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Medical Oncology in India

Medical Oncology

The treatment of cancer with the help of certain agents and drugs that travels in the entire system of the body for destroying cancer cells and simultaneously also helps the body to defend itself is the main focus of both medical oncology and hematology. This is assumed as a systemic treatment as compared to radiation oncology that only focuses on treating a particular part of the body. Chemotherapy, drugs and certain other related therapies such as hormone therapies and biological response modifiers are used in medical oncology for treating cancers.

Hormone Therapy : This therapy is considered as a systemic treatment and is also known as endocrine-based therapy. Hormone therapy interferes with certain hormones (natural body chemicals) that help in stimulating the growth of the cancer. Some cancers use these hormones to grow. Hormone therapy for cancer is the use of medicines to block the effects of hormones. It does not work for all types of cancer. Doctors use hormone therapy for people with cancers that are hormone sensitive or hormone dependent. Hormone therapies can slow down or stop the growth of cancer by either

  • Stopping hormones being made or
  • Preventing hormones from making cancer cells grow and divide

Chemotherapy: Chemotherapy literally means drug treatment. In cancer treatment, the term chemotherapy means treatment with cell killing (cytotoxic) drugs. You may have just one chemotherapy drug or a combination of different chemotherapy drugs. There are more than 100 different drugs currently available and new ones are being developed all the time. You may have chemotherapy with other types of cancer drugs. These drugs can be injected into a vein (intravenously) that enters into the bloodstream and travels through the entire body. Chemotherapy can also be administered in pill form. Whether chemotherapy is a suitable treatment for you, and which drugs you might have, depends on many things. These include

  • The type of cancer you have
  • Where in your body the cancer started
  • What the cancer cells look like under the microscope (the grade)
  • Whether the cancer has spread
  • Your general health

There are different types of chemotherapy drugs that include

Alkylating agents

Alkylating agents directly damage DNA (the genetic material in each cell) to keep the cell from reproducing. These drugs work in all phases of the cell cycle and are used to treat many different cancers, including leukemia, lymphoma, Hodgkin disease, multiple myeloma, and sarcoma, as well as cancers of the lung, breast, and ovary

Antimetabolites

Antimetabolites interfere with DNA and RNA growth by substituting for the normal building blocks of RNA and DNA. These agents damage cells during the S phase, when the cell’s chromosomes are being copied. They are commonly used to treat leukemias, cancers of the breast, ovary, and the intestinal tract, as well as other types of cancer

Anti-tumor antibiotics

These drugs are not like the antibiotics used to treat infections. They work by altering the DNA inside cancer cells to keep them from growing and multiplying.

Anthracyclines

Anthracyclines are anti-tumor antibiotics that interfere with enzymes involved in DNA replication. These drugs work in all phases of the cell cycle. They are widely used for a variety of cancers.

Topoisomerase inhibitors

These drugs interfere with enzymes called topoisomerases, which help separate the strands of DNA so they can be copied during the S phase. (Enzymes are proteins that cause chemical reactions in living cells.) Topoisomerase inhibitors are used to treat certain leukemias, as well as lung, ovarian, gastrointestinal, and other cancers

Mitotic inhibitors

Mitotic inhibitors are often plant alkaloids and other compounds derived from natural products. They work by stopping mitosis in the M phase of the cell cycle but can damage cells in all phases by keeping enzymes from making proteins needed for cell reproduction

Corticosteroids

Corticosteroids, often simply called steroids, are natural hormones and hormone-like drugs that are useful in the treatment of many types of cancer, as well as other illnesses. When these drugs are used as part of cancer treatment, they are considered chemotherapy drugs

How chemo is given

Examples of regional chemo include drugs given into these parts of the body:

  • Intra-arterial – injected into an artery that goes to a certain area of the body
  • Intravesical – put into the bladder
  • Intrapleural – put into the chest cavity between the lung and chest wall
  • Intraperitoneal – put into the belly (abdomen) around the intestines and other organs
  • Intrathecal – put into the central nervous system (brain and spinal cord)
  • Intralesional/intratumoral – injected right into the tumor
  • Topical – applied to the skin as a cream or lotion

Reasons for giving Chemotherapy Drugs

  1. Chemotherapy drugs controls the cancer and enhances the quality of life
  2. The drugs helps in treating those cancers that react well to chemotherapy
  3. The resistance of cancer cells can be overcome by giving these drugs in higher dosages
  4. The size of the tumors is decreased with the help of these drugs that also provides for a safer removal.
  5. The cancer-killing effectiveness is also increased of other treatments like radiation therapy

Molecular or Targeted Therapy

Targeted cancer therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules (“molecular targets”) that are involved in the growth, progression, and spread of cancer. Targeted cancer therapies are sometimes called “molecularly targeted drugs,” “molecularly targeted therapies,” “precision medicines,” or similar names.

What is Hematology?

Hematology is the science or study of blood, blood-forming organs and blood diseases. The medical aspect of hematology is concerned with the treatment of blood disorders and malignancies, including types of hemophilia, leukemia, lymphoma and sickle-cell anemia. Hematology is a branch of internal medicine that deals with the physiology, pathology, etiology, diagnosis, treatment, prognosis and prevention of blood-related disorders. Hematology science involves the five types of white blood cells — neutrophils, monocytes, lymphocytes, eosinophils and basophils. Red blood cells are also known as erythrocytes. Following tools are used for managing the blood diseases –

  • Stem cell transplant and bone marrow transplant
  • Removal and addition of blood components as required
  • Chemotherapy
  • Immunosuppressive drugs
  • Biological therapy for malignant and benign blood disorders
  • Growth factor drugs

Common Conditions of Blood Diseases

  • Thrombocytopenia
  • Anemia
  • Multiple Myeloma
  • Leukemias
  • Primary Amyloidosis
  • Immune Cytopenias
  • Porphyria
  • Clotting and bleeding disorders
  • Myeloproliferative disorders
  • Hematologic Malignancies
  • Myelofibrosis with Myeloid Metaplasia
  • Immune Cytopenias
  • Monoclonal Gammopathies of Undetermined Significance
  • Enlarged Lymph Nodes or Spleen
  • Myelodysplastic Syndromes
  • Lymphoproliferative disorders
  • Hypercoagulable States and Platelet Disorders