Oncology

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]

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.
"Clinical oncology" redirects here. For the medical journal, see Clinical Oncology.
Oncology
A coronal CT scan showing a malignant mesothelioma, indicated by the asterisk and the arrows
FocusCancerous tumor
SubdivisionsMedical oncology, radiation oncology, surgical oncology
Significant testsTumor markers, TNM staging, CT scans, MRI

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. 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,[8] clinicians may use a number of strategies such as SPIKES[9] for delivering the bad news.[10]

Risk factors
Tobacco
The leading cause of cancer, and death from cancer. 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.[11]
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.[12]
Obesity
Obese individuals have an increased risk of cancer of the breast, colon, rectum, endometrium, oesophagus, kidney, pancreas, and gallbladder.[13]
Age
Advanced age is a risk factor for many cancers. The median age of cancer diagnosis is 66 years.[14]
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,[15] cervix,[16] colon,[17] and lung.[18]

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.[19]
Endometrial cancer
Bleeding per vagina.[20]
Cervix cancer
Bleeding after sexual intercourse.[21]
Ovarian cancer
Nonspecific symptoms such as abdominal distension, dyspepsia.[22]
Lung cancer
Persistent cough, breathlessness, blood in the sputum, hoarseness of voice.[23]
Head and neck cancer
Non-healing ulcer or growth, lump in the neck.[24]
Brain cancer
Persistent headache, vomiting, loss of consciousness, double vision.[25]
Thyroid cancer
Lump in the neck.[26]
Oesophageal cancer
Painful swallowing predominantly with solid food, weight loss.[27]
Stomach cancer
Vomiting, dyspepsia, weight loss.[28]
Colon & rectal cancer
Bleeding per rectum, alteration of bowel habits.[29]
Liver cancer
Jaundice, pain and mass in right upper abdomen.[30]
Pancreatic cancer
Weight loss, jaundice.[31]
Skin cancer
Non-healing ulcer or growth, mole with sudden increase in size or irregular border, induration, or pain.[32]
Kidney cancer
Blood in urine, abdominal lump.[33]
Bladder cancer
Blood in urine.[34]
Prostate cancer
Urgency, hesitancy and frequency while passing urine, bony pain.[35]
Testis cancer
Swelling of testis, back pain, dyspnoea.[36]
Bone cancer
Pain and swelling of bones.[37]
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.[38]
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.[23]

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,[39] cytogenetics,[40] fluorescent in situ hybridisation and molecular studies.[41]

Lymphoma

Excision biopsy of lymph node for histopathological examination,[42] immunohistochemistry,[43] and molecular studies.[44]

Blood investigations include lactate dehydrogenase (LDH), serum uric acid, and kidney function tests.[45]

Imaging tests such as computerised tomography (CT scan), positron emission tomography (PET CT).[46]

Bone marrow biopsy.[47]

Solid tumors

Biopsy for histopathology and immunohistochemistry.[48]

Imaging tests like X-ray, ultrasonography, computerised tomography (CT), magnetic resonance imaging (MRI) and PET CT.[49]

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

Tumor markers including alphafetoprotein (AFP),[50] Beta Human Chorionic Gonadotropin (HCG),[50] Carcinoembionic Antigen (CEA),[51] CA 125,[52] Prostate specific antigen (PSA).[53]

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).[54]
Cervix cancer
Treatment options include radiation, surgery and chemotherapy.[55]
Endometrial cancer
Treatment options include surgery, radiation, and chemotherapy.[56]
Ovary cancer
Treatment options include surgery, chemotherapy, and targeted therapy (VEGF inhibitors).[57]
Lung cancer
Treatment options include surgery and robot-assisted surgery, radiation, chemotherapy, and targeted therapy (EGFR & ALK inhibitors).[58]
Head & Neck Cancer
Treatment options include surgery, radiosurgery, radiation, chemotherapy, and targeted therapy (EGFR inhibitors).[59]
Brain cancer
Treatment options include surgery, radiosurgery with the Cyberknife System, radiation, chemotherapy, and targeted therapy (VEGF inhibitors).[54]
Thyroid cancer
Treatment options include surgery and radioactive iodine.[60]
Oesophageal cancer
Treatment options include radiation, chemotherapy, and surgery.[61]
Stomach cancer
Treatment options include chemotherapy, surgery, radiation, and targeted therapy (Her 2 neu inhibitors).[62][63]
Colon cancer
Treatment options include surgery, chemotherapy, and targeted therapy (EGFR & VEGF inhibitors).[64]
Rectum cancer
Treatment options include chemotherapy, radiation, surgery.[65]
Liver cancer
Treatment options include surgery, Trans-arterial chemotherapy (TACE), Radio-frequency ablation (RFA), and multi-kinase (Sorafenib).[66]
Pancreas cancer
Treatment options include surgery, radiation, and chemotherapy.[67]
Skin cancer
Treatment options include surgery, radiation, targeted therapy (BRAF & MEK inhibitors), Immunotherapy (CTLA 4 & PD 1 inhibitors, and chemotherapy.[68]
Kidney cancer
Treatment options include surgery, multi-kinase inhibitors, and targeted therapy (mTOR & VEGF inhibitors).[69]
Bladder cancer
Treatment options include surgery, radiation, and chemotherapy.[70]
Prostate cancer
Treatment options include surgery, radiation, chemotherapy, anti-androgens, and immunotherapy.[71]
Testis cancer
Treatment options include surgery, chemotherapy, and radiation.[72]
Bone cancer
Treatment options include surgery, chemotherapy, and radiation.[73]

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).[74]
Non-Hodgkin lymphoma (NHL)
Chemo-immunotherapy (R-CHOP) for B cell lymphomas, and chemotherapy (CHOP) for T cell lymphomas.[75]

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.[76]
Acute myeloid leukemia (AML)
Induction with chemotherapy (Daunorubicin + Cytarabine), followed by consolidation chemotherapy (High dose cytarabine). Stem cell transplantation for high-risk patients.[77]
Chronic lymphocytic leukemia (CLL): Chemo-immunotherapy (FCR or BR regimen) for symptomatic patients.[78]
Chronic myeloid leukemia (CML)
Targeted therapy with tyrosine kinase inhibitor (Imatinib) as first-line treatment.[79]

Specialties
  • The three main divisions:
  • Sub-specialties in Oncology:
    • Neuro-oncology: focuses on cancers of brain.
    • Ocular oncology: focuses on cancers of eye.[82]
    • Head & Neck oncology: focuses on cancers of oral cavity, nasal cavity, oropharynx, hypopharyx and larynx.[83]
    • Thoracic oncology: focuses on cancers of lung, mediastinum, oesophagus and pleura.[84]
    • Breast oncology: focuses on cancers of breast
    • Gastrointestinal oncology: focuses on cancers of stomach, colon, rectum, anal canal, liver, gallbladder, pancreas.[85]
    • Bone & Musculoskeletal oncology: focuses on cancers of bones and soft tissue.[86]
    • 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.[87]
    • Gynecologic oncology: focuses on cancers of the female reproductive system.[88]
    • Pediatric oncology: concerned with the treatment of cancer in children.[89]
    • Adolescent and young adult (AYA) oncology.[90]
    • Hemato oncology: focuses on cancers of blood and stem cell transplantation
    • Preventive oncology: focuses on epidemiology & prevention of cancer.[91]
    • Geriatric oncology: focuses on cancers in elderly population.[92]
    • Pain & Palliative oncology: focuses on treatment of end stage cancer to help alleviate pain and suffering.[93]
    • Molecular oncology: focuses on molecular diagnostic methods in oncology.[94]
    • Oncopathology: A specialty of Pathology that focuses on the histopathological diagnosis of cancer. As a significant portion of all general pathology practice is concerned with cancer, the practice of oncology is deeply tied to, and dependent upon, the work of both anatomical and clinical pathologists.[81]
    • 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.[95]
  • Emerging specialties:
    • Computational oncology. An example is PRIMAGE. This four-year EU-funded Horizon 2020 project was launched in December 2018. The project proposes a cloud-based platform to support decision making in the clinical management of malignant solid tumours, offering predictive tools to assist diagnosis, prognosis, therapies choice and treatment follow up, based on the use of novel imaging biomarkers, in-silico tumour growth simulation, advanced visualisation of predictions with weighted confidence scores and machine-learning based translation of this knowledge into predictors for the most relevant, disease-specific, Clinical End Points. [96][97]

Research and progress
Main article: Cancer research
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See also

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