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Oncology
Oncology
There are three primary oncology disciplines: medical, surgical and radiation  oncology. A multidisciplinary approach is needed in fighting cancer as in most cases a combination of surgery, chemotherapy and radiation should be involved in an effective treatment.

•    Medical oncology specializes in treating cancer with chemotherapy  and medication, such as, targeted therapy and oral chemotherapy.
•    Surgical oncology specializes in the removal of the tumor and surrounding tissue as well as biopsy operations.
•    Radiation oncology specializes in treating cancer with radiation, aiming to kill cancer cells.  
While combating cancer, it is crucial to;
•    Explain the diagnosis and stage of the cancer in detail; where the cancer is located, where it has spread and whether it is affecting other parts is  
•    Discuss all treatment options
•    Deliver high-quality and compassionate patient care
•    Help maintain the quality of life


Diagnosis
The correct and early diagnosis of cancer plays a crucial role in the successful  treatment of cancer. Early diagnosis of many cancer types significantly increases the rate of survival.  Therefore, the first step is to ensure that high-tech equipments are used for the correct and early diagnosis of all cancer types.  3 dimensional imaging, that is,

Radiology: Radiology is widely used for the diagnosis of cancer. In the last years, there has been breakthrough innovations in this field.  

Tomosynthesis: Tomosynthesis, also called 3D mammography,  is a revolutionary 3D imaging technique used in early diagnosis of breast cancer.

The conventional 2D mammography produces a flattened, single image of the breast, making it impossible to detect small canvers. 3D imaging, on the other hand, give a multi-angled view of the breast, giving a more accurate imaging, thus making possible to detect even small cancers. This technique is especially critical  with women who have high density breast tissue. The procedure takes only a couple of seconds, producing a 3D image of the breast tissue in one millimeter slices, providing greater visibility for the radiologist to see tissue details like never before.

The advantages of tomosynthesis can be summarized as follows:

•    Early detection of small cancers that might not be diagnosed with conventional 2D imaging
•    More Accurate determination of size, shape and location of the tumor
•    Less callback, thus less exposed to radiology; fewer biopsies and additional tests
•    Greater likelihood of detecting multiple breast tumors, which occur in 15% of breast cancer patients

MRI
MRI is a scanning tool that uses a magnetic field and pulses of radio wave energy that produces digital images of the organs and structure of the bones, soft tissues and bones in the body.  It is considered to be a safe as it does not expose the patient to any radiation. Despite extensive research, no evidence has been found to suggest that MRI scanning poses a risk to human health and safety, making it one of the safest medical procedures currently available. However, people who have certain types of implants, such as pacemaker, cannot have an MRI scan. During scanning, the patient lies on a bed that is moved in a tube that contains a strong magnet. It might be uncomfortable to some people as it produces loud noises and in the case of a closed MRI scanner, it might feel claustrophobic. However, the patient can talk to the radiologist at all times through intercom and earplugs are given so that the noise is not that disturbing.  

The main advantage of MRI scanning is that it may show problems that cannot be detected with other imaging methods. In many cases, it is used after other diagnosing methods have been insufficient.

Doppler Ultrasound
Doppler uses bouncing high-frequency sound waves (ultrasound) to determine how blood flows through blood vessels. I can show blocked or reduced flow of blood through narrow areas in the major arteries of the neck that could cause a stroke,  reveal blood clots in leg veins) that could break loose and block blood flow  to lungs, narrowing or widening of an artery, arterial contractions brought on by cold or emotion (Spastic arterial disease) and closing of vein (Venous occlusion). During pregnancy, Doppler ultrasound may be used to look at blood flow in an unborn baby (fetus) to check the health of the fetus.  It is painless and safe.

X-ray

Bone Densiometry
Bone Densiy is a type of x-ray test used to measure the bone mineral density which estimated the true mass of bone. It is a crucial test to diagnose Osteoporosis and osteopenia

Treatment of Cancer

Radiation Therapy


Radioation therapy, also known as radiotherapy, irradiation, or x-ray therapy, is one of the most common methods for treating cancer. In some cases, it is used alone, especially when the cancer cells are localized in one part of the body.  In others it is complimentary to other treatments, such as surgery, immunotherapy or chemotherapy. Certain drugs used in chemotherapy are radiosentisizers, making cancer cells more sensitive to radiation, which enables radiation therapy to be more effective.  This increases the chances of a successul treatment.

Radioation therapy uses ionizing radiation, also known as high energy radiation, to kill cancer cells by damaging their DNA. It consists of a specific number of treatments given over a set period of time and is overseen by a radiation oncologist. During the treatment, it might be unavoidable to kill healthy, cancer-free cells, however, the goal is to kill healthy cells as few as possible.

The goal of radiation therapy might be curative or palliative. In Palliative treatments, the aim is to relieve symptoms and reduce suffering rather than curing.

Types of Radiation Therapy
External radiotherapy:  It is the most common therapy, in which radiation is given from a special beaming device, mostly a linear accelerator, located outside the body.  

A state-of-the art linear accelerator  has the following functionality:   
  •  Rapidarc
  •  IMRT  - Intensity Modulated Radiotherapy
  •  IGRT - Image Guided Radiotherapy
  •  SBRT - Stereotactic Body Radiotherapy
  •  SRS - Streotactic Radiosurgery
  •  3-D Conformal Treatment
  •  Electron Treatment
A state-of-the-art machine also allows that a minimum  number of healthy cells are killed. Moreover, with an advanced machine, skin damage can also be avoided.

Patients usually receive external-beam radiation therapy in daily treatment sessions over the course of usually 4-6 weeks. The number of sessions depends on many factors, such as the total dose that will be given.   Another reason to have sessions over several weeks is to increase the chance that cancer cells are exposed to radiation at the points in the cell cycle when they are most vulnerable to DNA damage The total dose cannot be given in a less number of sessions as healthy cells affected need time to recover.

External therapy, does not make patients radioactive, the radiation stays in the treatment room.  It is safe to be patients receiving this type of treatment.  

Internal radiation therapy (Brachytherapy): In brachytherapy, radiation is places in the cancer or in the tissues surrounding the cancer. There are several techniques.  Interstitial brachytherapy places the radiation source placed within tumor tissue. Intracavitary brachytherapy places the radiation source in a body cavity or a surgical cavity near a tumor. Episcleral brachytherapy is used to treat melanoma inside the eye and uses a source that is attached to the eye.

In this kind of treatment, radioactive isotopes are sealed in seeds which might be placed inside the body directly or using carrier devices, such as, catheter, needles. When they are places directly the seeds stay in the body permanently. The seeds will not cause harm if they are left in the body. When a carrier is used,  the carrier is removed after a while. In any case, patients who receive brachytherapy are radioactive until the isotopes are still active. Special precautions should be taken to protect other people from radiation exposure while the seeds are still active. In any case, the isotopes decay completely and no longer give off radiation
Other treatment options

Intraoperative radiation therapy (IORT): Radiation therapy is delivered directly to the tumor during surgery, either as external-beam radiation therapy or as internal radiation therapy. This technique allows the surgeon to move healthy tissue out of the way before radiation therapy occurs, and it may be helpful when vital (life-sustaining) organs are located very close to the tumor.

Systemic radiation therapy: In systemic radiation therapy, a patient swallows or receives an injection of a radioactive substance. It is a commonly used therapy for certain types of thyroid cancer.   As in brachytherapy, patients are radioactive and safety measures should be taken to protect people who are in contact with the patient.

Radioimmunotherapy: This treatment uses laboratory-made proteins designed to attach to specific factors only found in cancer cells (monoclonal antibodies) to deliver radiation directly to cancer cells.  As in brachtherapy and systemic radiation therapy, safety measures should be taken to protect other people from the radiation emitted by the patient.
Radiosensitizers and radioprotectors:   Radiosensitizers  are substances that help radiation better destroy tumors while  radioprotectors are those that better protect healthy tissues near the area being treated.

Chemotherapy:  Chemotherapy is the use of drugs to treat cancer. While it can be used as the only therapy, it can also be used as a complimentary treatment, along with surgery and radiation therapy. It is also used to prevent cancer from relapsing and slow down its growth as well as eliminate symptoms caused by cancer (eliminating or reducing pain and similar symptoms. There are more than 100 different kinds of chemotherapy drugs today which are used in the treatment of most cancers.

Healthy cells are reproduced in a balanced way when they die or damaged. However cancer calles divide and grow in an out of control way. As more of them are reproduced they start to occupy more space until they push out space occupied by healthy cells. Chemotherapy (chemo) drugs interfere with a cancer cell's ability to divide and reproduce. Chemo drugs may be applied into the bloodstream to attack cancer cells throughout the body, or they can be delivered directly to specific cancer sites.

Chemotherapy can be given as (monotherapy) or with a combination of medications (combination therapy).
There are several ways in which chemotherapy medication can be given, including tablets and injections directly into a vein.

Immunotherapy
Immunotherapy therapy is a cancer therapy that boosts the body’s own immune system to fight cancer.  There are mainly two methods:

•    The patient's own immune system is trained to recognize tumor cells as targets to be destroyed. Although these treatments boost the immune system in a non-specific way, they may still result in more activity against cancer cells.
•    Therapeutic antibodies are laboratory made immune system proteins, called interferon given to the patient to destroy tumor cells. Interferon is designed to target a specific part of cancer cells.  

In recent years, there is a growing number of research on immunotherapy. There has been success in controlling some kinds of cancer, such as, bladder, breast, colon, kidney, lung, and prostate, as well as leukemia, lymphoma, multiple myeloma, and melanoma.