Oncology at a Glance

Book Preface

Oncology is a discipline that embraces a number of scientific fields. It is at the cutting edge of technology with regard to developments in therapeutic approaches. It is a stimulating and intellectual challenge to not only deliver the therapies of today but also to research and develop the treatments of tomorrow. Research is embedded within the specialties and reflects the origins within academic departments. The delivery of high-quality chemotherapy and radiotherapy services is an important political target and there has been considerable financial investment by the government in expanding cancer services in the UK.

For the undergraduate medical student oncology can be overwhelming, and often the exposure to patients with cancer can be quite fragmented in the undergraduate curriculum. Most student rotations will focus on the diagnostic processes as patients with cancer present to general medical and surgical firms, possibly as acute admissions or via outpatients with a variety of presenting symptoms. Other schools will provide specific rotations in the oncology department and this text is to provide the core knowledge to underpin such a learning experience.

The clinical practice of oncology is the application of a foundation of sciences, including: anatomy, to interpret radiological imaging; physiology, for the impact of a multisystem disease; pharmacology, to design, deliver and monitor systemic anticancer treatments; molecular biology, for the development of viable targets of therapy and to understand the mechanisms of carcinogenesis, genetic risk and resistance to therapy; cell biology, the process of metastasis, vascular invasion and microenvironment of the tumour and how this can affect outcome and approaches to therapy; pathology, to recognise the features of a disease that can affect all systems of the body.

Oncology is therefore the clinical application of the knowledge of science that underpins so much of clinical medicine and does so in an evidence-based manner. This requires clarity of understanding, a fastidious approach to investigation of the patient to obtain a diagnosis, and effective communication with the patient, their family and others within the multidisciplinary team. There are frequent challenges, as sometimes the investigations do not produce a definitive answer and yet a clear plan of management is required for the benefit of the patient.

For many, oncology seems like a depressing specialty and yet there is so much reward for those involved in the care of complex patients. The satisfaction of demonstrating clinical improvement after the intellectual challenge of getting the right diagnosis, planning the right treatment, given the context of the patient and their disease, having communicated understanding to the patient to explain what is likely to happen in the future and having had opportunity to address their concerns and fears, is a reward for many clinicians involved in the management of patients with complex problems, especially those with cancer.

The origins of medical oncology as a specialty lie in the management of haematological and paediatric malignancies. It began as a small research-oriented specialty and clinical research remains an important feature of the specialty. Over the past 20 years, enormous developments have taken place in the medical management of cancer, particularly in the development of therapies for the common solid tumours. Today, medical oncology is a broad-based clinical specialty. It ensures that for common cancers, state-of-the-art therapies of established efficacy are delivered on a national basis, within a framework of care, tailored for the patient as an individual. Medical oncologists increasingly see patients at the beginning of their cancer journey for consideration of adjuvant and neoadjuvant therapies. They work as part of a multidisciplinary team and are able to advise on all aspects of oncological treatment, including its integration with surgery and radiotherapy as well as having the skills to deliver specialist medical therapy.