– Oncology –
There is no typical day in my work as an Oncologist in the local Complex oncological center. The work is very diverse as are the cases we deal with every day – some patients come for a routine follow-up treatment, while in the next moment I may get called in the emergency room. I try to focus on speaking with my patients to help them understand their condition, discuss the treatment options.
It is very hard talking to a patient with an incurable cancer – one of the most important things in such cases is providing a painless treatment, while not giving any false hopes. In this is one of the ethical questions of cancer care. Although therapeutic possibilities are developing fast in the recent years, malignant tumors are responsible for about 14% of all human deaths.
The Oncologists, also called Cancer specialists, are physicians who diagnose and treat any form of cancer.
They specialize in three main subspecialties of Oncology:
1) Medical oncology – focused on the diagnose and treatment of the patients with chemotherapy, surgery, immunotherapy, hormonal therapy as well as taking care for their follow-up treatment.
Some colleagues specialize in Gynecological oncology (of the female reproductive system) or Pediatric oncology (treatment of cancer in children);
2) Surgical oncology – in this subspecialty the physicians specialize in performing surgery and biopsies on patients with cancer;
3) Radiation oncology – a subspecialty focused on the use of radiotherapy to treat cancer, cancer diagnosis through x-ray imaging and other imaging techniques. Since there is a huge amount of research going on in all fields of oncology we, as cancer specialists, need to stay up-to-date with all progress.
What is Cancer?
The oncologist is trained to diagnose over 100 variations of cancer in the human body. The abnormal growth of cells in the body, which divide uncontrollably and pose a thread to the body as they form lumps or invade other tissues, is called a malignant tumor or cancer.
The cancer cells do not follow the life-cycle of normal cells due to mutations in their DNA. Since they do not follow a programmed growth, division and death, they accumulate and form tumors.
Not all tumors are cancerous — when the malignant cells do not spread into other parts of the body they are called benign tumors and do not pose a thread as serious as the cases of cancer.
Most cancers can be prevented by not smoking, maintaining a healthy weight and diet. Tobacco and obesity are the leading reasons for cancer, along with other environmental factors. Some specific foods and food additives, Carcinogens, infections from oncoviruses, which are responsible for about 17% of cancer cases worldwide, genetic predisposition (when there have been cases in the family), exposure to radiation and other medical factors like age.
Although radiation can be used to treat cancer, about 10% of cancer cases are related to different types of radiation exposure. The most common cancer in the world is caused by the ultraviolet radiation of the sun – non-melanoma skin cancer.
Diagnosis and treatment of cancer:
Today, every third person develops an oncological disease during his lifetime – patients with cancer are a large number of all the cases an average physician faces. Cancer is hard to diagnose at first, since it mimics numerous other conditions as the malignant tissues grow and many times, the patients have been treated for other conditions with similar symptoms, since there are few specific symptoms.
The diagnosis is a combination of review of symptoms, tissue analysis, which is called a biopsy and radiological imaging. The symptoms may include the presence of unusual lumps in different areas of the body, persistent cough, rapid weight loss, sweating at night, fever and tiredness or unexplained pain.
The oncologist chooses the most appropriate treatment depending on the location, type and stage of development of the malignant tumor, or even mastitis of the breast – this is always planned individually for the patient. If the tumor is in an early stage and the cancer cells have not spread, it can be removed in its entirety by surgery, which cures the patient completely in most cases. Surgical procedures are often chosen for Breast, Testicular cancer and most cases of non-melanoma skin cancer.
Some conditions like Leukemia require immediate intervention with Chemoterapy – this therapy is chosen when cancer cell spread throughout the body. Chemicals are used to affect the divisions of cells. All cells in the body get damaged, hence there are side effects like hair loss, nausea among others, however normal cells recover, while cancer cells cannot.
Leukemia is a cancer which forms in the bone marrow and causes the production of malignant white blood cells, also called ‘leukemia cells’. For this treatment to be successful all leukemia cells must be removed and normal cells must be allowed to form the bone marrow.
The chemotherapy kills the leukemia cells in the blood – the treatment usually lasts about 4 weeks. A follow-up consolidation treatment kills any remaining cancer cells and may include stem-cell transplantation or radiotherapy treatment of the the brain or spinal cord. A maintenance therapy that lasts up to 3 years follows to prevent the regrowth of cancer cells.
Radiation therapy or Radiotherapy destroys cancer cells by focusing high energy rays on them and thus killing them. This treatment is chosen when the tumor has not spread throughout the entire body, because it can be focused only on it. Like the chemotherapy, the radiation treatment may affect also healthy cells around the cancer, but while cancer cells die, normal cells recover.
The procedures may last up to 10 weeks depending on the size of the tumor, with breaks given in the weekends for recovery. This sometimes could be the only treatment a patient would need, but in other cases it’s goal is only to shrink or slow down the development of the tumor. This therapy is often combined Chemotherapy or Surgery.
In the clinic we have a lot of patients with non-melanoma skin cancer. Diagnosis is done via biopsy. In most cases, surgical removal of the skin in affected area by is very effective. This type of cancer develops slowly and if diagnosed early is easy to remove, however, if it has spread, chemotherapy would be necessary.
Medication is rarely used, but when the skin cancer is too large to be removed by surgery it may be prescribed and applied locally on the skin. The oncologist may recommend a follow-up treatment with radiation.
Immunotherapy is a very innovative way of treating different types of cancer and is developing fast in the recent years.
It may consist in the simple stimulation of one’s immune system or it can be targeted in specific way by teaching the immune system with Monoclonal antibodies to attack and kill the cancer cells.
When compared to chemotherapy, this type of treatment may have less side effects, but incan still cause fever, headaches, nausea and vomiting in many people.