Cancer is one of the most important health problems both in Turkey and all over the world. According to incidence, breast, prostate, lung, large intestine, and cervical cancers are the five most commonly seen cancer types. In terms of causing death, cancer ranks in the second place after cardiovascular diseases all over the world and is expected to rise to the first rank in this ranking in the near future.
Diagnosis and treatment of cancer is a process that requires the coordinated work of many specialist doctors from many different branches. Almost all the medical specialties, including radiology, nuclear medicine, interventional radiology, and pathology departments, play a role in the diagnosis process. In the treatment processes, surgical branches (general surgery, urology, thoracic surgery, ENT, gynecology, etc.), medical oncology, and radiation oncology departments take responsibility. Support from other fields of expertise (psychiatry, PTR, neurology, dietitian, etc.) is taken regarding the solution of additional problems that may develop during and after the treatment.
The primary duty of a medical oncology specialist is to be a leader in the coordination of the cancer treatment staff mentioned above and in the determination of the most appropriate treatment modality for the patient. Secondary task and main field of activity is the implementation of systemic cancer treatments (chemotherapy, hormone therapy, targeted therapy, immunotherapy), the long-term follow-up of the treatment side effects, and the disease.
Ankara Koru Hospital Department of Medical Oncology
The Department of Medical Oncology provides service on two separate floors in our hospital. There is an out-patient daily treatment unit with a capacity of 12 beds and an in-patient oncology service with a six-bed capacity. The systemic treatments of our patients are determined by Medical Oncology specialists and are administered by the nurses specialized in the field of cancer within the scope of our department.
Today, the drug options used in cancer treatment are increasing and developing at a dizzying speed. In this way, success in cancer treatment is increasing day by day. The biggest challenge caused by this progress is the follow-up of up-to-date scientific data. A medical oncologist is responsible for following up-to-date scientific data and providing patients with the latest and best cancer treatments. The treatments applied at the department of medical oncology are carried out at international standards, up-to-date treatment approaches are constantly followed, and these approaches are strictly not excluded.
Another key to success in cancer treatment is that the treatment is the product of a joint and harmonious work. While determining the treatments at our Department of Medical Oncology, the support of the “Multidisciplinary Oncology Council”, which is the biggest power of our hospital, is taken. Post-treatment follow-ups are carried out in collaboration with medical oncology specialists and radiation oncology, physical therapy, radiology, surgical branches, nuclear medicine, pathology, medical genetics, clinical psychology, rehabilitation, psychiatry, and nutrition specialists. Moreover, the nursing care and service provided by our nurses specialized in the field of cancer takes our department of Medical Oncology one step ahead.
What Diseases Does Medical Oncology Deal With?
Department of medical oncology deals with all the malignant diseases excluding hematological malignancies:
• Brain tumors (glioblastoma multiforme, astrocytoma, oligodendroglioma...)
• Head and neck cancers (tongue, mouth, nasopharynx, larynx, oropharynx, thyroid ...)
• Lung cancers
• Breast cancers
• Gastrointestinal system cancers (Esophagus, stomach, pancreas, liver, gall bladder, small intestine, large intestine, rectum, anus)
• Gynecological cancers (Over, fallopian tube, endometrium, cervix, vagina, vulva)
• Urological cancers (kidney, ureter, bladder, urethra, testis, penis)
• Skin cancers (Malignant melanoma, squamous cell carcinoma, basal cell carcinoma...)
• Sarcomas (Osteosarcoma, Ewing's sarcoma, soft tissue sarcomas...)
What are the treatment methods of the Department of Medical Oncology?
The medical oncology department undertakes the drug (systemic) treatment of cancer. We can essentially collect the treatment methods under two main titles as anti-cancer (aiming to destroy cancer cells) and supportive (aimed at eliminating the patient's complaints and regulating their nutrition). Anti-cancer drugs, which are the main treatment area of medical oncology, consist of chemotherapeutics, hormone therapeutics, goal-directed (smart) drugs, and immunotherapy drugs. Drug therapy is used for four main purposes in cancer treatment. The first is drug therapy, which is called as neoadjuvant therapy, aims to minimize the tumor before the main cancer treatment (usually surgery). Second one is the adjuvant therapy that is drug therapy applied to reduce the chance of cancer recurrence in patients, who have received the main treatment (surgery or chemoradiotherapy). The third is the definitive treatments; these are the drug treatments that are applied simultaneously with radiotherapy and aim to cure cancer completely. The last one, called as palliative treatment, is the treatment aimed at reducing the tumor size, reducing the patient's complaints, increasing the comfort of life, and prolonging the life expectancy.
Chemotherapy drugs are the most commonly used anti-cancer drug group in current oncology practices. It is formed by the combination of many different drug groups that aim to directly kill the cancer cell. These drugs do not act selectively while killing cancer cells. Along with the cancer cells, they can lead to the death of rapidly proliferating cells such as the mouth, intestines, hair follicles, and bone marrow of the body.
Chemotherapy applications are sometimes carried out as a single drug or sometimes more than one drug application together. The most important factor in drug selection is the type of cancer. For example, a chemotherapy drug that is very effective and preferred in breast cancer may not be used in colon cancer due to the reason that it does not have the same efficiency. In addition, many factors such as the patient's age, comorbidities, side-effect profiles of drugs, and patient expectations are also considered during the determination of treatment. Chemotherapy drugs are administered at different frequencies (weekly, 2-week, 3-week periods, etc.) and for different periods (3 months, 6 months, etc. or until disease progression or intolerable side effects are observed) in different cancer types for similar reasons. Drugs are usually administered via intravenous (into a vein) or oral (in the form of oral tablets) route. In addition, chemotherapy can be applied via intra-arterial (into veins), intra-cavitary (for example, closed areas such as the intra-abdominal cavity), and topical (on the skin in the form of a cream) application routes.
Since chemotherapy drugs do not have a selective activity against cancer cells, their side effects can be in a wide range, and sometimes serious. However, since we have many drugs to prevent side effects, side effects can be easily controlled, especially at the points of preventing nausea and vomiting and maintaining the strength of the immune system.
Hormonotherapy is used in breast cancer, prostate cancer, and some types of gynecological cancers. In some subtypes of these cancers, tumor growth is dependent on hormonal influence. The main purpose of hormone therapy is to eliminate or reduce the effect of estrogen or testosterone hormones that signal tumor growth. Hormonotherapy can sometimes be applied alone or in combination with other drugs. The route of administration is in the form of oral tablets or depot injections as 1- or 3-month. As it can be used for 5-10 years to reduce the risk of recurrence of operated breast cancer, it can also be used for the lifetime in metastatic prostate cancer. The duration of treatment may differ depending on factors such as the type of disease and the stage of the disease. These drugs are very easy to use and safe drugs in terms of side effect profile. However, the limited number of hormone-dependent cancer types means that these drugs cannot be a treatment option for many types of cancer.
Goal-Directed Treatment (Smart Drugs)
Goal-directed drugs constitute one of the most popular treatment options in oncology practice in recent years. This group of drugs is basically drugs that target a genetic defect (mutation) or receptor (the unit that provides contact in the cell) in the cancer cell. Goal-directed therapies can be used in many cancers, especially lung cancers, malignant melanoma, renal cell cancer, breast cancer, and colon cancer. The main difference from chemotherapy is that they aim to hit a target on the cancer cells. Thus, they are very safe when compared to chemotherapy in terms of the side-effect profile. In addition, although it is sometimes not possible to use chemotherapy in very debilitated patients, the use of goal-directed agents in severely debilitated patients is often possible due to the low side-effect profile. Although its side effects are relatively few, its efficiency is generally higher than chemotherapy. Goal-directed drugs are mostly used as oral tablets or are administered via intravenous route. Unfortunately, in addition to these features, the lack of a target that these drugs can affect in every cancer narrows the field of use.
Immunotherapy (Immune Treatment)
Immunotherapy is the newest and highest point reached in current oncology practices. Under normal conditions, a healthy immune system fights with all the foreign (viruses, bacteria, etc.) agents coming from outside into the human organism. Although the cancer cell is the own cell of the organism, it is now a foreign agent due to the mutations and its changing antigen structure. Under normal conditions, the immune system sees the cancer cell as a foreign body and destroys it. However, the cancer cell also secretes some substances that will inactivate (sleeper) immune cells in order to escape from the immune system cells. The main purpose of immunotherapy is to activate (awaken) the inactivated (sleeper) immune cells and bring them back into the fight again. Throughout the world, it has been approved for use in a wide range of cancer types, especially lung cancers, malignant melanoma, and renal cell cancers. Current medical research has focused on immunotherapy, and it is expected that these drugs will have a wider use in the future. All the immunotherapy drugs are used via intravenous applications every 2 or 3 weeks. They are quite safe drugs in terms of side effects, as they activate the defense system already present in the organism and this defense system has the ability to distinguish the normal cells and cancer cells. However, the fact that it is a new form of treatment and has some aspects that have not yet been standardized and that it is a very expensive treatment option are the factors limiting its use.