Oncology

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The world of medicine is huge and is divided into many different branches. Oncology is one the many branches of medicine and deals with tumors. It is practiced by professionals who have specialized in this field of study. These oncologists diagnose cancer in a person and then work towards treating it with the appropriate treatment options. Cancer is a serious and often a life threatening disease. Patients inflicted with it have to go through a very hard time to get through it and be healthy again. Having a good oncologist who would provide them with good health care is very important for the patient in order to keep him motivated and confident towards getting healthy again.

Oncology

An oncologist is a specialized doctor in the field of oncology. He is responsible for:

  • Diagnosing any type of cancer in a patient
  • Finding out the best possible treatment for a patient and recommending the most appropriate therapies for them. The oncologist decides whether the patient should get surgery for their tumor or should be treated with chemotherapy or radiotherapy.
  • The oncologist is responsible for patient’s follow up after the treatment has become successful.
  • Indulging those patients who have a terminally malignant tumor into palliative care.
  • Answer all the questions and clear confusions about managing cancer. The patient should be completely clear about his disease and the treatments that he would be required to go through. He should be explained everything in normal terms instead of using medical jargons with him.
  • Screening of population in the relatives of the patient.

Diagnosis of cancer

An oncologist is responsible for diagnosing cancer in a patient. Malignant tumors have the common symptoms such as fatigue and tiredness, sudden weight loss, anemia without any explanation and many other symptoms [1].

These symptoms then lead to further investigation for diagnosing a malignant tumor in the patient. The location of tumor is found through different diagnostic methods. These methods include:

  • Biopsy and Resection: This diagnostic method removes the neoplastic growth from the patient. This growth is often of suspicious nature and is then further examined to determine if it’s a cancerous tumor or not. Biopsy is the primary method of diagnosing cancer. It is extremely crucial as it determines the coming steps in managing patient’s disease. After the results of biopsy, the oncologist will then decide the treatment to be done to the patient in order to cure of their disease. The oncologist will decide whether the patient needs chemotherapy, radiation therapy, surgery or a combination of two or more treatments depending on the case of the patient.
  • Endoscopy: Another method to diagnose cancer in patients is endoscopy. It is done at either the upper or lower gastrointestinal areas for determining if the suspicious tumor is malignant or not.
  • X Rays, CT scans, MRI and ultrasound: All of these radiation methods help in guiding biopsy.
  • Blood tests: Simple enough, the blood tests can indicate suspicion about certain types of cancers.
  • SPECT: Single photon emission computed technology may be involved in diagnosing malignant tumors.

These techniques aren’t used to only diagnose cancer. Their use isn’t limited to diagnosis and it even determines the operations that can be done on the patient to cure him. Usually, the patient’s tissue needs to be examined for determining the type of cancer he has and classify his disease accordingly. Sometimes however this evaluation isn’t possible with such simplicity and empirical therapy needs to be considered for evaluating the patient’s profile.

Oncologists are specialized in treating all kinds of cancer. They can diagnose and then treat brain tumors, tumors at the head and the neck, sarcomas and melanoma. Other than that the diseases they can treat are kidney cancer, ovarian cancer, hepatoma, neuroendocrine cancer, billiary cancer, pancreatic cancer and other various cancers in the gynecological areas.

Cancer Therapy

After cancer has been identified in any patient, the next step which will follow will be the therapies suitable and appropriate for them.  The patient will go through follow ups and palliative care which will be under the administration of the oncologist treating them. Some patients may have certain disorders which will need urgent and immediate chemotherapy. Examples of these disorders could be the ALL or AML. ALL is the acute lymphocytic leukemia while AML is acute myelogenous leukemia. Leukemia is the type of cancer in which white blood cells start to multiply abnormally. Patients with these symptoms therefore are required to go through the process of chemotherapy immediately. These patients will be asked to get admitted immediately as well.

If the tumor is large enough and surgery is suitable for the patient, the oncologists will attempt surgery on the patient in order to remove the tumor from them completely. For such a surgery the oncologists need to be sure that the tumor is capable of being removed. If there’s a possibility for some part of the tumor to remain even after the surgery, curative surgery might be impossible. This happens if the tumor has spread out to invade some structure in the patient’s body which will be very risky to operate on and would be a threat the patient’s life. There are cases however, when despite the entire tumor being removed; surgery could still improve the chance of survival in that patient. This process is medically known as debulking which means that the overall amount of tumor tissue of the patient has been reduced in size. It can be reduced significantly even if it can’t be completely eliminated.

For the surgery of some cancers, oncologists may also use palliative treatments. For example, it could be done to relieve biliary obstructions and relieve the issues that are associated with cerebral tumors. Palliative treatments are basically and approach to special medical care for the patients who have some serious illness. This focuses on freeing the patients from the symptoms, pain, physical stress and mental stress which would occur from a serious illness. Surgeries are risky and their benefits must always be measured against their risks.

Cancer Specialties

In oncology, there are various sub specialties. Oncologists mostly develop expertise and get interested in managing particular types of cancer. These oncologists are often divided based on the types of treatments that are provided or the roles of some oncologists are primarily diagnostic.

  • Radiology: This is an image guided biopsy which is carried out in order to obtain tissues for preliminary diagnosis.
  • Anatomical pathology: Under this, the final diagnosis and prognosis of cancer is rendered. This is done to direct further treatment by the oncologists.
  • Radiation oncology: Treatment is basically done with radiation through a treatment called radiation therapy.
  • Surgical oncology: The surgeons who are specialized in removal of tumors from the patient’s body.
  • Medical oncology: Treatment here is done with drugs primarily. This includes chemotherapy, hormonal therapy and targeted therapy.
  • Gynecologic oncology: This department of oncology specializes on the cancers of women’s reproductive systems.
  • Pediatric oncology: This department simply is concerned with treating cancer in children.

Oncologists may be clinical or medical. Clinical oncologists deliver radiotherapy. Medical oncologists on the other hand do not. A common trend of multidisciplinary teams to cure the patients is now emerging at most of the countries. These teams discuss the cases of their patients and meet on frequent and regular basis. The teams consist of medical and clinical oncologists, radiotherapist, a surgeon, a radiologist, a pathologist, and organ specific specialist such as a gynecologist or dermatologist. A general practitioner is also sometimes involved. The problem with multidisciplinary teams is that it becomes very difficult to determine who’s in charge of the patient from among the team consisting of so many people from different departments.

Types of Oncologists

There are different types of oncologists. These oncologists usually work together to treat the patient suffering from cancer. Oncology is the study of cancer and is further divided into three disciplines. The three disciplines of oncology are medical oncology, surgical oncology and radiation oncology [2].

A medical oncologist is specialized in treatment of cancer patients with chemotherapy. Chemotherapy is basically a method of killing cancerous cells in the patient’s body. The patient is given drugs and chemicals in this therapy which stop the growth and further division of cancerous cells. The drugs can either be injected to the patient or given to him orally, by making him take them through his mouth.

A surgical oncologist is the one who is responsible for surgical treatments to be done on the patient in order to remove his tumor. The oncologist removes these tumors and tissues that surround it during the operation. The surgical oncologists also perform biopsies. Biopsy is the process in which a small amount of tissue is removed for the surgeon to examine the type of cancer that patient has. It is a crucial process since it determines the types of treatments that will be given to the patient to cure him.

The third discipline of oncology is radiation oncology. The radiation oncologists are specialized in treating cancer patients with radiation therapy which uses X rays and other high energy rays to kill cancer cells.

Apart from these three main types of oncologists, there are also some other types that have been recognized by the American school of Clinical Oncology.

  • The oncologist who focuses on treatment of women suffering from gynecological cancers is the gynecological oncologist. Such cancers include uterine cancer and cervical cancer as well.
  • The oncologist who is specialized in treating young children suffering from cancer is the pediatric oncologist. Pediatric oncologists include all the three main types of oncologists that have been mentioned above. There are a few types of cancer which usually only occur in children. If these however sometimes occur in adults, these adults could also be treated by pediatric oncologists.
  • The oncologists specializing in diagnosis and treatments of blood cancers are called a hematologist oncologist. The cancers of blood include leukemia, lymphoma and myeloma.

Progress in Oncology

There is a lot of research that is conducted for all areas of oncology. Oncology areas range from biology of cancerous cells to the chemotherapy treatments [3].

Oncology is a field that is always and continuously changing and developing. Research of cancer is carried out as trials in the clinics. These therapy trials basically involve patients from various hospitals in any particular region. Patients often get enrolled in big studies in UK in large studies coordinated by Cancer Research UK (CRUK) and Medical Research Council (MRC) [4].

Ethical Issues in Oncology

Oncological practice is a complicated field because cancer is a very complicated disease. Various ethical issues and questions arise in oncological practices. The dilemmas faced while dealing with cancer patients can be very crucial. Some of the ethical issues that are faced by the oncologists include the following:

  • The information that has to be given to the patients about the disease. The extent of the disease and its seriousness, the chances of survival and the process of being treated. The progression and prognosis of cancer in an individual at any particular time.
  • Withdrawing from active treatment.
  • The dilemma of entering into clinical trials, particularly in face of being terminally ill.

These issues are related to individual patients according to their personal cases. They depend on the personality of the patient, their religion and culture. Patient’s family life is also taken into consideration to tackle these ethical issues. These ethical issues are very complex. They can even become a very emotional problem for some patients. Even though they are difficult to manage, it is important for the patients to get the answers. The patients are advised to seek counsel from their friends who they trust and who are close to them. The oncologists don’t just have to be very good at treating the patients and diagnosing the disease. Another important part of their jobs is to communicate with the patients in a proper and appropriate manner. They need to be sensitive towards their patients and communicate with them accordingly.

 

References


[1] http://en.wikipedia.org/wiki/Oncology


[2] http://www.cancer.net/navigating-cancer-care/cancer-basics/cancer-care-team/types-oncologists


[3] http://www.news-medical.net/health/What-is-Oncology.aspx


[4] http://www.mrc.ac.uk/

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