Clinical Oncology and Molecular Diagnostics

Clinical oncology enfolds the non-surgical aspect of oncology. 85% of all clinical oncologists treat patients with a balance of chemotherapy and radiotherapy. Clinical oncologists are involved in the treatment of all types of cancer. They work intently in large multidisciplinary teams that focus on the treatment of cancer affecting parts of the body or systems. They treat patients and manage their cancer throughout the disease. This specialty gives the opportunity of developing clinical and scientific skills with great potential for academic and clinical research. Technologies in the field of clinical oncology are improving promptly. For example, some tumours can be treated with highly sophisticated precision external beam radiation therapy such as proton beam therapy. Some patients can be cured, but for others the emphasis is on effective palliative care and improving quality of life.

Radiation Oncology embraces all aspects of research that influences on the treatment of cancer using radiation. The field of radiation oncology covers the integration of radiation therapy into multimodal treatment approaches. External Beam radiotherapy is delivered outside the body. This includes directing high-energy radiation beams at the area being targeted within the body using various radiotherapy machines. Brachytherapy is radiation applied directly into the target. It is highly effective because the radiation is concentrated on the disease rather than healthy surrounding organs. Radioimmunotherapy (RIT) uses an antibody with specificity for a tumor- associated antigen labeled with a radionuclide to deliver cytotoxic radiation to a tumor cell. Systemic radiation therapy uses radioactive drugs to treat cancer systematically, in which the radioactive substance travels through the blood stream to reach cells all over the body.

Cancer is one among the primary causes of death all over the world. Organ Specific Cancers are cancers named based on the location of cancer in the parts of the body. There are different types of cancers, some of them are Head and Neck Cancer, Brain cancer, Lung cancer, Oral cancer, Liver cancer, Breast cancer, Prostate cancer, Gastric cancer, Pancreatic cancer, Kidney (Renal Cell) cancer, Leukemia and many more.  Lung, prostate, colon, rectum, stomach and liver are the most common organs affected by cancer in men. The most common organs affected by cancer in women are breast, colon, rectum, lung, cervix and stomach.

Cancer that spread to a different part of the body from where it started is called metastasis. For example, a breast cancer that spread to the liver is referred to as metastatic breast cancer. The most common sites where cancer spreads are the bone, liver, and lung. The clinical manifestation of metastasis in a vital organ is the ultimate phase of cancer progression and the main offender of cancer-related mortality.

Hematology- Oncology is the branch of medicine related to the study of diagnosis, treatment, and prevention of blood diseases and cancer. It includes such diseases as iron deficiency anemia, hemophilia, sickle cell disease, the thalassemia, leukemias and lymphomas.The study of hematology integrates clinical and laboratory medicine. Leukemia affects your white blood cells. These are significant, infection-fighting part of your immune system, made in your bone marrow. The cancerous formation affecting the lymphocytes is called as lymphoma. Lymphocytes are one of the varieties of white blood corpuscles. As part of Myeloma, the plasma (another variety of WBC) is affected by the cancer cells. Blood cancers can cause many different symptoms. Some are common across all blood cancers, others are more characteristic of types of blood cancer. For example, lymphomas can be recognized by swollen lymph nodes and one of the most common symptoms of myeloma is bone pain, especially in the back.

Breast cancer starts when cells in the breast initiate to grow out of control. These cells typically form a tumor that can often be felt as a lump. If the cells can grow into surrounding tissues or spread to distant areas of the body, the tumor is malignant. The breast cancer which initiate in the ducts that carry milk to the nipple is called ductal cancers. Some breast cancers begin in the glands that make breast milk is called lobular cancers. A small number of cancers start in other tissues in the breast. These cancers are called sarcomas and lymphomas. Benign breast tumors are uncharacteristic growths, but they do not extent outside of the breast and they are not aggressive. But some benign breast lumps can upsurge a woman's risk of getting breast cancer.

Skin cancers are cancers that develop from the skin. They are due to the progression of abnormal cells that can invade or spread to other parts of the body. Skin cancer is the most common form of cancer, globally accounting for at least 40% of cases. The most common type is non-melanoma skin cancer, which happens in at least 2-3 million people per year. There are three main types of skin cancers: basal-cell skin cancer (BCC), squamous-cell skin cancer (SCC) and melanoma. The lymphomas that start in the skin are called skin lymphoma. surgical excision is the most common form of treatment for skin cancers. About 90 percent of nonmelanoma skin cancers are assisted with exposure to ultraviolet (UV) radiation from the sun. Sunscreen is effective and thus recommended to avert melanoma and squamous-cell carcinoma.

Biomarkers are molecules that indicate normal or abnormal process occur in your body. Biomarkers may be produced by the cancer tissue itself or by other cells in the body in response to cancer. It is especially used for the identification of breast cancer.  They can be found in the blood, stool, urine, tumor tissue and bodily fluids. Cancer biomarkers can include Proteins, Gene mutations (changes), Gene rearrangements, Extra copies of genes, Missing genes and Other Molecules Biomarkers helps in cancer research to diagnose the early stage cancers, find out the aggressiveness and develop cancer drugs.

The sub-division of genomics that characterizes cancer-associated genes is related to oncogenomics. It focuses on epigenomic, genomic and transcript alterations in cancer. The evolution from normal tissue to aggressive cancer is thought to occur over a timescale of 5–20 years. This transformation is determined by both inherited genetic factors and somatic genetic alterations and mutations, and it results in uncontrolled cell growth and leads to death. The genetic mutations that lead to cancer occur only in certain genes. Cancer-causing genes have been classified as proto-oncogenes (e.g., the genes for MYC, ERBB2 and EGFR) and tumor suppressor genes such as the genes that encode TP53, CDKN2A, and RB. The completion of the Human Genome Project simplified the field of oncogenomic and improved the abilities of researchers to find oncogenes. Sequencing technologies and global methylation profiling methods are practiced to the study of oncogenomics.

Screening tests can help to find cancer at an early stage, before recognizing the symptoms. When abnormal tissue or cancer is found early, it may be easier to treat or cure. The main aim of cancer screening is to reduce the mortality rate. Each type of cancer has its own screening test through which the pathologist can identifies the precancerous or cancerous cells. Lung cancer is screened by using spiral computed tomography technique.  Mammography and Magnetic resonance imaging methods are used to screen the breast cancer. Human Papillomavirus testing and pap test are used to find out the cervical cancer. The techniques practice to screen the colorectal cancer are colonoscopy, sigmoidoscopy and fecal occult blood test. Screening tests must be safe, well-tolerated and effective with appropriately low rates of false positive and false negative results. Screening has many risks such as over diagnosis, false positives, increased testing and false assurance.

Biopsy is the removal of small amount of tissue or sample of cells from your body for examination under a microscope. Other diagnostic techniques can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The removal of entire lump or suspicious area is called an excisional biopsy. A larger needle with a cutting tip is used to draw a column of tissue out of a suspicious area is called core needle biopsy. In Vacuum-assisted biopsy, the suction device is used to collect the sample which increases the amount of fluid and cell that is extracted through the needle. Endoscopic biopsy is most often used in gastric cancers to remove the tissues for examination. The removal of small amount of solid tissue from a bone marrow using a needle is called bone marrow biopsy. This method is used to find out if a person has a blood cancer. Blood cancers include leukemia, lymphoma, or multiple myeloma. The combination of an imaging procedure such as X-ray, computerized tomography (CT), magnetic resonance imaging (MRI) or ultrasound with a needle biopsy is known as Image-guided biopsy.

Chemotherapy is a type of cancer treatment that uses chemotherapeutic drugs to destroy the tumor cells. A doctor who specializes in treating cancer with medication, called a medical oncologist. The chemotherapy which is used before surgery or radiation to shrink a tumor is known as neoadjuvant chemotherapy and after surgery or radiation to kill any remaining cancer cell is known as adjuvant chemotherapy. In intravenous chemotherapy, chemotherapeutic agents are given directly into vein to reach the tumor cells. Oral chemotherapy is usually taken in the form of a pill or capsule. Chemotherapeutic drugs are injected into an artery to treat the cancer is called intra-arterial chemotherapy (IA chemotherapy).  Topical Chemotherapy is a cream or lotion applied directly to treat the skin cancer. When chemotherapeutic agents travel through the bloodstream to reach cells throughout the body, it is called systemic chemotherapy. When chemotherapeutic drugs are directed to a specific area of the body, it is called regional chemotherapy. These treatment cures many types of cancer effectively, but also cause different side effects.

Molecular diagnosis is evolving as a new and eye-opening methodology that merges proteomics and genomics for early detection and diagnosis of cancer. Genomics and proteomics tools are used to detect distinctive molecular signatures like changes in gene expressions, protein biomarker profiles, genetic and epigenetic signatures and other metabolite profile changes. This allows to identify the combinations of biomarkers which may sense the presence or risk of cancer or monitor cancer therapies. sometimes mutations occur in oncogenes, such as KRAS and CTNNB1(β-catenin). Investigating the molecular signature of cancerous cells i.e.  the DNA and its levels of expression via messenger RNA aids physicians to characterize the cancer and to choose the best therapy for their patients

Cancer Drugs are used for treating cancer and relieving symptoms of the cancer (e.g. pain), and side-effects, such as nausea. Doctors treat cancer with two or more chemotherapy drugs and sometimes with other medicines, such as steroids or biological therapies. Anti-cancer drugs eradicate cancer cells by stopping growth or multiplication at some point in their life cycles. Vaccines are medicines that enhance the immune system's natural ability to protect the body against “foreign invaders,” mainly infectious agents, that may cause disease. HPV vaccine and Hepatitis B vaccine are cancer prevention vaccines approved by the U.S. Food and Drug Administration (FDA). Cancer treatment vaccines are called therapeutic vaccines, which increase the ability of immune system to recognize and destroy the antigens. 

Alternative cancer treatments cannot help in curing your cancer, but help to relieve symptoms and improve quality of life during cancer treatment. Common signs and symptoms such as anxiety, fatigue, nausea and vomiting, pain, difficulty sleeping, and stress may be lessened by alternative treatments. Integrating the best of evidence-based complementary and alternative cancer treatments with the treatments you receive from your doctor may help relieve many of the symptoms associated with cancer and its treatment. Ayurvedic, Homeopathy, Acupuncture, Aromatherapy, Exercise, Hypnosis and Music therapy are examples of complementary and alternative medicine therapies which help to cope with side effects of cancer treatments.

A nursing professional who specializes in caring for people with cancer is an Oncology nurse. They monitor physical conditions, prescribe medication, and administer chemotherapy and other treatments. Oncology is one of the most challenging and gratifying fields in nursing. The scope of oncology nursing extents from prevention and early stage diagnosis to treatment (such as surgical oncology, radiation oncology, medical oncology) through symptom management and palliative care. Oncology nurses have a cancer-specific knowledge base and clinical specialize in cancer.  Oncology nurses must inspect numerous details about each patient and they must tend to several patients each day. One mistake could affect a patient’s health, so their attention to detail is critical.

Around 330,000 people are analyzed with cancer each year and 161,000 will die, according to statistics from Cancer Research UK. Cancer is caused by both internal factors (such as hormones, inherited mutations and immune conditions) and environmental factors. The important lifestyle factors include alcohol, tobacco, diet, obesity, infectious agents, environmental pollutants, and radiation increase the mortality of cancer. Tobacco use increases the threat of developing at least 14 types of cancer. The chronic alcohol consumption is a risk factor for cancers of the upper aero digestive tract, including cancers of the oral cavity, pharynx, hypopharynx, larynx, and esophagus. Numerous air pollutants such as PAHs (polycyclic aromatic hydrocarbons) increase the risk of lung cancer. Some cancer cases may be persuaded by ultraviolet (UV), pulsed electromagnetic fields and radiation. Diet is linked to cancer deaths in colorectal cancer cases. The lesser hereditary impact of cancer and the modifiable nature of the environmental factors direct to the preventability of cancer

The study of factors affecting cancer is known as cancer epidemiology. It helps to infer possible trends and causes. The study of cancer epidemiology uses epidemiological approaches to discover the cause of cancer and to classify and develop improved treatments. Observational epidemiological studies that show relation between risk factors and specific cancers mostly aid to generate hypotheses about potential interventions that could reduce morbidity or cancer incidence. Randomized controlled trials then test whether hypotheses generated by epidemiological studies and laboratory research result in reduced cancer incidence and mortality. In many instances, results from observational epidemiological studies are not confirmed by randomized controlled trials.

 The study of epigenetic modifications to the genome of cancer cells that do not include a change in the nucleotide sequence is known as Cancer Epigenetics. Epigenetic alterations are as important as genetic mutations in a cell's transformation to cancer and their manipulation embraces great potential for cancer prevention, detection, and therapy. A variety of compounds are considered as epigenetic carcinogens such as arsenite, diethylstilbestrol, hexachlorobenzene and nickel compounds. They result in an increased incidence of tumors, but they do not show mutagen activity.