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.
Let's delve into the world of cancer treatment, providing a detailed overview in English. Cancer treatment encompasses a range of approaches aimed at eliminating cancer cells, inhibiting their growth, or managing the disease to improve the patient's quality of life. The specific treatment plan depends on various factors, including the type and stage of cancer, the patient's overall health, and personal preferences.
Major Categories of Cancer Treatment:
Surgery:
Curative Surgery: This aims to completely remove the tumor and surrounding affected tissue. It's often used when the cancer is localized and has not spread.
Debulking Surgery: When complete removal isn't possible, this surgery removes as much of the tumor as possible to improve the effectiveness of other treatments like radiation or chemotherapy.
Palliative Surgery: This focuses on relieving symptoms and improving quality of life rather than curing the cancer. Examples include relieving pain, obstruction, or bleeding.
Preventive (Prophylactic) Surgery: This involves removing tissue or organs at high risk of developing cancer, such as removing polyps in the colon or breasts in individuals with strong family histories of cancer.
Diagnostic Surgery: Biopsies are surgical procedures used to obtain tissue samples for microscopic examination to confirm a cancer diagnosis.
Radiation Therapy (Radiotherapy):
External Beam Radiation Therapy (EBRT): Delivers high-energy beams of radiation from outside the body to the tumor site. Techniques like 3D-conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and stereotactic radiosurgery (SRS) allow for precise targeting, minimizing damage to healthy tissues.
Internal Radiation Therapy (Brachytherapy): Involves placing radioactive sources (seeds, wires, or catheters) directly into or near the tumor.
Systemic Radiation Therapy: Uses radioactive substances, such as radioactive iodine for thyroid cancer, that travel through the bloodstream to target cancer cells throughout the body.
Chemotherapy:
Uses drugs to kill cancer cells throughout the body. It's often used for cancers that have spread or are likely to spread.
Chemotherapy drugs work by interfering with different stages of cell division.
Different chemotherapy regimens are used depending on the type of cancer.
Chemotherapy can be administered intravenously, orally, or through other routes.
Immunotherapy:
Enhances the body's immune system to recognize and attack cancer cells.
Checkpoint Inhibitors: Block proteins that prevent immune cells (T cells) from attacking cancer cells.
CAR T-cell Therapy: Genetically modifies a patient's T cells to target specific proteins on cancer cells.
Monoclonal Antibodies: Laboratory-produced antibodies that bind to specific targets on cancer cells, marking them for destruction by the immune system or directly inhibiting cancer cell growth.
Cancer Vaccines: Stimulate the immune system to attack cancer cells.
Cytokines: Proteins that regulate immune responses and can boost anti-cancer immunity.
Targeted Therapy:
Drugs that target specific molecules or pathways involved in cancer cell growth and survival.
Small Molecule Inhibitors: These are drugs that can enter cells easily and interfere with specific cellular processes.
Monoclonal Antibodies: As mentioned in immunotherapy, some monoclonal antibodies are also considered targeted therapies as they target specific proteins on cancer cells.
Hormone Therapy:
Used for cancers that rely on hormones for growth, such as breast and prostate cancer.
Works by blocking or reducing the production of hormones or interfering with hormone receptors on cancer cells.
Stem Cell Transplant (Bone Marrow Transplant):
Replaces damaged bone marrow with healthy stem cells.
Used for certain blood cancers, such as leukemia and lymphoma.
Can be autologous (using the patient's own stem cells) or allogeneic (using stem cells from a donor).
Other Treatment Modalities:
Photodynamic Therapy (PDT): Uses a light-sensitive drug and a specific type of light to destroy cancer cells.
Cryotherapy (Cryosurgery): Uses extreme cold to freeze and destroy cancer cells.
Radiofrequency Ablation (RFA): Uses high-frequency electrical currents to heat and destroy cancer cells.
Treatment Planning:
Multidisciplinary Approach: Cancer treatment often involves a team of specialists, including medical oncologists, radiation oncologists, surgeons, pathologists, and other healthcare professionals.
Personalized Medicine: Treatment plans are tailored to the individual patient based on the specific characteristics of their cancer.
Clinical Trials: Participation in clinical trials can provide access to new and innovative treatments.
Supportive Care:
Managing Side Effects: Addressing the side effects of cancer treatment is an important part of comprehensive care. This can involve medications, therapies, and lifestyle changes.
Palliative Care: Focuses on relieving pain and other symptoms and improving the quality of life for patients with advanced cancer.
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