Oncology is the branch of
medicine that studies tumours (cancer) and seeks to understand their growth,
diagnosis, treatment, and prevention. Oncologists are physicians who
practice oncology. They coordinate multidisciplinary care for cancer
patients, which may involve physiotherapy, counselling, and clinical
genetics, etc. They also often coordinate with pathologists to understand
the exact biological nature of the tumour under treatment.
Oncology deals with:
Diagnosis of cancer
Therapy (e.g. surgery, chemotherapy, and other modalities)
Follow-up of cancer patients after treatment
Palliative care of patients with terminal malignancies
Diagnosis of Cancer
Initially, the medical
history- the character of the complaints and any specific symptoms like
fatigue, weight loss, unexplained anaemia, paraneoplastic phenomena and
other signs, could indicate the existence of the cancer. Usually a physical
examination may reveal the location of the malignancy.
Diagnostic methods used for the detection of cancer include:
Biopsy, either incisional or excisional;
Endoscopy, either upper or lower gastrointestinal, bronchoscopy, or
nasendoscopy;
X-rays, CT scanning, MRI scanning, ultrasound and other radiological
techniques;
Scintigraphy, Positron emission tomography and other methods of nuclear
medicine;
Blood tests, including Tumour markers, which can increase the suspicion of
certain types of tumours.
Apart from diagnosis, these procedures especially imaging by CT scanning,
are often used to determine the operability, i.e. whether it is surgically
possible to remove a tumour completely.
Generally, a "tissue diagnosis" (from a biopsy) is considered essential for
the proper identification of the malignancy. Sometimes, a metastatic lump or
pathological lymph node is found (typically in the neck) for which a primary
tumour cannot be found. This situation is referred to as carcinoma of
unknown primary", and again, treatment is empirical based on past experience
of the most likely origin.
Therapy for the Cancer
The applied therapy depends
completely on the nature of the tumour identified. Certain disorders require
immediate admission and chemotherapy (such as ALL or AML), while others may
be followed up with regular physical examination and blood tests.
Surgery is often attempted to remove a tumour entirely. However, this is
feasible only when there is some certainty that the tumour can in fact be
removed. Although, curative surgery is often impossible, occasionally it can
improve survival even if not all the tumour tissue has been removed; this
type of 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, for e.g. - to relieve biliary obstruction or to relieve the
problems associated with some cerebral tumours. The risks of surgery must be
evaluated against the benefits.
Chemotherapy and radiotherapy are used as a first-line radical therapy in a
number of malignancies. They are also used for adjuvant therapy, i.e. when a
macroscopic tumour has already been completely removed surgically but there
is a reasonable risk that it may recur. Chemotherapy and radiotherapy are
commonly used for palliation, where disease is clearly incurable: in this
situation the aim is to improve the quality and prolong life.
Hormone 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 (Rituximab), and
breast cancer (Trastuzumab). The use of vaccines and other immunotherapies
is the subject of intensive research.
Follow-up
A large segment of the
oncologist's work is the following-up of cancer patients who have been
treated. For some cancers, early identification of recurrence, with prompt
treatment, can lead to better survival and quality of life. However, it
depends on the nature of the cancer whether the follow-up lasts a number of
years or remains "life long".
Palliative care
There may be ongoing issues
with symptom control along with cancer, and also with the treatment of the
disease. These problems may be- pain, nausea, anorexia, fatigue, immobility,
and depression. But not all issues are physical: psychology of the patient
is also affected to a large extent. Moral and spiritual issues are also
important.
While many of these problems are of concern to the oncologist, palliative
care has matured into a separate, but closely affiliated speciality to
address such problems associated with the disease. Palliative care is an
essential and inseparable part of the multidisciplinary cancer care team.
Specialities within
Oncology
At the Saifee Hospital
Oncology Department, there are two primary disciplines:
Medical oncology - That involves the treatment of cancer with medicine,
including chemotherapy.
Surgical oncology That involves surgical procedures in dealing with
cancer including biopsy, staging and surgical resection of tumours.
Within these disciplines, oncologists further specialize in specific types
of cancer such as breast cancer, lung cancer, prostate cancer, leukaemia,
lymphoma, brain and spinal cord cancer (neuro-oncology), Head and Neck
Oncology etc.
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