Oncology

FromWikipedia,thefreeencyclopedia

Oncologyisabranchofmedicinethatdealswiththe
prevention,diagnosisandtreatmentofcancer.Amedical
professionalwhopracticesoncologyisanoncologist.[1]The
name'setymologicaloriginistheGreekword(nkos),
meaning"tumor","volume"or"mass".[2]

OncologyThestudyofCancercells

Thethreecomponentswhichhaveimprovedsurvivalin
cancerare:
1.PreventionThisisbyreductionofriskfactorslike
tobaccoandalcoholconsumption[3]
2.EarlydiagnosisScreeningofcommoncancers[4]and
comprehensivediagnosisandstaging
3.TreatmentMultimodalitymanagement[5]by
discussionintumourboardandtreatmentina
comprehensivecancercentre[6]
Cancersarebestmanagedthroughdiscussiononmulti
disciplinarytumourboards[7]wheremedicaloncologist,
surgicaloncologist,radiationoncologist,pathologist,
radiologistandorganspecificoncologistsmeettofindthe
bestpossiblemanagementforanindividualpatient
consideringthephysical,social,psychological,emotional
andfinancialstatusofthepatients.Itisveryimportantfor
oncologiststokeepupdatedofthelatestadvancementsin
oncology,aschangesinmanagementofcancerarequite
common.Alleligiblepatientsinwhomcancerprogresses
andforwhomnostandardofcaretreatmentoptionsare
availableshouldbeenrolledinaclinicaltrial.

Contents
1
2
3
4

Riskfactors
Screening
Symptoms
Diagnosisandstaging
4.1 Bloodcancer
4.2 Lymphoma
4.3 Solidtumours
5 Treatment
5.1 Solidtumours
5.2 Lymphoma
5.3 Bloodcancer
6 Specialties
7 Progressandfuture
8 References
9 Bibliography
10 Externallinks

AcoronalCTscanshowingamalignant
mesothelioma,indicatedbytheasteriskandthe
arrows
Focus

Canceroustumor

Subdivisions Medicaloncology,radiation
oncology,surgicaloncology
Significant
tests

Tumormarkers,TNMstaging,CT
scans,MRI

Specialist

Oncologist

Riskfactors
Tobacco
Itistheleadingcauseofcancerandofdeathfromcancer.Smokingisassociatedwithincreasedriskof
cancersoflung,larynx,mouth,oesophagus,throat,bladder,kidney,liver,stomach,pancreas,colon,
rectum,cervixandacutemyeloidleukemia.Smokelesstobacco(snufforchewingtobacco)isassociated
withincreasedrisksofcancersofthemouth,oesophagus,andpancreas.[8]
Alcohol
Itcanincreaseyourriskofcancerofthemouth,throat,oesophagus,larynx,liverandbreast.Theriskof
cancerismuchhigherforthosewhodrinkalcoholandalsousetobacco.[9]
Obesity
Obeseindividualshaveanincreasedriskofcancersofbreast,colon,rectum,endometrium,oesophagus,
kidney,pancreas,andgallbladder.[10]
Age
Advancedageisariskfactorformanycancers.Themedianageofcancerdiagnosisis66years.[11]

Screening
Screeningisrecommendedforcancersofbreast,[12]cervix,[13]colon[14]andlung.[15]

Symptoms
Symptomsusuallydependonthesiteandtypeofcancer.
Breastcancer
Lumpinbreastandaxillaassociatedwithorwithoutulcerationorbloodynippledischarge.[16]
Endometrialcancer
Bleedingpervagina.[17]
Cervixcancer
Bleedingaftersexualintercourse.[18]
Ovarycancer
Nonspecificsymptomslikeabdominaldistension,dyspepsia.[19]
Lungcancer
Persistentcough,breathlessness,bloodinthesputum,hoarsenessofvoice.[20]
Head&neckcancer
Nonhealingulcerorgrowth,lumpintheneck.[21]
Braincancer
Persistentheadache,vomiting,lossofconsciousness,doublevision.[22]
Thyroidcancer
Lumpintheneck.[23]
Oesophaguscancer
Painfulswallowingpredominantlytosolidfood,weightloss.[24]
Stomachcancer
Vomiting,dyspepsia,weightloss.[25]
Colon&rectumcancer
Bleedingperrectum,alterationofbowelhabits.[26]
Livercancer
Jaundice,painandmassinrightupperabdomen.[27]
CarcinomaPancreas
Weightloss,jaundice.[28]
Skincarcinoma
Nonhealingulcerorgrowth,molewithsuddenincreaseinsize,irregularborder,indurationorpain.[29]

Kidneycancer
Bloodinurine,abdominallump.[30]
Bladdercancer
Bloodinurine.[31]
Prostatecancer
Urgency,hesitancyandfrequencywhilepassingurine,bonypain.[32]
Testiscancer
Swellingoftestis,backpain,dyspnoea.[33]
Bonecancer
Painandswellingofbones.[34]
Lymphoma
Fever,weightlossmorethan10%bodyweightinpreceding6monthsanddrenchingnightsweatswhich
constitutestheBsymptoms,lumpinneck,axillaorgroin.[35]
Bloodcancer
Bleedingmanifestationsincludingbleedinggums,bleedingfromnose,bloodinvomitus,bloodin
sputum,bloodstainedurine,blackcolouredstools,fever,lumpinneck,axillaorgroin,lumpinupper
abdomen.[20]

Diagnosisandstaging
Diagnosticandstaginginvestigationsdependonthesiteandtypeofmalignancy

Bloodcancer
BloodinvestigationsincludingHaemoglobin,Totalleucocytecount,Plateletcount,PeripheralSmear,Redcell
indices
Bonemarrowstudiesincludingaspiration,Flowcytometry,[36]Cytogenetics,[37]Fluorescentinsitu
hybridisationandmolecularstudies.[38]

Lymphoma
ExcisionbiopsyoflymphnodeforHistopathologicalExamination(HPE),[39]Immunohistochemistry(IHC)[40]
andmolecularstudies.[41]
BloodinvestigationsincludingLactatedehydrogenase(LDH),SerumUricAcid,RenalFunctions.[42]
ImagingtestslikeComputerisedTomography(CT),Positronemissiontomography(PETCT).[43]
Bonemarrowbiopsy.[44]

Solidtumours
Biopsyforhistopathology&IHC.[45]
ImagingtestslikeRoentgenogram(Xray),Ultrasonography,Computerisedtomography(CT),Magnetic
ResonanceImaging(MRI)andPETCT.[46]
EndoscopyincludingNasopharyngoscopy,Direct&IndirectLaryngoscopy,UpperGastrointestinal
Endoscopy,Colonoscopy,Cystoscopy.

Tumourmarkersincludingalphafetoprotein(AFP),[47]BetaHumanChorionicGonadotropin(HCG),[47]
CarcinoembionicAntigen(CEA),[48]CA125,[49]Prostatespecificantigen(PSA).[50]

Treatment
Treatmentdependsonthesiteandtypeofcancer.

Solidtumours
Breastcancer
Treatmentoptionsincludessurgery,radiation,chemotherapy,hormonaltherapyandtargetedtherapy(Her
2neuinhibitors).[51]
Cervixcancer
Treatmentoptionsincludesradiation,surgeryandchemotherapy.[52]
Endometrialcancer
Treatmentoptionsincludessurgery,radiationandchemotherapy.[53]
Ovarycancer
Treatmentoptionsincludessurgery,chemotherapyandtargetedtherapy(VEGFinhibitors).[54]
Lungcancer
Treatmentoptionsincludessurgery,radiation,chemotherapyandtargetedtherapy(EGFR&ALK
inhibitors).[55]
Head&NeckCancerTreatmentoptionsincludessurgery,radiation,chemotherapyandtargetedtherapy
(EGFRinhibitors).[56]
Braincancer
Treatmentoptionsincludessurgery,radiation,chemotherapyandtargetedtherapy(VEGFinhibitors).[51]
Thyroidcancer
Treatmentoptionsincludessurgeryandradioactiveiodine.[57]
Oesophagealcancer
Treatmentoptionsincludesradiation,chemotherapyandsurgery.[58]
Stomachcancer
Treatmentoptionsincludeschemotherapy,surgery,radiationandtargetedtherapy(Her2neu
inhibitors).[59]
Coloncancer
Treatmentoptionsincludessurgery,chemotherapyandtargetedtherapy(EGFR&VEGFinhibitors).[60]
Rectumcancer
Treatmentoptionsincludeschemotherapy,radiation,surgery.[61]
Livercancer
Treatmentoptionsincludessurgery,Transarterialchemotherapy(TACE),Radiofrequencyabalation
(RFA)andmultikinase(Sorafenib).[62]
Pancreascancer
Treatmentoptionsincludessurgery,radiationandchemotherapy.[63]
Skincancer
Treatmentoptionsincludessurgery,radiation,targetedtherapy(BRAF&MEKinhibitors),
Immunotherapy(CTLA4&PD1inhibitors)andchemotherapy.[64]
Kidneycancer
Treatmentoptionsincludessurgery,multikinaseinhibitorsandtargetedtherapy(mTOR&VEGF
inhibitors).[65]
Bladdercancer
Treatmentoptionsincludessurgery,radiationandchemotherapy.[66]
Prostatecancer
Treatmentoptionsincludessurgery,radiation,chemotherapy,antiandrogensandimmunotherapy.[67]

Testiscancer
Treatmentoptionsincludessurgery,chemotherapyandradiation.[68]
Bonecancer
Treatmentoptionsincludessurgery,chemotherapyandradiation.[69]

Lymphoma
ItincludesHodgkinlymphoma(HL)andnonHodgkinlymphoma(NHL):
Hodgkinlymphoma(HL)
ChemotherapywithABVDorBEACOPPregimenandInvolvedfieldradiationtherapy(IFRT).[70]
NonHodgkinlymphoma(NHL)
Chemoimmunotherapy(RCHOP)forBcelllymphomasandchemotherapy(CHOP)forTcell
lymphomas.[71]

Bloodcancer
Includesacuteandchronicleukemias.Acuteleukemiasincludesacutelymphoblasticleukemia(ALL)andacute
myeloidleukemia(AML).Chronicleukemiasincludechroniclymphocyticleukemia(CLL)andchronic
myeloidleukemia(CML).
Acutelymphoblasticleukemia(ALL)
Intensivechemotherapyphaseforinitial6monthsandmaintenancechemotherapyfor2years.
Prophylacticcranialandstemcelltransplantationforhighriskpatients.[72]
Acutemyeloidleukemia(AML)
Inductionwithchemotherapy(Daunorubicin+Cytarabine)followedbyconsolidationchemotherapy
(Highdosecytarabine).Stemcelltransplantationforhighriskpatients.[73]
Chroniclymphocyticleukemia(CLL):Chemoimmunotherapy(FCRorBRregimen)forsymptomatic
patients.[74]
Chronicmyeloidleukemia(CML)
Targetedtherapywithtyrosinekinaseinhibitor(Imatinib)asfirstlinetreatment.[75]

Specialties
Thethreemaindivisionincludes
Medicaloncology:focusesontreatmentoncancerwithchemotherapy,targetedtherapy,
immunotherapyandhormonaltherapy.[76]
Surgicaloncology:focusesontreatmentofcancerwithsurgery.[77]
Radiationoncology:focusesontreatmentofcancerwithradiation.[77]
SubspecialitiesinOncology:
Neurooncology:focusesoncancersofbrain.
Ocularoncology:focusesoncancersofeye.[78]
Head&Neckoncology:focusesoncancersoforalcavity,nasalcavity,oropharynx,hypopharyx
andlarynx.[79]
Thoraciconcology:focusesoncancersoflung,mediastinum,oesophagusandpleura.[80]
Breastoncology:focusesoncancersofbreast
Gastrointestinaloncology:focusesoncancersofstomach,colon,rectum,analcanal,liver,
gallbladder,pancreas.[81]
Bone&Musculoskeletaloncology:focusesoncancersofbonesandsofttissue.[82]
Genitourinaryoncology:focusesoncancersofgenitalandurinarysystem.[83]
Gynecologiconcology:focusesoncancersofthefemalereproductivesystem.[84]
Pediatriconcology:concernedwiththetreatmentofcancerinchildren.[85]
Hematooncology:focusesoncancersofbloodandstemcelltransplantation

Preventiveoncology:focusesonepidemiology&preventionofcancer.[86]
Geriatriconcology:focusesoncancersinelderlypopulation.[87]
Pain&Palliativeoncology:focusesontreatmentofendstagecancertoalleviatethesuffering.[88]
Molecularoncology:focusesonmoleculardiagnosticmethodsinoncology.[89]
Oncopathology:focusesonhistopathologicaldiagnosisofcancer
Nuclearmedicineoncology:focusesondiagnosisandtreatmentofcancerwith
radiopharmaceuticals.
Psychooncology:focusesonpsychosocialissuesondiagnosisandtreatmentofcancerpatients.
Veterinaryoncology:focusesontreatmentofcancerinanimals.[90]

Progressandfuture
Leukemia,[91]Lymphoma,[92]Germcelltumours[93]andearlystagesolidtumourswhichwereonce
incurablehavebecomecurablemalignanciesnow
Survivalofcancerhassignificantlyimprovedoverthepastyearsduetoimprovedscreening,diagnostic
methodsandtreatmentoptionswithtargetedtherapy.
LargemulticentricPhaseIIIrandomisedcontrolledclinicaltrialsbyNationalSurgicalAdjuvantBreast
&BowelProject(NSABP)[94]MedicalResearchCouncil(MRC),[95]theEuropeanOrganisationfor
ResearchandTreatmentofCancer(EORTC),[96]andNationalCancerInstitute(NCI)havecontributed
significantlytotheimprovementinsurvival

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MedicalEducation".NationalComprehensiveCancerNetwork.Retrieved20160116.
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