Oncology Medical Management

Original Editor - Elaine Lonnemann

Top Contributors - Manisha Shrestha, Admin, Lucinda hampton, Kim Jackson, George Prudden, Vidya Acharya, WikiSysop and Evan Thomas

This article is currently under review and may not be up to date. Please come back soon to see the finished work! (9/07/2020)

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Introduction

About cancer and oncology and then link up it with main page of oncology

Oncology is a branch of medicine that deals with tumors. A medical professional who practices oncology is an oncologist. Tumors simply refer to the mass. Whereas cancer is a particularly threatening type of tumor that refers to new growth and has the ability to invade surrounding tissues, metastasize (spread to other organs), and which may eventually lead to the patient's death if untreated. Another term in oncology is Neoplasm which is an abnormal new growth of cells. The cells in a neoplasm usually grow more rapidly than normal cells and will continue to grow if not treated. As they grow, they may impinge or damage adjacent tissues. A neoplasm can be classified as a benign tumor (localized and does not metastasized) and malignant tumors (cancerous and metastasized). Cancer can be also defined as a malignant neoplasm. Thus, Cancer is a chronic disease which if untreated is progressive in nature.

Medical histories remain an important screening tool: the character of the complaints and nonspecific symptoms (such as fatigue, weight loss, unexplained anemia, fever of unknown origin, Paraneoplastic phenomena, and other signs) may warrant further investigation for malignancy. A physical examination may help localize of a malignancy. The radiographic finding helps to find the location, size of the neoplasm. Diagnostic methods include: Biopsy or Resection; these are methods by which suspicious neoplastic growths can be removed in part or in whole, and evaluated by a pathologist to determine malignancy. This is currently the gold standard for the diagnosis of cancer and is crucial in guiding the next step in management

Multidisciplinary treatment approach

about role of different teams and evidences supporting multidisciplinary approaches and link up physiotherapy treatment page

Cancer is managed in a multidisciplinary team setting to improve outcome (quality of life and prolong the person's life) and decrease morbidity of treatment. Multidisciplinary team includes following members include surgeons, radiation and medical oncologists/hematologists, palliative care physicians, radiologists, pathologists, general practitioners, nurses and allied health professionals (Occupation therapist, physiotherapist).

There are various roles specified to each multidisciplinary team members. For instance,

Specialties	Examples of roles
Medical oncologist	Chemotherapy, biological therapy, hormonal therapy
Radiation oncologist	External beam radiotherapy, brachytherapy, systemic radiation
Palliative care	Symptom control, hospice care
Oncological surgeons	Definitive and palliative surgery
Allied health: Dietician, physiotherapy, occupational therapy, social work, pharmacy and psychology	Relevant to each speciality
Cancer nurses	Care coordination, clinical trials, chemotherapy administration

Principle of cancer management

The overall approach to cancer management depends upon following considerations:

1. Type of cancer
2. Stage of cancer/Extent of the spread of the cancer
3. Curable VS Incurable cancer

These considerations helps to find out the goal of the treatment for the patients and thus prognostic factors of the patients.

Curable cancer:

The goals for curable cancer could be : curative care (active anti-cancer therapy, surgery)

For curable cancers, rate of cure is determined by prognostic factors (for example: tumour size and nodal status in breast cancer).

Incurable cancer:

The goals for incurable cancer is to prolong survival and improve quality of life. It may include palliative care (aim of palliative care is to improve quality of life by controlling symptoms).In most of the cases, concurrent use of palliative care and active anti-cancer therapy are necessary to maintain quality of life.In these situation,it is important to identify and treat the cause of the symptoms rather than adopting a 'one size fits all' management plan.

For instances,

Pain: simple analgesics, narcotics, parenteral narcotics

Nausea: metoclopramide, 5HT3 antagonist, steroids

Loss of appetite: steroids

Cough/SOB: codeine, narcotics, nebulisers.

Depression: control symptoms, correct causes, counselling, antidepressants,family support, aids, home visits, physiotherapy, nutrition, occupational therapy, social work

For incurable cancers, duration of survival is expressed in median survival rather than in absolute time frame which is determined from previous large databases.

Types of cancer management

There are various cancer management approaches which is determined based on principle of cancer management. Most peoplewith cance have combination of treatments eg:sugery with chemotherapy and/or radiation therapy.

Medical therapies including chemotherapy, biological therapy and hormones.

communicates the results of clinical and experimental research in oncology and hematology, particularly with experimental therapeutics with the field of immunotherapy and chemotherapy.

Oncological Emergencies

Physical Therapists need to be aware that certain oncologic emergencies may develop over Time and it is important to know the primary systems affected or causes as well as signs and symptoms for referral. The study suggests using a multidisciplinary treatment system for early diagnosis (MRI) and referral to orthopedists for treatment and prevention of Malignant spinal cord compression (MSCC) in patients with bone metastases.

I. Metabolic

1. Tumor Lysis Syndrome
2. Hypercalcemia of Malignancy
3. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

II. Hematologic

1. Febrile neutropenia
2. Hyperviscosity syndrome

III. Structural

1. Epidural Spinal Cord Compression
2. Malignant Pericardial Effusion
3. Superior Vena Cava Syndrome

IV. Side Effects from Chemotherapy

1. Diarrhea
2. Extravasations
3. Obstipation