). 2002-01-01. PMID 26389355.
  56. ↑ Argiris, Athanassios; Karamouzis, Michalis V.; Raben, David; Ferris, Robert L. (2008-05-17). "Head and neck cancer". Lancet (London, England) 371 (9625): 1695–1709. doi:10.1016/S0140-6736(08)60728-X. ISSN 1474-547X. PMID 18486742.
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  58. ↑ Esophageal Cancer Treatment (PDQ®): Health Professional Version. Bethesda (MD): National Cancer Institute (US). 2002-01-01. PMID 26389338.
  59. ↑ Gastric Cancer Treatment (PDQ®): Patient Version. Bethesda (MD): National Cancer Institute (US). 2002-01-01. PMID 26389328.
  60. ↑ Colon Cancer Treatment (PDQ®): Patient Version. Bethesda (MD): National Cancer Institute (US). 2002-01-01. PMID 26389319.
  61. ↑ Rectal Cancer Treatment (PDQ®): Health Professional Version. Bethesda (MD): National Cancer Institute (US). 2002-01-01. PMID 26389402.
  62. ↑ Adult Primary Liver Cancer Treatment (PDQ®): Patient Version. Bethesda (MD): National Cancer Institute (US). 2002-01-01. PMID 26389251.
  63. ↑ Pancreatic Cancer Treatment (PDQ®): Patient Version. Bethesda (MD): National Cancer Institute (US). 2002-01-01. PMID 26389396.
  64. ↑ Skin Cancer Treatment (PDQ®): Patient Version. Bethesda (MD): National Cancer Institute (US). 2002-01-01. PMID 26389265.
  65. ↑ Jonasch, Eric (2015-05-01). "Kidney cancer: current and novel treatment options". Journal of the National Comprehensive Cancer Network: JNCCN 13 (5 Suppl): 679–681. ISSN 1540-1413. PMID 25995429.
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  67. ↑ Prostate Cancer Treatment (PDQ®): Patient Version. Bethesda (MD): National Cancer Institute (US). 2002-01-01. PMID 26389353.
  68. ↑ Testicular Cancer Treatment (PDQ®): Health Professional Version. Bethesda (MD): National Cancer Institute (US). 2002-01-01. PMID 26389220.
  69. ↑ "Osteosarcoma and MFH of Bone Treatment". National Cancer Institute. Retrieved 2016-01-17.
  70. ↑ Adult Hodgkin Lymphoma Treatment (PDQ®): Health Professional Version. Bethesda (MD): National Cancer Institute (US). 2002-01-01. PMID 26389473.
  71. ↑ "Adult Non-Hodgkin Lymphoma Treatment". National Cancer Institute. Retrieved 2016-01-17.
  72. ↑ "Adult Acute Lymphoblastic Leukemia Treatment". National Cancer Institute. Retrieved 2016-01-17.
  73. ↑ "Adult Acute Myeloid Leukemia Treatment". National Cancer Institute. Retrieved 2016-01-17.
  74. ↑ "Chronic Lymphocytic Leukemia Treatment". National Cancer Institute. Retrieved 2016-01-17.
  75. ↑ "Chronic Myelogenous Leukemia Treatment". National Cancer Institute. Retrieved 2016-01-17.
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  78. ↑ "Neurooncology". Wikipedia, the free encyclopedia.
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Bibliography

External links

  1. ↑ "Comprehensive Cancer Information". National Cancer Institute. Retrieved 2016-01-16.
  2. ↑ "NCCN - Evidence-Based Cancer Guidelines, Oncology Drug Compendium, Oncology Continuing Medical Education". www.nccn.org. Retrieved 2016-01-16.
  3. ↑ "European Society for Medical Oncology | ESMO". www.esmo.org. Retrieved 2016-01-16.
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