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{{Short description|Branch of medicine dealing with cancer}}
{{Short description|Branch of medicine dealing with, or specializing in, cancer}}
{{Distinguish|Ontology}}
{{Distinguish|Ontology}}
{{For|the journal|Oncology (journal)}}
{{For|the journal|Oncology (journal){{!}}''Oncology'' (journal)}}
{{Redirect|Clinical oncology|the medical journal|Clinical Oncology}}
{{Redirect|Clinical oncology|the journal|Clinical Oncology{{!}}''Clinical Oncology''}}
{{Refimprove|date=July 2022}}
{{Refimprove|date=July 2022}}
{{Infobox medical specialty
{{Infobox medical specialty
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* [[Bachelor of Medicine, Bachelor of Surgery]] (M.B.B.S.)
* [[Bachelor of Medicine, Bachelor of Surgery]] (M.B.B.S.)
* [[Bachelor of Medicine, Bachelor of Surgery]] (MBChB)
* [[Bachelor of Medicine, Bachelor of Surgery]] (MBChB)
| employment_field = [[Hospital]]s, [[clinic]]s
| employment_field = [[Hospital]]s, [[clinic]]s, [[clinical research center]]s
| related_occupation =
| related_occupation =
}}
}}
'''Oncology''' is a branch of [[medicine]] that deals with the study, treatment, diagnosis and prevention of [[cancer]]. A medical professional who practices oncology is an ''oncologist''.<ref>Maureen McCutcheon. ''Where Have My Eyebrows Gone?''. Cengage Learning, 2001. ISBN 0766839346. Page 5.</ref> The name's etymological origin is the Greek word ὄγκος (''ónkos''), meaning "tumor", "volume" or "mass".<ref>[http://www.cancer.net/navigating-cancer-care/cancer-basics/cancer-care-team/types-oncologists Types of Oncologists], American Society of Clinical Oncology (ASCO).</ref> Oncology is concerned with:
'''Oncology''' is a branch of [[medicine]] that deals with the study, treatment, diagnosis, and prevention of [[cancer]]. A medical professional who practices oncology is an ''oncologist''.<ref>Maureen McCutcheon. ''Where Have My Eyebrows Gone?''. Cengage Learning, 2001. ISBN 0766839346. Page 5.</ref> The name's etymological origin is the Greek word ὄγκος (''ónkos''), meaning "tumor", "volume" or "mass".<ref>[http://www.cancer.net/navigating-cancer-care/cancer-basics/cancer-care-team/types-oncologists Types of Oncologists] {{Webarchive|url=https://web.archive.org/web/20170726093123/http://www.cancer.net/navigating-cancer-care/cancer-basics/cancer-care-team/types-oncologists |date=2017-07-26 }}, American Society of Clinical Oncology (ASCO).</ref> Oncology is concerned with:
* The [[diagnosis]] of any cancer in a person (pathology)
* The [[diagnosis]] of any cancer in a person (pathology)
* Therapy (e.g. [[surgery]], [[chemotherapy]], [[radiotherapy]] and other modalities)
* Therapy (e.g. [[surgery]], [[chemotherapy]], [[radiotherapy]] and other modalities)
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Diagnostic methods include:
Diagnostic methods include:
* [[Biopsy]] or [[Segmental resection|resection]]; these are methods by which suspicious neoplastic growths can be removed in part or in whole, and evaluated by a pathologist to determine malignancy. This is currently the gold standard for the diagnosis of cancer and is crucial in guiding the next step in management (active surveillance, surgery, radiation therapy, chemotherapy or a combination of these)
* [[Biopsy]] or [[Segmental resection|resection]]; these are methods by which suspicious neoplastic growths can be removed in part or in whole, and evaluated by a pathologist to determine malignancy. This is currently the gold standard for the diagnosis of cancer and is crucial in guiding the next step in management (active surveillance, surgery, radiation therapy, chemotherapy, or a combination of these)<ref>{{Cite web |title=How biopsy procedures are used to diagnose cancer |url=https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/biopsy/art-20043922 |access-date=2023-06-13 |website=Mayo Clinic |language=en |archive-date=2023-06-13 |archive-url=https://web.archive.org/web/20230613042429/https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/biopsy/art-20043922 |url-status=live }}</ref>
* [[Endoscopy]], either upper or lower gastrointestinal, cystoscopy, bronchoscopy, or nasendoscopy; to localise areas suspicious for malignancy and biopsy when necessary.
* [[Endoscopy]], either upper or lower gastrointestinal, cystoscopy, bronchoscopy, or nasendoscopy; to localise areas suspicious for malignancy and biopsy when necessary.<ref>{{cite encyclopedia |year=1990 |title=Endoscopy |encyclopedia=British Medical Association Complete Family Health Encyclopedia |publisher=Dorling Kindersley Limited}}</ref>
* [[X-rays]], [[Computed axial tomography|CT scanning]], [[Magnetic resonance imaging|MRI scanning]], [[ultrasound]] and other radiological techniques to localise and guide biopsy.
* [https://www.cdc.gov/cancer/breast/basic_info/screening.htm#:~:text=if%20you%20qualify.-,Mammogram,of%20dying%20from%20breast%20cancer. Mammograms], [[X-rays]], [[Computed axial tomography|CT scanning]], [[Magnetic resonance imaging|MRI scanning]], [[ultrasound]] and other radiological techniques to localise and guide biopsy.
* [[Scintigraphy]], [[Single Photon Emission Computed Tomography|single photon emission computed tomography]] (SPECT), [[positron emission tomography]] (PET) and other methods of [[nuclear medicine]] to identify areas suspicious for malignancy.
* [[Scintigraphy]], [[Single Photon Emission Computed Tomography|single photon emission computed tomography]] (SPECT), [[positron emission tomography]] (PET) and other methods of [[nuclear medicine]] to identify areas suspicious of malignancy.
* [[Blood test]]s, including [[tumor marker]]s, which can increase the suspicion of certain types of cancers.
* [[Blood test]]s, including [[tumor marker]]s, which can increase the suspicion of certain types of cancers.


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Currently, a tissue diagnosis (from a [[biopsy]]) by a pathologist is essential for the proper classification of [[cancer]] and to guide the next step of treatment. On extremely rare instances when this is not possible, "empirical therapy" (without an exact diagnosis) may be considered, based on the available evidence (e.g. history, x-rays and scans.)
Currently, a tissue diagnosis (from a [[biopsy]]) by a pathologist is essential for the proper classification of [[cancer]] and to guide the next step of treatment. On extremely rare instances when this is not possible, "empirical therapy" (without an exact diagnosis) may be considered, based on the available evidence (e.g. history, x-rays and scans.)


On very rare occasions, a metastatic lump or pathological lymph node is found (typically in the neck) for which a primary tumor cannot be found. However, immunohistochemical markers often give a strong indication of the primary malignancy. This situation is referred to as "[[Cancer of unknown primary origin|malignacy of unknown primary]]", and again, treatment is empirical based on past experience of the most likely origin.<ref name=NICE>{{NICE|104|Metastatic malignant disease of unknown primary origin: Diagnosis and management of metastatic malignant disease of unknown primary origin|2010}}</ref>
On very rare occasions, a metastatic lump or pathological lymph node is found (typically in the neck) for which a primary tumor cannot be found. However, immunohistochemical markers often give a strong indication of the primary malignancy. This situation is referred to as "[[Cancer of unknown primary origin|malignancy of unknown primary]]", and again, treatment is empirically based on past experience of the most likely origin.<ref name=NICE>{{NICE|104|Metastatic malignant disease of unknown primary origin: Diagnosis and management of metastatic malignant disease of unknown primary origin|2010}}</ref>


==Therapy==
==Therapy==
Depending upon the cancer identified, followup and palliative care will be administered at that time. Certain disorders (such as [[acute lymphocytic leukemia|ALL]] or [[acute myelogenous leukemia|AML]]) will require immediate admission and [[chemotherapy]], while others will be followed up with regular physical examination and [[blood test]]s.
Depending upon the cancer identified, follow-up and palliative care will be administered at that time. Certain disorders (such as [[acute lymphocytic leukemia|ALL]] or [[acute myelogenous leukemia|AML]]) will require immediate admission and [[chemotherapy]], while others will be followed up with regular physical examination and [[blood test]]s.


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 [[metastasis|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; the 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 be weighed against the benefits.
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 [[metastasis|metastases]], Occasionally, 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; the 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, e.g. to relieve biliary obstruction, or to relieve the problems associated with some cerebral tumors. The risks of surgery must be weighed 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 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 life and to prolong it
[[Chemotherapy]] and [[radiotherapy]] are used as a first-line radical therapy in several malignancies. They 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 life and to prolong it.


[[Hormone]] manipulation is well established, particularly in the treatment of breast and prostate cancer.
[[Hormone]] manipulation is well established, particularly in the treatment of breast and prostate cancer.
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There is currently a rapid expansion in the use of [[monoclonal antibody]] treatments, notably for [[lymphoma]] ([[Rituximab]]) and [[breast cancer]] ([[Trastuzumab]]).
There is currently a rapid expansion in the use of [[monoclonal antibody]] treatments, notably for [[lymphoma]] ([[Rituximab]]) and [[breast cancer]] ([[Trastuzumab]]).


[[Vaccine]] and other [[immunotherapy|immunotherapies]] are the subject of intensive research.
[[Vaccine|Vaccines]] and other [[immunotherapy|immunotherapies]] are the subject of intensive research.


== Palliative care==
== Palliative care==
Approximately 50% of all cancer cases in the Western world can be treated to [[remission (medicine)|remission]] with radical treatment. For pediatric patients, that number is much higher. A large number of cancer patients will die from the disease, and a significant proportion of patients with incurable cancer will die of other causes. There may be ongoing issues with symptom control associated with progressive cancer, and also with the treatment of the disease. These problems may include [[pain]], [[nausea]], [[anorexia (symptom)|anorexia]], [[fatigue (physical)|fatigue]], immobility, and [[clinical depression|depression]]. Not all issues are strictly physical: personal dignity may be affected. Moral and spiritual issues are also important.
Approximately 50% of all cancer cases in the Western world can be treated to [[remission (medicine)|remission]] with radical treatment. For pediatric patients, that number is much higher. A large number of cancer patients will die from the disease, and a significant proportion of patients with incurable cancer will die of other causes. There may be ongoing issues with symptom control associated with progressive cancer, and also with the treatment of the disease. These problems may include [[pain]], [[nausea]], [[anorexia (symptom)|anorexia]], [[fatigue (physical)|fatigue]], immobility, and [[clinical depression|depression]]. Not all issues are strictly physical: personal dignity may be affected. Moral and spiritual issues are also important.


While many of these problems fall within the remit of the oncologist, [[palliative care]] has matured into a separate, closely allied speciality to address the problems associated with advanced disease. Palliative care is an essential part of the multidisciplinary cancer care team. Palliative care services may be less hospital-based than oncology, with nurses and doctors who are able to visit the patient at home.
While many of these problems fall within the remit of the oncologist, [[palliative care]] has matured into a separate, closely allied specialty to address the problems associated with advanced disease. Palliative care is an essential part of the multidisciplinary cancer care team. Palliative care services may be less hospital-based than oncology, with nurses and doctors who are able to visit the patient at home.


== Ethical issues==
== Ethical issues==
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* Entry into [[clinical trials]], especially in the face of [[terminal illness]].
* Entry into [[clinical trials]], especially in the face of [[terminal illness]].
* Withdrawal of active treatment.
* Withdrawal of active treatment.
* "[[Do Not Resuscitate]]" orders and other end of life issues.
* "[[Do Not Resuscitate]]" orders and other end-of-life issues.


These issues are closely related to the patients' personality, religion, culture, and family life. Though these issues are complex and emotional, the answers are often achieved by the patient seeking counsel from trusted personal friends and advisors. It requires a degree of sensitivity and very good communication on the part of the oncology team to address these problems properly.
These issues are closely related to the patient's personality, religion, culture, and family life. Though these issues are complex and emotional, the answers are often achieved by the patient seeking counsel from trusted personal friends and advisors. It requires a degree of sensitivity and very good communication on the part of the oncology team to address these problems properly.


==Progress and research==
==Progress and research==
There is a tremendous amount of research being conducted on all frontiers of oncology, ranging from cancer cell biology, radiation therapy to [[chemotherapy]] treatment regimens and optimal [[palliative care]] and [[analgesia|pain relief]]. In the past decade, the advent of next-generation sequencing and whole-genome sequencing has completely changed our understanding of cancers. Identification of novel genetic/molecular markers will dramatically change how we diagnose and treat cancer, which will pave the way for personalized medicine.
There is a tremendous amount of research being conducted on all frontiers of oncology, ranging from cancer cell biology, and radiation therapy to [[chemotherapy]] treatment regimens and optimal [[palliative care]] and [[analgesia|pain relief]]. [[Next-generation sequencing]] and [[whole-genome sequencing]] have completely changed the understanding of cancers. Identification of novel genetic/molecular markers will change the methods of diagnosis and treatment, paving the way for personalized medicine.


Therapeutic trials often involve patients from many different hospitals in a particular region. In the UK, patients are often enrolled in large studies coordinated by [[Cancer Research UK]] (CRUK),<ref>[http://www.cancerresearchuk.org.uk Cancer Research UK<!-- Bot generated title -->]</ref> [[Medical Research Council (UK)|Medical Research Council]] (MRC),<ref>[http://www.mrc.ac.uk Home - Medical Research Council<!-- Bot generated title -->]</ref> the [[European Organisation for Research and Treatment of Cancer]] (EORTC)<ref>[http://www.eortc.be EORTC<!-- Bot generated title -->]</ref> or the [[National Cancer Research Network]] (NCRN).
Therapeutic trials often involve patients from many different hospitals in a particular region. In the UK, patients are often enrolled in large studies coordinated by [[Cancer Research UK]] (CRUK),<ref>{{Cite web|url=https://www.cancerresearchuk.org/home|title=Cancer Research UK|website=Cancer Research UK|date=10 May 2021 |access-date=2022-12-30|archive-date=2022-12-30|archive-url=https://web.archive.org/web/20221230024308/https://www.cancerresearchuk.org/home|url-status=live}}</ref> [[Medical Research Council (UK)|Medical Research Council]] (MRC),<ref>{{Cite web |url=http://www.mrc.ac.uk/ |title=Home - Medical Research Council<!-- Bot generated title --> |access-date=2004-03-29 |archive-date=2017-09-12 |archive-url=https://web.archive.org/web/20170912150433/https://www.mrc.ac.uk/ |url-status=live }}</ref> the [[European Organisation for Research and Treatment of Cancer]] (EORTC)<ref>{{Cite web|url=https://www.eortc.org/|title=European Organisation For Research And Treatment Of Cancer|date=January 17, 2017|website=EORTC|access-date=March 2, 2020|archive-date=October 28, 2022|archive-url=https://web.archive.org/web/20221028085102/https://www.eortc.org/|url-status=live}}</ref> or the [[National Cancer Research Network]] (NCRN).

The most valued companies worldwide whose leading products are in Oncology include [[Pfizer]] (United States), [[Roche]] (Switzerland), [[Merck & Co.|Merck]] (United States), [[AstraZeneca]] (United Kingdom), [[Novartis]] (Switzerland) and [[Bristol-Myers Squibb]] (United States) who are active in the treatment areas Kinase inhibitors, [[Antibody|Antibodies]], [[Cancer immunotherapy|Immuno-oncology]] and [[Radiopharmaceuticals]].<ref>{{cite web |url=https://torreya.com/publications/pharma-1000-report-update-torreya-2021-11-18.pdf |title=Top Global Pharmaceutical Company Report |work=The Pharma 1000 |date=November 2021 |access-date=29 December 2022 |archive-date=2022-03-15 |archive-url=https://web.archive.org/web/20220315051910/https://torreya.com/publications/pharma-1000-report-update-torreya-2021-11-18.pdf |url-status=live }}</ref>


== Specialties ==
== Specialties ==
* The four main divisions:
* The four main divisions:
** Medical oncology: focuses on treatment of cancer with [[chemotherapy]], [[targeted therapy]], [[immunotherapy]], and [[hormonal therapy (oncology)|hormonal therapy]].<ref>{{cite journal |title=Medical oncology as a discipline |journal=Oncology |date=1997-12-01 |issn=0030-2414 |pmid=9394841 |pages=459–462 |volume=54 |issue=6 |first=B. J. |last=Kennedy|doi=10.1159/000227603 }}</ref>
** Medical oncology: focuses on the treatment of cancer with [[chemotherapy]], [[targeted therapy]], [[immunotherapy]], and [[hormonal therapy (oncology)|hormonal therapy]].<ref>{{cite journal |title=Medical oncology as a discipline |journal=Oncology |date=1997-12-01 |issn=0030-2414 |pmid=9394841 |pages=459–462 |volume=54 |issue=6 |first=B. J. |last=Kennedy|doi=10.1159/000227603 }}</ref>
** [[Surgical oncology]]: focuses on treatment of cancer with surgery.<ref name="Cancer.Net">{{cite web|title=Types of Oncologists|url=http://www.cancer.net/all-about-cancer/newly-diagnosed/find-oncologist/types-oncologists|publisher=Cancer.Net : American Society of Clinical Oncology (ASCO)|access-date=25 May 2013|date=2011-05-09}}</ref>
** [[Surgical oncology]]: focuses on treatment of cancer with surgery.<ref name="Cancer.Net">{{cite web|title=Types of Oncologists|url=http://www.cancer.net/all-about-cancer/newly-diagnosed/find-oncologist/types-oncologists|publisher=Cancer.Net : American Society of Clinical Oncology (ASCO)|access-date=25 May 2013|date=2011-05-09|archive-date=2013-06-01|archive-url=https://web.archive.org/web/20130601155338/http://www.cancer.net/all-about-cancer/newly-diagnosed/find-oncologist/types-oncologists|url-status=live}}</ref>
** [[Radiation oncology]]: focuses on treatment of cancer with radiation.<ref name="Cancer.Net"/>
** [[Radiation oncology]]: focuses on treatment of cancer with radiation.<ref name="Cancer.Net"/>
** Clinical oncology: focuses on treatment of cancer with both systemic therapies and radiation.<ref>{{Cite web|url=https://www.rcr.ac.uk/discover-explore/discover-oncology/what-clinical-oncology|title = What is clinical oncology? &#124; the Royal College of Radiologists}}</ref>
** Clinical oncology: focuses on treatment of cancer with both systemic therapies and radiation.<ref>{{Cite web|url=https://www.rcr.ac.uk/discover-explore/discover-oncology/what-clinical-oncology|title=What is clinical oncology? &#124; the Royal College of Radiologists|access-date=2021-08-11|archive-date=2021-08-11|archive-url=https://web.archive.org/web/20210811081632/https://www.rcr.ac.uk/discover-explore/discover-oncology/what-clinical-oncology|url-status=live}}</ref>
* Sub-specialties in Oncology:
* Sub-specialties in Oncology:
** [[Neuro-oncology]]: focuses on cancers of brain.
** [[Neuro-oncology]]: focuses on cancers of brain.
** [[Ocular oncology]]: focuses on cancers of eye.<ref>{{cite journal |title=Ocular oncology – A multidisciplinary specialty |journal=Indian Journal of Ophthalmology |date=2015-02-01 |issn=0301-4738 |pmc=4399140 |pmid=25827536 |page=91 |volume=63 |issue=2 |doi=10.4103/0301-4738.154364 |first=Sundaram |last=Natarajan}}</ref>
** [[Ocular oncology]]: focuses on cancers of eye.<ref>{{cite journal |title=Ocular oncology – A multidisciplinary specialty |journal=Indian Journal of Ophthalmology |date=2015-02-01 |issn=0301-4738 |pmc=4399140 |pmid=25827536 |page=91 |volume=63 |issue=2 |doi=10.4103/0301-4738.154364 |first=Sundaram |last=Natarajan |doi-access=free }}</ref>
** [[Head and neck cancer|Head & Neck oncology]]: focuses on cancers of oral cavity, nasal cavity, oropharynx, hypopharyx and larynx.<ref>{{cite journal |title=Sub-specialty training in head and neck surgical oncology in the European Union |journal=European Archives of Oto-Rhino-Laryngology |date=2009-07-01 |issn=1434-4726 |pmid=19015865 |pages=1005–1010 |volume=266 |issue=7 |doi=10.1007/s00405-008-0832-4 |first1=Argyris |last1=Manganaris |first2=Myles |last2=Black |first3=Alistair |last3=Balfour |first4=Christopher |last4=Hartley |first5=Jean-Pierre |last5=Jeannon |first6=Ricard |last6=Simo|s2cid=20700214 }}</ref>
** [[Head and neck cancer|Head & Neck oncology]]: focuses on cancers of oral cavity, nasal cavity, oropharynx, hypopharynx and larynx.<ref>{{cite journal |title=Sub-specialty training in head and neck surgical oncology in the European Union |journal=European Archives of Oto-Rhino-Laryngology |date=2009-07-01 |issn=1434-4726 |pmid=19015865 |pages=1005–1010 |volume=266 |issue=7 |doi=10.1007/s00405-008-0832-4 |first1=Argyris |last1=Manganaris |first2=Myles |last2=Black |first3=Alistair |last3=Balfour |first4=Christopher |last4=Hartley |first5=Jean-Pierre |last5=Jeannon |first6=Ricard |last6=Simo|s2cid=20700214 }}</ref>
** [[Thorax|Thoracic]] oncology: focuses on cancers of lung, mediastinum, oesophagus and pleura.<ref>{{cite journal |title=Multidisciplinary teams in thoracic oncology-from tragic to strategic |journal=Annals of Translational Medicine |date=2015-05-01 |issn=2305-5839 |pmc=4430737 |pmid=26015931 |volume=3 |issue=7 |page=89 |doi=10.3978/j.issn.2305-5839.2015.01.31 |first1=Krishnamachar |last1=Harish |first2=Agrahara Sreenivasa |last2=Kirthi Koushik}}</ref>
** [[Thorax|Thoracic]] oncology: focuses on cancers of lung, mediastinum, oesophagus and pleura.<ref>{{cite journal |title=Multidisciplinary teams in thoracic oncology-from tragic to strategic |journal=Annals of Translational Medicine |date=2015-05-01 |issn=2305-5839 |pmc=4430737 |pmid=26015931 |volume=3 |issue=7 |page=89 |doi=10.3978/j.issn.2305-5839.2015.01.31 |first1=Krishnamachar |last1=Harish |first2=Agrahara Sreenivasa |last2=Kirthi Koushik}}</ref>
** [[Breast cancer|Breast oncology]]: focuses on cancers of breast
** [[Breast cancer|Breast oncology]]: focuses on cancers of breast.
** [[Gastrointestinal cancer|Gastrointestinal oncology]]: focuses on cancers of stomach, colon, rectum, anal canal, liver, gallbladder, pancreas.<ref>{{cite journal |title=Digestive oncologist in the gastroenterology training curriculum |journal=World Journal of Gastroenterology |date=2011-03-07 |issn=1007-9327 |pmc=3063902 |pmid=21556128 |pages=1109–1115 |volume=17 |issue=9 |doi=10.3748/wjg.v17.i9.1109 |first1=Chris Jacob Johan |last1=Mulder |first2=Marc |last2=Peeters |first3=Annemieke |last3=Cats |first4=Anna |last4=Dahele |first5=Jochim Terhaar sive |last5=Droste}}</ref>
** [[Gastrointestinal cancer|Gastrointestinal oncology]]: focuses on cancers of the stomach, colon, rectum, anal canal, liver, gallbladder, pancreas.<ref>{{cite journal |title=Digestive oncologist in the gastroenterology training curriculum |journal=World Journal of Gastroenterology |date=2011-03-07 |issn=1007-9327 |pmc=3063902 |pmid=21556128 |pages=1109–1115 |volume=17 |issue=9 |doi=10.3748/wjg.v17.i9.1109 |first1=Chris Jacob Johan |last1=Mulder |first2=Marc |last2=Peeters |first3=Annemieke |last3=Cats |first4=Anna |last4=Dahele |first5=Jochim Terhaar sive |last5=Droste |doi-access=free }}</ref>
** [[Bone cancer|Bone]] & Musculoskeletal oncology: focuses on cancers of bones and soft tissue.<ref>{{cite journal |title=What's new in musculoskeletal oncology |journal=The Journal of Bone and Joint Surgery. American Volume |date=2003-04-01 |issn=0021-9355 |pmid=12672857 |pages=761–767 |volume=85-A |issue=4 |first1=Kristy L. |last1=Weber |first2=Mark C. |last2=Gebhardt|doi=10.2106/00004623-200304000-00029 }}</ref>
** [[Bone cancer|Bone]] & Musculoskeletal oncology: focuses on cancers of bones and soft tissue.<ref>{{cite journal |title=What's new in musculoskeletal oncology |journal=The Journal of Bone and Joint Surgery. American Volume |date=2003-04-01 |issn=0021-9355 |pmid=12672857 |pages=761–767 |volume=85-A |issue=4 |first1=Kristy L. |last1=Weber |first2=Mark C. |last2=Gebhardt|doi=10.2106/00004623-200304000-00029 }}</ref>
** [[Skin cancer|Dermatological oncology]]: focuses on the medical and surgical treatment of skin, hair, sweat gland, and nail cancers
** [[Skin cancer|Dermatological oncology]]: focuses on the medical and surgical treatment of skin, hair, sweat gland, and nail cancers
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** [[Gynecologic oncology]]: focuses on cancers of the female reproductive system.<ref>{{cite journal |title=Gynecologic oncology specialty |journal=European Journal of Gynaecological Oncology |date=2004-01-01 |issn=0392-2936 |pmid=15053057 |pages=25–26 |volume=25 |issue=1 |first1=P. |last1=Benedetti-Panici |first2=R. |last2=Angioli}}</ref>
** [[Gynecologic oncology]]: focuses on cancers of the female reproductive system.<ref>{{cite journal |title=Gynecologic oncology specialty |journal=European Journal of Gynaecological Oncology |date=2004-01-01 |issn=0392-2936 |pmid=15053057 |pages=25–26 |volume=25 |issue=1 |first1=P. |last1=Benedetti-Panici |first2=R. |last2=Angioli}}</ref>
** [[Pediatric oncology]]: concerned with the treatment of cancer in children.<ref>{{cite journal |title=History of pediatric oncology |journal=Pediatric Hematology and Oncology |date=1991-06-01 |issn=0888-0018 |pmid=1863546 |pages=89–91 |volume=8 |issue=2 |first=J. A. |last=Wolff|doi=10.3109/08880019109033436 }}</ref>
** [[Pediatric oncology]]: concerned with the treatment of cancer in children.<ref>{{cite journal |title=History of pediatric oncology |journal=Pediatric Hematology and Oncology |date=1991-06-01 |issn=0888-0018 |pmid=1863546 |pages=89–91 |volume=8 |issue=2 |first=J. A. |last=Wolff|doi=10.3109/08880019109033436 }}</ref>
** [[Cancer in adolescents and young adults|Adolescent and young adult (AYA) oncology]].<ref>{{Cite journal|last1=Shaw|first1=Peter H.|last2=Reed|first2=Damon R.|last3=Yeager|first3=Nicholas|last4=Zebrack|first4=Bradley|last5=Castellino|first5=Sharon M.|last6=Bleyer|first6=Archie|s2cid=27695404|date=April 2015|title=Adolescent and Young Adult (AYA) Oncology in the United States: A Specialty in Its Late Adolescence|journal=Journal of Pediatric Hematology/Oncology|volume=37|issue=3|pages=161–169|doi=10.1097/MPH.0000000000000318|issn=1536-3678|pmid=25757020}}</ref>
** [[Adolescent and young adult oncology|Adolescent and young adult (AYA) oncology]].<ref>{{Cite journal|last1=Shaw|first1=Peter H.|last2=Reed|first2=Damon R.|last3=Yeager|first3=Nicholas|last4=Zebrack|first4=Bradley|last5=Castellino|first5=Sharon M.|last6=Bleyer|first6=Archie|s2cid=27695404|date=April 2015|title=Adolescent and Young Adult (AYA) Oncology in the United States: A Specialty in Its Late Adolescence|journal=Journal of Pediatric Hematology/Oncology|volume=37|issue=3|pages=161–169|doi=10.1097/MPH.0000000000000318|issn=1536-3678|pmid=25757020}}</ref>
** [[Tumors of the hematopoietic and lymphoid tissues|Hemato oncology]]: focuses on cancers of blood and stem cell transplantation
** [[Tumors of the hematopoietic and lymphoid tissues|Hemato oncology]]: focuses on cancers of blood and stem cell transplantation.
** [[Cancer prevention|Preventive oncology]]: focuses on epidemiology & prevention of cancer.<ref>{{cite journal |title=On a new strategy of preventive oncology |journal=Neurochemical Research |date=2010-06-01 |issn=1573-6903 |pmid=20119639 |pages=868–874 |volume=35 |issue=6 |doi=10.1007/s11064-009-0110-x |first=L. N. |last=Mkrtchyan|s2cid=582313 }}</ref>
** [[Cancer prevention|Preventive oncology]]: focuses on epidemiology & prevention of cancer.<ref>{{cite journal |title=On a new strategy of preventive oncology |journal=Neurochemical Research |date=2010-06-01 |issn=1573-6903 |pmid=20119639 |pages=868–874 |volume=35 |issue=6 |doi=10.1007/s11064-009-0110-x |first=L. N. |last=Mkrtchyan|s2cid=582313 }}</ref>
** [[Geriatric oncology]]: focuses on cancers in elderly population.<ref>{{cite journal |title=Geriatric oncology: The need for a separate subspecialty |journal=Indian Journal of Medical and Paediatric Oncology |date=2012-01-01 |issn=0971-5851 |pmc=3439792 |pmid=22988358 |pages=134–136 |volume=33 |issue=2 |first1=D. K. |last1=Vijaykumar |first2=R. |last2=Anupama |first3=Tejal Kishor |last3=Gorasia |first4=T. R. Haleema |last4=Beegum |first5=P. |last5=Gangadharan|doi=10.4103/0971-5851.99755 }}</ref>
** [[Geriatric oncology]]: focuses on cancers in elderly population.<ref>{{cite journal |title=Geriatric oncology: The need for a separate subspecialty |journal=Indian Journal of Medical and Paediatric Oncology |date=2012-01-01 |issn=0971-5851 |pmc=3439792 |pmid=22988358 |pages=134–136 |volume=33 |issue=2 |first1=D. K. |last1=Vijaykumar |first2=R. |last2=Anupama |first3=Tejal Kishor |last3=Gorasia |first4=T. R. Haleema |last4=Beegum |first5=P. |last5=Gangadharan|doi=10.4103/0971-5851.99755 |doi-access=free }}</ref>
** Pain & Palliative oncology: focuses on treatment of end stage cancer to help alleviate pain and suffering.<ref>{{cite journal |title=Palliative oncology: identity, progress, and the path ahead |journal=Annals of Oncology |date=2012-04-01 |issn=1569-8041 |pmc=3493143 |pmid=22628415 |pages=43–48 |volume=23 Suppl 3 |doi=10.1093/annonc/mds087 |first1=A. S. |last1=Epstein |first2=R. S. |last2=Morrison}}</ref>
** Pain & Palliative oncology: focuses on treatment of end stage cancer to help alleviate pain and suffering.<ref>{{cite journal |title=Palliative oncology: identity, progress, and the path ahead |journal=Annals of Oncology |date=2012-04-01 |issn=1569-8041 |pmc=3493143 |pmid=22628415 |pages=43–48 |volume=23 |doi=10.1093/annonc/mds087 |first1=A. S. |last1=Epstein |first2=R. S. |last2=Morrison|issue=Suppl 3 }}</ref>
** [[Molecular oncology]]: focuses on molecular diagnostic methods in oncology.<ref>{{cite journal |title=Principles of Molecular Oncology. |journal=American Journal of Human Genetics |date=2001-04-01 |issn=0002-9297 |pmc=1275628 |page=1068 |volume=68 |issue=4 |first=Robert |last=Jenkins |doi=10.1086/319526}}</ref>
** [[Molecular oncology]]: focuses on molecular diagnostic methods in oncology.<ref>{{cite journal |title=Principles of Molecular Oncology. |journal=American Journal of Human Genetics |date=2001-04-01 |issn=0002-9297 |pmc=1275628 |page=1068 |volume=68 |issue=4 |first=Robert |last=Jenkins |doi=10.1086/319526}}</ref>
** Nuclear medicine oncology: focuses on diagnosis and treatment of cancer with radiopharmaceuticals.
** Nuclear medicine oncology: focuses on diagnosis and treatment of cancer with radiopharmaceuticals.
Line 117: Line 119:
** [[Veterinary oncology]]: focuses on treatment of cancer in animals.<ref>{{cite journal |title=Update on genomics in veterinary oncology |journal=Topics in Companion Animal Medicine |date=2009-08-01 |issn=1938-9736 |pmc=2754151 |pmid=19732729 |pages=113–121|volume=24 |issue=3 |doi=10.1053/j.tcam.2009.03.002 |first=Matthew |last=Breen}}</ref>
** [[Veterinary oncology]]: focuses on treatment of cancer in animals.<ref>{{cite journal |title=Update on genomics in veterinary oncology |journal=Topics in Companion Animal Medicine |date=2009-08-01 |issn=1938-9736 |pmc=2754151 |pmid=19732729 |pages=113–121|volume=24 |issue=3 |doi=10.1053/j.tcam.2009.03.002 |first=Matthew |last=Breen}}</ref>
* Emerging specialties:
* Emerging specialties:
** [[Cardiooncology]] is a branch of cardiology that addresses the cardiovascular impact of cancer and its treaments<ref>{{cite journal |last1=Ghosh |first1=AK |last2=Walker |first2=JM |title=Cardio-oncology. |journal=British Journal of Hospital Medicine |date=2 January 2017 |volume=78 |issue=1 |pages=C11–C13 |doi=10.12968/hmed.2017.78.1.C11 |pmid=28067553}}</ref>
** [[Cardiooncology]] is a branch of cardiology that addresses the cardiovascular impact of cancer and its treatments.<ref>{{cite journal |last1=Ghosh |first1=AK |last2=Walker |first2=JM |title=Cardio-oncology. |journal=British Journal of Hospital Medicine |date=2 January 2017 |volume=78 |issue=1 |pages=C11–C13 |doi=10.12968/hmed.2017.78.1.C11 |pmid=28067553}}</ref>


== See also ==
== See also ==
Line 124: Line 126:
* [[Cancer research]]
* [[Cancer research]]
* [[Comparative oncology]]
* [[Comparative oncology]]
* [[Oncology nursing]]
* [[Oncometabolism]]
* [[Oncometabolism]]
* [[Tumour heterogeneity]]
* [[Tumour heterogeneity]]

Latest revision as of 20:56, 22 May 2024

Not to be confused with Ontology.
For the journal, see Oncology (journal).
"Clinical oncology" redirects here. For the journal, see Clinical Oncology.
Oncology
A coronal CT scan showing a malignant mesothelioma, indicated by the asterisk and the arrows
FocusCancerous tumor
SubdivisionsMedical oncology, radiation oncology, surgical oncology
Significant testsTumor markers, TNM staging, CT scans, MRI
Oncologist
Occupation
Occupation type
Specialty
Activity sectors
Medicine
Description
Education required
Fields of
employment
Hospitals, clinics, clinical research centers

Oncology is a branch of medicine that deals with the study, treatment, diagnosis, and prevention of cancer. A medical professional who practices oncology is an oncologist.[1] The name's etymological origin is the Greek word ὄγκος (ónkos), meaning "tumor", "volume" or "mass".[2] Oncology is concerned with:

Diagnosis[edit]

Medical histories remain an important screening tool: the character of the complaints and nonspecific symptoms (such as fatigue, weight loss,[3] unexplained anemia,[4] fever of unknown origin, paraneoplastic phenomena and other signs) may warrant further investigation for malignancy. Occasionally, a physical examination may find the location of a malignancy.

Diagnostic methods include:

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 tumor in its entirety.

Currently, a tissue diagnosis (from a biopsy) by a pathologist is essential for the proper classification of cancer and to guide the next step of treatment. On extremely rare instances when this is not possible, "empirical therapy" (without an exact diagnosis) may be considered, based on the available evidence (e.g. history, x-rays and scans.)

On very rare occasions, a metastatic lump or pathological lymph node is found (typically in the neck) for which a primary tumor cannot be found. However, immunohistochemical markers often give a strong indication of the primary malignancy. This situation is referred to as "malignancy of unknown primary", and again, treatment is empirically based on past experience of the most likely origin.[7]

Therapy[edit]

Depending upon the cancer identified, follow-up and palliative care will be administered at that time. Certain disorders (such as ALL or AML) will require immediate admission and chemotherapy, while others will be followed up with regular physical examination and blood tests.

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, Occasionally, 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; the 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, e.g. to relieve biliary obstruction, or to relieve the problems associated with some cerebral tumors. The risks of surgery must be weighed against the benefits.

Chemotherapy and radiotherapy are used as a first-line radical therapy in several malignancies. They 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 life and to prolong it.

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).

Vaccines and other immunotherapies are the subject of intensive research.

Palliative care[edit]

Approximately 50% of all cancer cases in the Western world can be treated to remission with radical treatment. For pediatric patients, that number is much higher. A large number of cancer patients will die from the disease, and a significant proportion of patients with incurable cancer will die of other causes. There may be ongoing issues with symptom control associated with progressive cancer, and also with the treatment of the disease. These problems may include pain, nausea, anorexia, fatigue, immobility, and depression. Not all issues are strictly physical: personal dignity may be affected. Moral and spiritual issues are also important.

While many of these problems fall within the remit of the oncologist, palliative care has matured into a separate, closely allied specialty to address the problems associated with advanced disease. Palliative care is an essential part of the multidisciplinary cancer care team. Palliative care services may be less hospital-based than oncology, with nurses and doctors who are able to visit the patient at home.

Ethical issues[edit]

There are a number of recurring ethical questions and dilemmas in oncological practice. These include:

These issues are closely related to the patient's personality, religion, culture, and family life. Though these issues are complex and emotional, the answers are often achieved by the patient seeking counsel from trusted personal friends and advisors. It requires a degree of sensitivity and very good communication on the part of the oncology team to address these problems properly.

Progress and research[edit]

There is a tremendous amount of research being conducted on all frontiers of oncology, ranging from cancer cell biology, and radiation therapy to chemotherapy treatment regimens and optimal palliative care and pain relief. Next-generation sequencing and whole-genome sequencing have completely changed the understanding of cancers. Identification of novel genetic/molecular markers will change the methods of diagnosis and treatment, paving the way for personalized medicine.

Therapeutic trials often involve patients from many different hospitals in a particular region. In the UK, patients are often enrolled in large studies coordinated by Cancer Research UK (CRUK),[8] Medical Research Council (MRC),[9] the European Organisation for Research and Treatment of Cancer (EORTC)[10] or the National Cancer Research Network (NCRN).

The most valued companies worldwide whose leading products are in Oncology include Pfizer (United States), Roche (Switzerland), Merck (United States), AstraZeneca (United Kingdom), Novartis (Switzerland) and Bristol-Myers Squibb (United States) who are active in the treatment areas Kinase inhibitors, Antibodies, Immuno-oncology and Radiopharmaceuticals.[11]

Specialties[edit]

See also[edit]

Organizations

References[edit]

  1. ^ Maureen McCutcheon. Where Have My Eyebrows Gone?. Cengage Learning, 2001. ISBN 0766839346. Page 5.
  2. ^ Types of Oncologists Archived 2017-07-26 at the Wayback Machine, American Society of Clinical Oncology (ASCO).
  3. ^ Alfred E. Chang & authors. Oncology: An Evidence-Based Approach. Springer Science & Business Media, 2007. ISBN 0387310568. Page 1488.
  4. ^ Alice Villalobos, Laurie Kaplan. Canine and Feline Geriatric Oncology: Honoring the Human-Animal Bond. John Wiley & Sons, 2008. ISBN 0470344075. Page 77.
  5. ^ "How biopsy procedures are used to diagnose cancer". Mayo Clinic. Archived from the original on 2023-06-13. Retrieved 2023-06-13.
  6. ^ "Endoscopy". British Medical Association Complete Family Health Encyclopedia. Dorling Kindersley Limited. 1990.
  7. ^ National Institute for Health and Clinical Excellence. Clinical guideline 104: Metastatic malignant disease of unknown primary origin: Diagnosis and management of metastatic malignant disease of unknown primary origin. London, 2010.
  8. ^ "Cancer Research UK". Cancer Research UK. 10 May 2021. Archived from the original on 2022-12-30. Retrieved 2022-12-30.
  9. ^ "Home - Medical Research Council". Archived from the original on 2017-09-12. Retrieved 2004-03-29.
  10. ^ "European Organisation For Research And Treatment Of Cancer". EORTC. January 17, 2017. Archived from the original on October 28, 2022. Retrieved March 2, 2020.
  11. ^ "Top Global Pharmaceutical Company Report" (PDF). The Pharma 1000. November 2021. Archived (PDF) from the original on 2022-03-15. Retrieved 29 December 2022.
  12. ^ Kennedy, B. J. (1997-12-01). "Medical oncology as a discipline". Oncology. 54 (6): 459–462. doi:10.1159/000227603. ISSN 0030-2414. PMID 9394841.
  13. ^ a b "Types of Oncologists". Cancer.Net : American Society of Clinical Oncology (ASCO). 2011-05-09. Archived from the original on 2013-06-01. Retrieved 25 May 2013.
  14. ^ "What is clinical oncology? | the Royal College of Radiologists". Archived from the original on 2021-08-11. Retrieved 2021-08-11.
  15. ^ Natarajan, Sundaram (2015-02-01). "Ocular oncology – A multidisciplinary specialty". Indian Journal of Ophthalmology. 63 (2): 91. doi:10.4103/0301-4738.154364. ISSN 0301-4738. PMC 4399140. PMID 25827536.
  16. ^ Manganaris, Argyris; Black, Myles; Balfour, Alistair; Hartley, Christopher; Jeannon, Jean-Pierre; Simo, Ricard (2009-07-01). "Sub-specialty training in head and neck surgical oncology in the European Union". European Archives of Oto-Rhino-Laryngology. 266 (7): 1005–1010. doi:10.1007/s00405-008-0832-4. ISSN 1434-4726. PMID 19015865. S2CID 20700214.
  17. ^ Harish, Krishnamachar; Kirthi Koushik, Agrahara Sreenivasa (2015-05-01). "Multidisciplinary teams in thoracic oncology-from tragic to strategic". Annals of Translational Medicine. 3 (7): 89. doi:10.3978/j.issn.2305-5839.2015.01.31. ISSN 2305-5839. PMC 4430737. PMID 26015931.
  18. ^ Mulder, Chris Jacob Johan; Peeters, Marc; Cats, Annemieke; Dahele, Anna; Droste, Jochim Terhaar sive (2011-03-07). "Digestive oncologist in the gastroenterology training curriculum". World Journal of Gastroenterology. 17 (9): 1109–1115. doi:10.3748/wjg.v17.i9.1109. ISSN 1007-9327. PMC 3063902. PMID 21556128.
  19. ^ Weber, Kristy L.; Gebhardt, Mark C. (2003-04-01). "What's new in musculoskeletal oncology". The Journal of Bone and Joint Surgery. American Volume. 85-A (4): 761–767. doi:10.2106/00004623-200304000-00029. ISSN 0021-9355. PMID 12672857.
  20. ^ Bukowski, Ronald M. (2011-10-10). "Genitourinary Oncology: Current Status and Future Challenges". Frontiers in Oncology. 1: 32. doi:10.3389/fonc.2011.00032. ISSN 2234-943X. PMC 3355990. PMID 22649760.
  21. ^ Benedetti-Panici, P.; Angioli, R. (2004-01-01). "Gynecologic oncology specialty". European Journal of Gynaecological Oncology. 25 (1): 25–26. ISSN 0392-2936. PMID 15053057.
  22. ^ Wolff, J. A. (1991-06-01). "History of pediatric oncology". Pediatric Hematology and Oncology. 8 (2): 89–91. doi:10.3109/08880019109033436. ISSN 0888-0018. PMID 1863546.
  23. ^ Shaw, Peter H.; Reed, Damon R.; Yeager, Nicholas; Zebrack, Bradley; Castellino, Sharon M.; Bleyer, Archie (April 2015). "Adolescent and Young Adult (AYA) Oncology in the United States: A Specialty in Its Late Adolescence". Journal of Pediatric Hematology/Oncology. 37 (3): 161–169. doi:10.1097/MPH.0000000000000318. ISSN 1536-3678. PMID 25757020. S2CID 27695404.
  24. ^ Mkrtchyan, L. N. (2010-06-01). "On a new strategy of preventive oncology". Neurochemical Research. 35 (6): 868–874. doi:10.1007/s11064-009-0110-x. ISSN 1573-6903. PMID 20119639. S2CID 582313.
  25. ^ Vijaykumar, D. K.; Anupama, R.; Gorasia, Tejal Kishor; Beegum, T. R. Haleema; Gangadharan, P. (2012-01-01). "Geriatric oncology: The need for a separate subspecialty". Indian Journal of Medical and Paediatric Oncology. 33 (2): 134–136. doi:10.4103/0971-5851.99755. ISSN 0971-5851. PMC 3439792. PMID 22988358.
  26. ^ Epstein, A. S.; Morrison, R. S. (2012-04-01). "Palliative oncology: identity, progress, and the path ahead". Annals of Oncology. 23 (Suppl 3): 43–48. doi:10.1093/annonc/mds087. ISSN 1569-8041. PMC 3493143. PMID 22628415.
  27. ^ Jenkins, Robert (2001-04-01). "Principles of Molecular Oncology". American Journal of Human Genetics. 68 (4): 1068. doi:10.1086/319526. ISSN 0002-9297. PMC 1275628.
  28. ^ Breen, Matthew (2009-08-01). "Update on genomics in veterinary oncology". Topics in Companion Animal Medicine. 24 (3): 113–121. doi:10.1053/j.tcam.2009.03.002. ISSN 1938-9736. PMC 2754151. PMID 19732729.
  29. ^ Ghosh, AK; Walker, JM (2 January 2017). "Cardio-oncology". British Journal of Hospital Medicine. 78 (1): C11–C13. doi:10.12968/hmed.2017.78.1.C11. PMID 28067553.

Further reading[edit]

External links[edit]

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