Oncology

Original Editor - Elaine Lonnemann

Top Contributors - Elaine Lonnemann, Admin, Lucinda hampton, Fasuba Ayobami, Kim Jackson, Rachael Lowe, George Prudden, WikiSysop and Nicole Hills

Introduction

Oncology is a branch of medicine that specialises in the diagnosis and treatment of cancer. It includes

• Medical oncology (the use of chemotherapy, immunotherapy, hormone therapy, and other drugs to treat cancer),
• Radiation oncology (the use of radiation therapy to treat cancer)
• Surgical oncology (the use of surgery and other procedures to treat cancer).

Cancer is the second leading cause of death globally

• Responsible for an estimated 9.6 million deaths in 2018. Globally, about 1 in 6 deaths is due to cancer.
• Approximately 70% of deaths from cancer occur in low- and middle-income countries.
• Around one third of deaths from cancer are due to the 5 leading behavioral and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, and alcohol use.

Physiotherapy are involved in care, management and rehabilitation of cancer patients from diagnosis to the end of life. They:

• Conduct ongoing assessment of the needs of this patient group and their carers, in order to apply skilled interventions, which are vital for patients’ independence, functional capacity and quality of life.
• Are an essential member of the multi-disciplinary team, which is the key to successful rehabilitation and management of patients with cancer and palliative care.
• The absence of physiotherapy intervention would be detrimental to patient care and the ability of the patient/family to cope with the effects of the disease or its treatment on their functional capacity and quality of life.

The following 5 minutes video is entitled "What causes cancer and how is it treated"

Pathophysiology

Oncology is the branch of medicine that involves the prevention, diagnosis, treatment, and study of cancer. Cancer describes the abnormal growth of cells that results in a large mass known as a tumour.

• Malignant tumours can spread into and invade surrounding tissues and in some cases the cells can break off and travel to other areas of the body, which is known as metatstasis.
• Benign tumours do not invade surrounding tissues and do not continue to grow once they have been removed.
• The regulation of cells is controlled by genetics and it takes changes to genes to create abnormal cancerous cells.
• Genetic changes can be due to either the loss or gain of chromosomes through mitosis (the process of cell duplication) or due to mutations, changes in the nucleotide sequence of genomic DNA.

Causes

There are several causes of cancer, the most common being genetic mutations due to environmental and lifestyle factors, which account for between 90-95% of cases. The remaining are due to inherited genetics. There are many known environmental factors that increase the risk of developing cancer:

• Carcinogens: There are many known carcinogens with the most obvious one being tobacco.
• Tobacco: Each year tobacco is responsible for than 7 million deaths worldwide, more than 6 million of those can be attributed to direct tobacco use, but there are approximately 890,000 that are the result of second-hand tobacco smoke. Recent decreases in the numbers of people smoking has led to a decrease, in many countries, of cancer deaths related to lung cancer 1990.
• Radiation: Radiation has long been known to be carcinogenic. Initially studies focused on incidents that involve large amounts of radiation and it was evident that large doses of radiation were at a higher risk of developing cancer. It is now known that even low doses of radiation emitted by an X-ray machine can put a person at risk, especially if exposure starts young and is repeated often.
• Pollution: Air pollution has been identified as a contributing risk factor for developing cancer and also for lowering the rates of a positive prognosis

• Diet, Exercise and Obesity: Obesity has been recognised as a contributing factor, in relation, to cancer; both in terms of risk and mortality. As well as controlling obesity diet an exercise also have role to play in preventing and managing cancer. The World Health Organisation estimated a 20% to 40% decrease in the risk of developing breast cancer amongst physically active women. And in another study, published in 2008, a group of 2987 women participated in a study, via questionnaire, that showed physical activity was associated with an improved prognosis. As much as physical activity can have a positive effect on preventing and improving prognosis, lack of physical activity can be detrimental

• Infections: It has long been recognised that infections are a cause of cancer and in 2002 it was estimated that approximately 18% of of malignant cancers could be attributed to an infection.

• Stress: There is evidence that stress has a detrimental effect on the immune response and may be a contributing factor to the initiation and in some cases progression of cancer.

Conditions

There are many types of cancer, see below:

• Acute Lymphoblastic Leukemia
• Acute Myeloid Leukemia
• Brain Tumors
• Breast Cancer
• Cervical Cancer
• Chondroblastoma
• Colorectal Cancer
• Ewing's Sarcoma
• Gastric Cancer
• Giant Cell Tumor
• Glioblastoma Multiforme
• Hodgkin's Lymphoma
• Malignant Melanoma
• Multiple Myeloma
• Neuroblastoma
• 
  Non Hodgkin Lymphoma
• Osteoblastoma
• Osteochondroma
• Osteoid Osteoma
• Osteosarcoma
• Pancreatic Cancer
• Paraneoplastic Syndrome
• Renal Cancer
• Skeletal Metastases
• Testicular Cancer
• Thyroid Cancer

Examination

• Oncology Examination

Interventions

• Medical Management
• Physiotherapy Management
• Radiation Side Effects and Syndromes
• Chemotherapy Side Effects & Syndromes

Outcome Measures

Visual Analogue Scale (VAS)

Quality of Life Questionnaire (QoL)

European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30)

Functional Assessment of Cancer and Therapy – General measure (FACT-G)