Oncology is a branch of medicine that focuses on the diagnosis and treatment of people with cancer or suspected cancer. It covers a range of areas, including:
Medical histories are still a key way of spotting potential issues. The nature of the symptoms (such as fatigue, weight loss, unexplained anaemia, fever of unknown origin, paraneoplastic phenomena and other signs) may indicate the need for further investigation for malignancy. Sometimes, a physical examination can pinpoint the location of a malignancy.
There are a few ways to diagnose this.
A biopsy or resection is a way of removing and examining suspicious neoplastic growths to determine whether they are malignant. This is the best way to diagnose cancer right now, and it's really important for deciding what to do next (active surveillance, surgery, radiation therapy, chemotherapy, or a combination of these).
Endoscopy, either upper or lower gastrointestinal, cystoscopy, bronchoscopy, or nasendoscopy, is used to find out where there might be something wrong and take a biopsy when necessary.
Mammograms, X-rays, CT scans, MRI scans, ultrasound and other radiological techniques are used to localise and guide biopsies.
Scintigraphy, single photon emission computed tomography (SPECT), positron emission tomography (PET) and other nuclear medicine methods can be used to identify areas that might be suspicious of malignancy.
Blood tests, including tumour markers, can sometimes increase the suspicion of certain types of cancers.
Apart from diagnoses, these modalities (especially imaging by CT scanning) are often used to determine operability, i.e. whether it is surgically possible to remove a tumour in its entirety.
At the moment, a tissue diagnosis (from a biopsy) by a pathologist is really important for classifying cancer properly and for deciding on the next treatment. In extremely rare cases, when a tissue diagnosis isn't possible, we can consider "empirical therapy" (without an exact diagnosis) based on the available evidence (e.g. history, x-rays and scans). However, immunohistochemical markers often give a pretty good indication of the primary malignancy. This is what we call 'malignancy of unknown primary'. Once again, we base the treatment on what we think is the most likely origin, based on past experience.
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