Oncology is the branch of medical science that studies cancer. A medical professional who practices oncology is an oncologist. The term originates from the Greek, 'Onkos', meaning bulk, mass, or tumor and the suffix -logy, meaning "study of".
The oncologist organizes the care of cancer patients, which may involve various treatments of different disciplines such as physiotherapy, counseling, clinical genetics. Oncologists often consults with pathologists on the exact biological nature of a tumor that is being treated.
Oncology is concerned with:
* The diagnosis of cancer
* Therapy and treatment (e.g., surgery, chemotherapy, radiotherapy and other modalities)
* Follow-up and post operative care of cancer patients after successful treatment
* Palliative care of patients with terminal malignancies
* Ethical and social questions surrounding cancer care
* Screening efforts:
o of populations, or
o of the relatives of patients (in types of cancer that are thought to have a hereditary basis, such as breast cancer).
The most important diagnostic tool remains the medical history: the character of the complaints and any specific symptoms (fatigue, weight loss, unexplained anemia, fever of unknown origin, paraneoplastic phenomena and other signs). Often a physical examination will reveal the location of a malignancy.
Diagnostic methods include:
* Biopsy, either incisional or excisional; This is very crucial to detect malignancy
* Endoscopy, either upper or lower gastrointestinal, bronchoscopy, or nasendoscopy;
* X-rays, CT, MRI (magnetic resonance imaging ) scans, ultrasound and other radiological techniques;
* Scintigraphy, Single Photon Emission Computed Tomography, Positron emission tomography and other methods of nuclear medicine;
* Blood tests, including Tumor markers, which can increase the suspicion of certain types of tumors or even be pathognomonic of a particular disease.
Apart from in diagnosis, 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.
Often a "tissue diagnosis" (from a biopsy) is considered essential for the proper identification of cancer. When this is not possible, "empirical therapy" (without an exact diagnosis) may be given, based on the available evidence (e.g. history, x-rays and scans.)
Occasionally, a metastatic lump or pathological lymph node is found (typically in the neck) for which a primary tumor 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.
Treatment depends completely on the nature of the tumor identified. Certain disorders will require immediate admission and chemotherapy (such as ALL or AML), while others will be followed up with regular physical examination and blood tests.
Very often, surgery is attempted to remove a tumor 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 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. This 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 always be weighed up against the benefits.
Doctors often use Chemotherapy and radiotherapy as a first-line radical therapy in a number of malignancies. These are also used for adjuvant 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 and prolong life.
Treatment using Hormone manipulation is well established, particularly in the treatment of breast and prostate cancer.
Now a days there is a rapid expansion in the use of monoclonal antibody treatments, notably for lymphoma (Rituximab), and breast cancer (Trastuzumab).
Vaccine and other immunotherapies are being the subject to intensive research.
The application of ultrasound in the form of HIFU to solid tumors is under investigation.
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