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
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:
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".
Specialities within Oncology
At the nishat 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.