Oncology

Oncology is a branch of medicine that deals with the prevention, diagnosis, and treatment of cancer. A medical professional who practices oncology is an oncologist.[1] The name's etymological origin is the Greek word ὄγκος (ónkos), meaning "tumor", "volume" or "mass" and the word λόγος (logos), meaning "study".[2]

Cancer survival has improved due to three main components including improved prevention efforts to reduce exposure to risk factors (e.g., tobacco smoking and alcohol consumption),[3] improved screening of several cancers (allowing for earlier diagnosis),[4] and improvements in treatment.[5][6]

Cancers are often managed through discussion on multi-disciplinary cancer conferences[7] where medical oncologists, surgical oncologists, radiation oncologists, pathologists, radiologists, and organ specific oncologists meet to find the best possible management for an individual patient considering the physical, social, psychological, emotional, and financial status of the patient. It is very important for oncologists to keep updated with respect to the latest advancements in oncology, as changes in management of cancer are quite common.

Oncology
Tumor Mesothelioma2 legend
A coronal CT scan showing a malignant mesothelioma, indicated by the asterisk and the arrows
FocusCancerous tumor
SubdivisionsMedical oncology, radiation oncology, surgical oncology
Significant testsTumor markers, TNM staging, CT scans, MRI

Risk factors

Tobacco
The leading cause of cancer, and death from cancer. Smoking is associated with increased risk of cancers of the lung, larynx, mouth, oesophagus, throat, bladder, kidney, liver, stomach, pancreas, colon, rectum, cervix and acute myeloid leukemia. Smokeless tobacco (snuff or chewing tobacco) is associated with increased risks of cancers of the mouth, oesophagus, and pancreas.[8]
Alcohol
Can increase risk of cancer of the mouth, throat, oesophagus, larynx, liver, and breast. The risk of cancer is much higher for those who drink alcohol and also use tobacco.[9]
Obesity
Obese individuals have an increased risk of cancer of the breast, colon, rectum, endometrium, oesophagus, kidney, pancreas, and gallbladder.[10]
Age
Advanced age is a risk factor for many cancers. The median age of cancer diagnosis is 66 years.[11]

Screening

Screening is recommended for cancers of breast,[12] cervix,[13] colon,[14] and lung.[15]

Signs and symptoms

Signs and symptoms usually depend on the site and type of cancer.

Breast cancer
Lump in breast and axilla associated with or without ulceration or bloody nipple discharge.[16]
Endometrial cancer
Bleeding per vagina.[17]
Cervix cancer
Bleeding after sexual intercourse.[18]
Ovarian cancer
Nonspecific symptoms such as abdominal distension, dyspepsia.[19]
Lung cancer
Persistent cough, breathlessness, blood in the sputum, hoarseness of voice.[20]
Head and neck cancer
Non-healing ulcer or growth, lump in the neck.[21]
Brain cancer
Persistent headache, vomiting, loss of consciousness, double vision.[22]
Thyroid cancer
Lump in the neck.[23]
Oesophageal cancer
Painful swallowing predominantly with solid food, weight loss.[24]
Stomach cancer
Vomiting, dyspepsia, weight loss.[25]
Colon & rectal cancer
Bleeding per rectum, alteration of bowel habits.[26]
Liver cancer
Jaundice, pain and mass in right upper abdomen.[27]
Pancreatic cancer
Weight loss, jaundice.[28]
Skin cancer
Non-healing ulcer or growth, mole with sudden increase in size or irregular border, induration, or pain.[29]
Kidney cancer
Blood in urine, abdominal lump.[30]
Bladder cancer
Blood in urine.[31]
Prostate cancer
Urgency, hesitancy and frequency while passing urine, bony pain.[32]
Testis cancer
Swelling of testis, back pain, dyspnoea.[33]
Bone cancer
Pain and swelling of bones.[34]
Lymphoma
Fever, weight loss more than 10% body weight in preceding 6 months and drenching night sweats which constitutes the B symptoms, lump in neck, axilla or groin.[35]
Blood cancer
Bleeding manifestations including bleeding gums, bleeding from nose, blood in vomitus, blood in sputum, blood stained urine, black coloured stools, fever, lump in neck, axilla, or groin, lump in upper abdomen.[20]

Diagnosis and staging

Diagnostic and staging investigations depend on the site and type of malignancy.

Blood cancer

Blood investigations including hemoglobin, total leukocyte count, platelet count, peripheral smear, red cell indices.

Bone marrow studies including aspiration, flow cytometry,[36] cytogenetics,[37] fluorescent in situ hybridisation and molecular studies.[38]

Lymphoma

Excision biopsy of lymph node for histopathological examination,[39] immunohistochemistry,[40] and molecular studies.[41]

Blood investigations include lactate dehydrogenase (LDH), serum uric acid, and kidney function tests.[42]

Imaging tests such as computerised tomography (CT), positron emission tomography (PET CT).[43]

Bone marrow biopsy.[44]

Solid tumors

Biopsy for histopathology and immunohistochemistry.[45]

Imaging tests like X-ray, ultrasonography, computerised tomography (CT), magnetic resonance imaging (MRI) and PET CT.[46]

Endoscopy including Naso-pharyngoscopy, Direct & Indirect Laryngoscopy, Upper Gastrointestinal Endoscopy, Colonoscopy, Cystoscopy.

Tumor markers including alphafetoprotein (AFP),[47] Beta Human Chorionic Gonadotropin (HCG),[47] Carcinoembionic Antigen (CEA),[48] CA 125,[49] Prostate specific antigen (PSA).[50]

Treatment

Treatment depends on the site and type of cancer.

Solid tumors

Breast cancer
Treatment options include surgery, radiation, chemotherapy, hormonal therapy, and targeted therapy (Her 2 neu inhibitors).[51]
Cervix cancer
Treatment options include radiation, surgery and chemotherapy.[52]
Endometrial cancer
Treatment options include surgery, radiation, and chemotherapy.[53]
Ovary cancer
Treatment options include surgery, chemotherapy, and targeted therapy (VEGF inhibitors).[54]
Lung cancer
Treatment options include surgery, radiation, chemotherapy, and targeted therapy (EGFR & ALK inhibitors).[55]
Head & Neck Cancer
Treatment options include surgery, radiation, chemotherapy, and targeted therapy (EGFR inhibitors).[56]
Brain cancer
Treatment options include surgery, radiation, chemotherapy, and targeted therapy (VEGF inhibitors).[51]
Thyroid cancer
Treatment options include surgery and radioactive iodine.[57]
Oesophageal cancer
Treatment options include radiation, chemotherapy, and surgery.[58]
Stomach cancer
Treatment options include chemotherapy, surgery, radiation, and targeted therapy (Her 2 neu inhibitors).[59][60]
Colon cancer
Treatment options include surgery, chemotherapy, and targeted therapy (EGFR & VEGF inhibitors).[61]
Rectum cancer
Treatment options include chemotherapy, radiation, surgery.[62]
Liver cancer
Treatment options include surgery, Trans-arterial chemotherapy (TACE), Radio-frequency ablation (RFA), and multi-kinase (Sorafenib).[63]
Pancreas cancer
Treatment options include surgery, radiation, and chemotherapy.[64]
Skin cancer
Treatment options include surgery, radiation, targeted therapy (BRAF & MEK inhibitors), Immunotherapy (CTLA 4 & PD 1 inhibitors, and chemotherapy.[65]
Kidney cancer
Treatment options include surgery, multi-kinase inhibitors, and targeted therapy (mTOR & VEGF inhibitors).[66]
Bladder cancer
Treatment options include surgery, radiation, and chemotherapy.[67]
Prostate cancer
Treatment options include surgery, radiation, chemotherapy, anti-androgens, and immunotherapy.[68]
Testis cancer
Treatment options include surgery, chemotherapy, and radiation.[69]
Bone cancer
Treatment options include surgery, chemotherapy, and radiation.[70]

Lymphoma

It includes Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL):

Hodgkin lymphoma (HL)
Chemotherapy with ABVD or BEACOPP regimen and Involved field radiation therapy (IFRT).[71]
Non-Hodgkin lymphoma (NHL)
Chemo-immunotherapy (R-CHOP) for B cell lymphomas, and chemotherapy (CHOP) for T cell lymphomas.[72]

Blood cancer

Includes acute and chronic leukemias. Acute leukemias includes acute lymphoblastic leukemia (ALL), and acute myeloid leukemia (AML). Chronic leukemias include chronic lymphocytic leukemia (CLL), and chronic myeloid leukemia (CML).

Acute lymphoblastic leukemia (ALL)
Intensive chemotherapy phase for initial 6 months and maintenance chemotherapy for 2 years. Prophylactic cranial and stem cell transplantation for high-risk patients.[73]
Acute myeloid leukemia (AML)
Induction with chemotherapy (Daunorubicin + Cytarabine), followed by consolidation chemotherapy (High dose cytarabine). Stem cell transplantation for high-risk patients.[74]
Chronic lymphocytic leukemia (CLL): Chemo-immunotherapy (FCR or BR regimen) for symptomatic patients.[75]
Chronic myeloid leukemia (CML)
Targeted therapy with tyrosine kinase inhibitor (Imatinib) as first-line treatment.[76]

Specialties

  • The three main divisions:
  • Sub-specialties in Oncology:
    • Neuro-oncology: focuses on cancers of brain.
    • Ocular oncology: focuses on cancers of eye.[79]
    • Head & Neck oncology: focuses on cancers of oral cavity, nasal cavity, oropharynx, hypopharyx and larynx.[80]
    • Thoracic oncology: focuses on cancers of lung, mediastinum, oesophagus and pleura.[81]
    • Breast oncology: focuses on cancers of breast
    • Gastrointestinal oncology: focuses on cancers of stomach, colon, rectum, anal canal, liver, gallbladder, pancreas.[82]
    • Bone & Musculoskeletal oncology: focuses on cancers of bones and soft tissue.[83]
    • Dermatological oncology: focuses on the medical and surgical treatment of skin, hair, sweat gland, and nail cancers
    • Genitourinary oncology: focuses on cancers of genital and urinary system.[84]
    • Gynecologic oncology: focuses on cancers of the female reproductive system.[85]
    • Pediatric oncology: concerned with the treatment of cancer in children.[86]
    • Hemato oncology: focuses on cancers of blood and stem cell transplantation
    • Preventive oncology: focuses on epidemiology & prevention of cancer.[87]
    • Geriatric oncology: focuses on cancers in elderly population.[88]
    • Pain & Palliative oncology: focuses on treatment of end stage cancer to help alleviate pain and suffering.[89]
    • Molecular oncology: focuses on molecular diagnostic methods in oncology.[90]
    • Oncopathology: A specialty of Pathology that focuses on the histopathological diagnosis of cancer. As a significant portion of all general pathology practice is concerned with cancer, the practice of oncology is deeply tied to, and dependent upon, the work of both anatomical and clinical pathologists.[78]
    • Nuclear medicine oncology: focuses on diagnosis and treatment of cancer with radiopharmaceuticals.
    • Psycho-oncology: focuses on psychosocial issues on diagnosis and treatment of cancer patients.
    • Veterinary oncology: focuses on treatment of cancer in animals.[91]

Progress and future

See also

References

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Bibliography

External links

American Society of Clinical Oncology

The American Society of Clinical Oncology (ASCO) is a professional organization representing physicians of all oncology sub-specialties who care for people with cancer. Founded in 1964 by Drs. Fred Ansfield, Harry Bisel, Herman Freckman, Arnoldus Goudsmit, Robert Talley, William Wilson, and Jane C. Wright, ASCO has nearly 45,000 members worldwide.

Benignity

Benignity (from Latin benignus "kind, good", itself deriving from bonus "good" and genus "origin") is any condition that is harmless in the long run. The opposite of benignity is malignity (or malignancy in Medical discourse).

In oncology (the study of cancer)Benign tumorOutside oncologyBenign intracranial hypertension

Benign myalgic encephalomyelitis

Benign paroxysmal positional vertigo

Benign prostatic hyperplasia

Benign tertian malaria (malaria caused specifically by Plasmodium vivax or Plasmodium ovale)

Chemotherapy

Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents) as part of a standardized chemotherapy regimen. Chemotherapy may be given with a curative intent (which almost always involves combinations of drugs), or it may aim to prolong life or to reduce symptoms (palliative chemotherapy). Chemotherapy is one of the major categories of the medical discipline specifically devoted to pharmacotherapy for cancer, which is called medical oncology.

The term chemotherapy has come to connote non-specific usage of intracellular poisons to inhibit mitosis, cell division. The connotation excludes more selective agents that block extracellular signals (signal transduction). The development of therapies with specific molecular or genetic targets, which inhibit growth-promoting signals from classic endocrine hormones (primarily estrogens for breast cancer and androgens for prostate cancer) are now called hormonal therapies. By contrast, other inhibitions of growth-signals like those associated with receptor tyrosine kinases are referred to as targeted therapy.

Importantly, the use of drugs (whether chemotherapy, hormonal therapy or targeted therapy) constitutes systemic therapy for cancer in that they are introduced into the blood stream and are therefore in principle able to address cancer at any anatomic location in the body. Systemic therapy is often used in conjunction with other modalities that constitute local therapy (i.e. treatments whose efficacy is confined to the anatomic area where they are applied) for cancer such as radiation therapy, surgery or hyperthermia therapy.

Traditional chemotherapeutic agents are cytotoxic by means of interfering with cell division (mitosis) but cancer cells vary widely in their susceptibility to these agents. To a large extent, chemotherapy can be thought of as a way to damage or stress cells, which may then lead to cell death if apoptosis is initiated. Many of the side effects of chemotherapy can be traced to damage to normal cells that divide rapidly and are thus sensitive to anti-mitotic drugs: cells in the bone marrow, digestive tract and hair follicles. This results in the most common side-effects of chemotherapy: myelosuppression (decreased production of blood cells, hence also immunosuppression), mucositis (inflammation of the lining of the digestive tract), and alopecia (hair loss). Because of the effect on immune cells (especially lymphocytes), chemotherapy drugs often find use in a host of diseases that result from harmful overactivity of the immune system against self (so-called autoimmunity). These include rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis, vasculitis and many others.

Department of Oncology, University of Cambridge

The Department of Oncology at the University of Cambridge is part of the School of Clinical Medicine. It is based on 6 locations at or near to Addenbrooke's Hospital, Cambridge and has large university and NHS components.

In 2008, the Department staff, together with the Departments of Pathology and Haematology, were formally assessed as:

35% of submissions were awarded a 4* grading (world-leading in originality, significance and rigour)

40% was awarded a 3* grading (internationally excellent in originality, significance and rigour)

Fellowship (medicine)

A Fellowship is the period of medical training, in the United States and Canada, that a physician or dentist may undertake after completing a specialty training program (residency). During this time (usually more than one year), the physician is known as a Fellow. Fellows are capable of acting as an Attending Physician or a Consultant Physician in the generalist field in which they were trained, such as Internal Medicine or Pediatrics. After completing a Fellowship in the relevant sub-specialty, the Physician is permitted to practice without direct supervision by other physicians in that sub-specialty, such as Cardiology or Oncology.

Glioblastoma

Glioblastoma, also known as glioblastoma multiforme (GBM), is the most aggressive cancer that begins within the brain. Initially, signs and symptoms of glioblastoma are non-specific. They may include headaches, personality changes, nausea, and symptoms similar to those of a stroke. Worsening of symptoms often is rapid. This may progress to unconsciousness.The cause of most cases is unclear. Uncommon risk factors include genetic disorders such as neurofibromatosis and Li–Fraumeni syndrome, and previous radiation therapy. Glioblastomas represent 15% of brain tumors. They can either start from normal brain cells or develop from an existing low-grade astrocytoma. The diagnosis typically is made by a combination of CT scan, MRI scan, and tissue biopsy.There is no clear way to prevent the disease. Typically, treatment involves surgery, after which chemotherapy and radiation therapy are used. The medication temozolomide is used frequently as part of chemotherapy. High dose steroids may be used to help reduce swelling and decrease symptoms. It is unclear whether trying to remove all or simply most of the cancer is better.Despite maximum treatment, the cancer usually recurs. The most common length of survival following diagnosis is 12 to 15 months, with fewer than 3% to 5% of people surviving longer than five years. Without treatment, survival is typically three months. It is the most common cancer that begins within the brain and the second most common brain tumor, after meningioma. About 3 per 100,000 people develop the disease a year. It most often begins around 64 years of age and occurs more commonly in males than females. Immunotherapy is being studied.

Gynecologic oncology

Gynecologic oncology is a specialized field of medicine that focuses on cancers of the female reproductive system, including ovarian cancer, uterine cancer, vaginal cancer, cervical cancer, and vulvar cancer. As specialists, they have extensive training in the diagnosis and treatment of these cancers.

In the United States, 82,000 women are diagnosed with gynecologic cancer annually. In 2013, an estimated 91,730 were diagnosed.The Society of Gynecologic Oncology and the European Society of Gynaecological Oncology are professional organizations for gynecologic oncologists, and the Gynecologic Oncology Group is a professional organization for gynecological oncologists as well as other medical professionals who deal with gynecologic cancers. The Foundation for Women's Cancer is the major U.S. organization that raises awareness and research funding and provides educational programs and materials about gynecologic cancers.

History of cancer

The history of cancer describes the development of the field of oncology and its role in the history of medicine.

Kidwai Memorial Institute of Oncology

Kidwai Memorial Institute of Oncology (Kannada: ಕಿದ್ವಾಯಿ ಸ್ಮಾರಕ ಗಂಥಿ ಸಂಸ್ಥೆ ) is a cancer care hospital in Bangalore Karnataka state, India. It is an autonomous institution of the Government of Karnataka and a Regional Cancer Centre funded by the Government of India. It was granted Regional Cancer Centri status on 1 November 1980. The Indian Council of Medical Research has recognised this referral Institution as a research organization.

Malabar Cancer Centre

Malabar Cancer Center (MCC), established at Kodiyeri near Thalassery in Kerala state, South India, is an autonomous centre under the government of Kerala. MCC is constituted as a Charitable Society under the Department of Power.

This project is envisaged to develop a hospital with all modern facilities for diagnosis and management of cancer patients, and is proposed to be constructed with financial assistance collected from various sources in Canada sponsored by M/s SNC Lavalin Inc., Canada.

As token of constant service January 2001, and the therapeutic service was started from the 1 March 2001. Apart from the diagnostic procedures, the therapeutic services include chemotherapy, surgery and palliative treatment.

A full-fledged blood bank with component separation facility is available along with the Radiation Oncology and medical imaging departments which are equipped with the Cobalt tele therapy machine, Brachy therapy machine, Radiotherapy Simulator and Multi Slice CT scanner unit.

The centre, once fully completed, is proposed to be one of the best cancer treatment centres in the country, catering at least half of the population of Kerala, particularly in the northern district of the state, and also people of the neighboring areas of Tamil Nadu and Karnataka with major departments like Medical Oncology, Radiation, oncology, Surgical Oncology, and Preventive Oncology. It also includes facilities of radiotherapy using linear accelerator, facility for bone marrow transplant, and all cancer-related investigatory facilities every year with an estimated patient visit of 70,000 per year.

www.mcc.kerala.gov.in

Malignancy

Malignancy (from Latin male, meaning 'badly', and -gnus, meaning 'born') is the tendency of a medical condition to become progressively worse.

Malignancy is most familiar as a characterization of cancer. A malignant tumor contrasts with a non-cancerous benign tumor in that a malignancy is not self-limited in its growth, is capable of invading into adjacent tissues, and may be capable of spreading to distant tissues. A benign tumor has none of those properties.

Malignancy in cancers is characterized by anaplasia, invasiveness, and metastasis. Malignant tumors are also characterized by genome instability, so that cancers, as assessed by whole genome sequencing, frequently have between 10,000 and 100,000 mutations in their entire genomes. Cancers usually show tumour heterogeneity, containing multiple subclones. They also frequently have reduced expression of DNA repair enzymes due to epigenetic methylation of DNA repair genes or altered microRNAs that control DNA repair gene expression.

Uses of "malignant" in oncology:

Malignancy, malignant neoplasm and malignant tumor are synonymous with cancer

Malignant ascites

Malignant transformationNon-oncologic disorders referred to as "malignant":

Malignant hypertension

Malignant hyperthermia

Malignant otitis externa

Malignant tertian malaria (malaria caused specifically by Plasmodium falciparum)

Neuroleptic malignant syndrome

Molecular oncology

Molecular oncology is an interdisciplinary medical speciality at the interface of medicinal chemistry and oncology that refers to the investigation of the chemistry of cancer and tumors at the molecular scale. Also the development and application of molecularly targeted therapies.

Oncology nursing

An oncology nurse is a specialized nurse who cares for cancer patients. These nurses require advanced certifications and clinical experiences in oncology further than the typical baccalaureate nursing program provides. Oncology nursing care can defined as meeting the various needs of oncology patients during the time of their disease including appropriate screenings and other preventative practices, symptom management, care to retain as much normal functioning as possible, and supportive measures upon end of life.

Pediatrics

Pediatrics (also spelled paediatrics or pædiatrics) is the branch of medicine that involves the medical care of infants, children, and adolescents. The American Academy of Pediatrics recommends people be under pediatric care up to the age of 21. A medical doctor who specializes in this area is known as a pediatrician, or paediatrician. The word pediatrics and its cognates mean "healer of children"; they derive from two Greek words: παῖς (pais "child") and ἰατρός (iatros "doctor, healer"). Pediatricians work both in hospitals, particularly those working in its subspecialties such as neonatology, and as primary care physicians.

Radiation therapy

Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is therapy using ionizing radiation, generally as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radiation therapy may be curative in a number of types of cancer if they are localized to one area of the body. It may also be used as part of adjuvant therapy, to prevent tumor recurrence after surgery to remove a primary malignant tumor (for example, early stages of breast cancer). Radiation therapy is synergistic with chemotherapy, and has been used before, during, and after chemotherapy in susceptible cancers. The subspecialty of oncology concerned with radiotherapy is called radiation oncology.

Radiation therapy is commonly applied to the cancerous tumor because of its ability to control cell growth. Ionizing radiation works by damaging the DNA of cancerous tissue leading to cellular death. To spare normal tissues (such as skin or organs which radiation must pass through to treat the tumor), shaped radiation beams are aimed from several angles of exposure to intersect at the tumor, providing a much larger absorbed dose there than in the surrounding, healthy tissue. Besides the tumour itself, the radiation fields may also include the draining lymph nodes if they are clinically or radiologically involved with tumor, or if there is thought to be a risk of subclinical malignant spread. It is necessary to include a margin of normal tissue around the tumor to allow for uncertainties in daily set-up and internal tumor motion. These uncertainties can be caused by internal movement (for example, respiration and bladder filling) and movement of external skin marks relative to the tumor position.

Radiation oncology is the medical specialty concerned with prescribing radiation, and is distinct from radiology, the use of radiation in medical imaging and diagnosis. Radiation may be prescribed by a radiation oncologist with intent to cure ("curative") or for adjuvant therapy. It may also be used as palliative treatment (where cure is not possible and the aim is for local disease control or symptomatic relief) or as therapeutic treatment (where the therapy has survival benefit and it can be curative). It is also common to combine radiation therapy with surgery, chemotherapy, hormone therapy, immunotherapy or some mixture of the four. Most common cancer types can be treated with radiation therapy in some way.

The precise treatment intent (curative, adjuvant, neoadjuvant therapeutic, or palliative) will depend on the tumor type, location, and stage, as well as the general health of the patient. Total body irradiation (TBI) is a radiation therapy technique used to prepare the body to receive a bone marrow transplant. Brachytherapy, in which a radioactive source is placed inside or next to the area requiring treatment, is another form of radiation therapy that minimizes exposure to healthy tissue during procedures to treat cancers of the breast, prostate and other organs. Radiation therapy has several applications in non-malignant conditions, such as the treatment of trigeminal neuralgia, acoustic neuromas, severe thyroid eye disease, pterygium, pigmented villonodular synovitis, and prevention of keloid scar growth, vascular restenosis, and heterotopic ossification. The use of radiation therapy in non-malignant conditions is limited partly by worries about the risk of radiation-induced cancers.

Specialty (medicine)

A medical speciality is a branch of medical practice that is focused on a defined group of patients, diseases, skills or philosophy, e.g. children (paediatrics), cancer (oncology), laboratory medicine (pathology) or primary care (family medicine). After completing medical school, physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple year residency to become a medical specialist.

Surgical oncology

Surgical oncology is the branch of surgery applied to oncology; it focuses on the surgical management of tumors, especially cancerous tumors.

As one of several modalities in the management of cancer, the specialty of surgical oncology, before modern medicine the only cancer treatment with a chance of success, has evolved in steps similar to medical oncology (pharmacotherapy for cancer), which grew out of hematology, and radiation oncology, which grew out of radiology. The Ewing Society known today as the Society of Surgical Oncology was started by surgeons interested in promoting the field of oncology. Complex General Surgical Oncology was ratified by a specialty Board certification in 2011 from the American Board of Surgery. The proliferation of cancer centers will continue to popularize the field, as will developments in minimally invasive techniques, palliative surgery, and neo-adjuvant treatments.

The Lancet

The Lancet is a weekly peer-reviewed general medical journal. It is among the world's oldest, most prestigious, and best known general medical journals.The journal was founded in 1823 by Thomas Wakley, an English surgeon who named it after the surgical instrument called a lancet, as well as after the architectural term "lancet arch", a window with a sharp pointed arch, to indicate the "light of wisdom" or "to let in light".

The journal publishes original research articles, review articles ("seminars" and "reviews"), editorials, book reviews, correspondence, as well as news features and case reports. The Lancet has been owned by Elsevier since 1991. Since 1995, the editor-in-chief is Richard Horton. The journal has editorial offices in London, New York, and Beijing.

Urology

Urology (from Greek οὖρον ouron "urine" and -λογία -logia "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the male and female urinary-tract system and the male reproductive organs. Organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles, prostate, and penis).

The urinary and reproductive tracts are closely linked, and disorders of one often affect the other. Thus a major spectrum of the conditions managed in urology exists under the domain of genitourinary disorders. Urology combines the management of medical (i.e., non-surgical) conditions, such as urinary-tract infections and benign prostatic hyperplasia, with the management of surgical conditions such as bladder or prostate cancer, kidney stones, congenital abnormalities, traumatic injury, and stress incontinence.

Urological techniques include minimally invasive robotic and laparoscopic surgery, laser-assisted surgeries, and other scope-guided procedures. Urologists receive training in open and minimally invasive surgical techniques, employing real-time ultrasound guidance, fiber-optic endoscopic equipment, and various lasers in the treatment of multiple benign and malignant conditions. Urology is closely related to (and urologists often collaborate with the practitioners of) oncology, nephrology, gynaecology, andrology, pediatric surgery, colorectal surgery, gastroenterology, and endocrinology.

Urology is one of the most competitive and highly sought surgical specialties for physicians, with new urologists comprising less than 1.5% of United States medical-school graduates each year.Urologic surgeons, or urologists, undergo a post-graduate surgical training period for a minimum of five years, of which 12 months must be completed in general surgery and 36 months must be completed in clinical urology. The remaining 12 months are spent in general surgery, urology, or other clinical disciplines relevant to urology. Upon successful completion of a residency program, many urologists choose to undergo further advanced training in a subspecialty area of expertise through a fellowship lasting an additional 12 to 36 months. Subspecialties may include: urologic surgery, urologic oncology and urologic oncological surgery, endourology and endourologic surgery, urogynecology and urogynecologic surgery, reconstructive urologic surgery (a form of reconstructive surgery), minimally invasive urologic surgery, pediatric urology and pediatric urologic surgery (including adolescent urology, the treatment of premature or delayed puberty, and the treatment of congenital urological syndromes, malformations, and deformations), transplant urology (the field of transplant medicine and surgery concerned with transplantation of organs such as the kidneys, bladder tissue, ureters, and, recently, penises), voiding dysfunction, neurourology, and androurology and sexual medicine. Additionally, some urologists supplement their fellowships with a master's degree (2–3 years) or with a Ph.D. (4–6 years) in related topics to prepare them for academic as well as focused clinical employment.

Specialties
and
subspecialties
Medical education
Related topics
Overview of tumors, cancer and oncology (C00–D48, 140–239)
Conditions
Staging/grading
Carcinogenesis
Misc.

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