MEDICAL ONCOLOGY

Oncology is a branch of medicine that deals with cancer. A medical professional who practices oncology is an oncologist.

A cancer is treated by mainly four ways:

• Surgery / Operation
• Radiotherapy
• Medicines
• Cell Therapy – also known as Transplant

Cancer Management is a highly multi disciplinary work. It requires a TEAM approach. It requires PLANNING not PANICK. Many patients in India panick after a cancer diagnosis, and get surgery done in 1-2 days after diagnosis, without going through all treatment options. Most solid tumors can wait for 1-3 weeks before main treatment is done, as is done in USA / Europe. Not all cancer patients need surgery, not all need surgery first. Individualized treatment decisions are important based on careful evaluation of patient’s diagnosis, stage, histology type, patient factors and more.

Three main pillars of cancer management are Surgeon, Radiation oncologist and Medical oncologist. However, other very important team members are pathologist, radiologist, hospitalist, nutrition specialists, rehabilitation experts of different kinds, social worker and more.

Many new patients require input of all three main branches to decide BEST plan for the patient. Such multidisciplinary decision making is done through joint meetings or discussions, frequently known as “tumor board meeting”.

Medical oncology is the branch that deals with Medicines used to treat cancers, and Cellular therapy i.e. Transplant:

• Chemotherapy – these are medicines similar to antibiotics, but instead of bacteria, they kill cancer cells in the body. There are over 50 different chemotherapy medicines, with different uses, side effects, cost, method of administration etc.
• Hormone therapy – medicines that work by altering or blocking various hormones that promote cancer growth.
• Targeted therapy – these are the latest medicines, of many different kinds. They work in various ways. Different drugs are indicated in different cancers or stage, side effects, cost etc. These medicines are based on highly complex research, and have proved extremely important in some cases.

A medical oncologist is expert in use of above noted groups of medicines. There is a separate training, for three years generally, after completing training in medicine. Since these medicines are life saving, and proper use is important to obtain best results, such training is mandatory for use of these medicines. Also, if not used properly, they can result in severe side effects.

All cancer patients do not need chemotherapy. This depends on type of cancer, histology, stage, patient factors, and more.

Because of chemotherapy or other medicines, many patients can now be cured without surgery / operation. For example, chemotherapy added to radiotherapy allows cure of several cancers without surgery which was not possible earlier – many cancers of mouth and throat, food pipe (esophagus), lungs, cervix (part of uterus), urinary bladder and others.

Chemotherapy also revolutionized the treatment of blood cancers (field of Hemato-oncology). These were the cancers which were earlier universally or highly fatal. After chemotherapy, they are now cancers with one of the best cure rates. For example, ALL, a type of leukemia, has 80-90% cure rate in children; Hodgkin’s lymphoma has a cure rate of 80%, and more. Similarly CML now has an excellent targeted therapy known as Imatinib. Rituximab has improved cure rate of lymphomas.

New medicines are constantly being developed to improve cancer cure or control rates.