CLINICAL ONCOLOGY

Clinical oncology is a branch of medicine concerned with the diagnosis, prevention, and systemic and supportive treatment (also in combination with radiotherapy and surgical treatment) of cancers.

Malignant tumors arise as a result of uncontrolled multiplication of mutated cells in the body. Cancer disease can develop by infiltrating adjacent tissues and creating distant metastases. Metastases most often occur through the movement of cancer cells with blood or lymph to other organs, where they settle and form another focus of the disease – a metastasis.

Methods of systemic treatment:

• chemotherapy,
• immunotherapy,
• targeted therapy,
• hormone therapy,

Chemotherapy refers to therapy using cytotoxic/cytostatic drugs, which have the ability to disrupt cell functioning, damage, or destroy them. The toxic effect may consist of, for example, disrupting cell metabolism, impairing the production of essential components by the cell, or preventing the process of cell growth or division, i.e., multiplication. Cytostatic drugs act most strongly on rapidly dividing cells such as cancer cells, and to a lesser extent on other cells in the body. However, those that are characterized by fairly rapid division (e.g., bone marrow cells constantly producing blood cells or continually renewing epithelial cells of the intestines or hair bulbs) are more exposed to the toxicity of chemotherapy. Hence, for example, one of the more common complications of chemotherapy is blood composition disorders or hair loss.

Immunotherapy is one of the modern methods of anticancer therapy. It is based on activating the patient's own immune system to destroy cancer cells or by using molecules similar to those naturally produced by the immune system (antibodies) to modify pathological immune processes caused by the tumor. One of the mechanisms of immunotherapy is modulating the activity of immune system cells. Immunological drugs bind to specific receptors in immune system cells, i.e., to the so-called checkpoints of this system. This causes activation of the immune system and destruction of malignant tumor cells. Complications of immunotherapy are the result of excessive activation of the immune system, in which case healthy cells of the body may also be destroyed.

Targeted therapy, also called molecularly targeted treatment, is one of the modern methods of cancer treatment. These drugs inhibit the transmission of signals to cells or within cells and thereby affect the metabolism, growth processes, and multiplication of cancer cells. Targeted treatment is not justified in every case of cancer. Often, the decision about the possibility and purposefulness of using molecularly targeted drugs requires additional molecular tests.

Hormone therapy is used in the treatment of so-called hormone-sensitive or hormone-dependent tumors, which respond to specific hormones in the body. Hormones naturally bind to target cells and stimulate or block various cell functions, e.g., their growth. Hormonal drugs interfere with this process most often by reducing hormone concentration or blocking its receptors. Compared to other methods of systemic treatment, hormone therapy is characterized by low toxicity.

The type of systemic therapy is closely related to the type of cancer. The drugs used depend on many factors, primarily the pathomorphological diagnosis (histopathological result), additional molecular and genetic determinations, stage of disease advancement (result of medical examination, imaging tests), as well as the patient's blood test results and general performance status. The application of therapy is possible after assessing the patient's general fitness and organ efficiency, and during treatment, tests are performed to evaluate the safety and effectiveness of treatment.

There are various routes of drug administration: oral (tablets, capsules), intravenous (drips – infusions of varying duration, e.g., 10 min, 30 min, 3 hours, or even many hours: 24-46 hours), subcutaneous (injections). The route of administration depends on which drug is being used.

The duration of therapy depends on the results obtained and the tolerance of treatment and results from the intention of the conducted treatment. The patient has the right to discontinue treatment at any time.

Systemic therapy is administered at specific intervals, which are defined from the beginning but may change, e.g., due to poor tolerance by the body. Treatment cycles may be repeated at intervals of 1 to 6 weeks, most often 2 to 4 weeks. Similarly, the dose of the administered drug, although determined at the beginning of therapy, may change under the influence of various factors, e.g., treatment tolerance or changes in body weight or changes in laboratory blood tests.

Some drugs may cause fertility disorders or infertility. The topic of possible procreation must be discussed with the attending physician before starting treatment. Some drugs have a damaging effect on the fetus, and some have not been tested in this direction. Pregnancy must be reported to the attending physician.

Systemic therapy affects all cells of the body and therefore also healthy cells, which is an undesirable effect. The time of occurrence of adverse effects of therapy can be very different; symptoms may occur after one dose but also many weeks after the end of therapy (distant effects).

The type and severity of side effects depend on the drug or drugs used and on the patient's general fitness, presence of comorbidities, age, stage of cancer advancement, or previous treatment. The occurrence and severity of adverse effects are monitored by the physician conducting the treatment, and the therapeutic process is accordingly modified. To avoid intensification of the adverse effect, life-threatening, and permanent interruption of therapy, you should immediately inform the doctor about worrying symptoms. During intravenous drug administration, extravasation of the drug may occur, meaning the drug escaping outside the vessel – any pain around the injection site should be reported immediately.

At the Specialist Oncology Hospital in Tomaszów Mazowiecki, patients undergo treatment within the clinical oncology department and in the day-stay room. In other centers of the Affidea NU-MED Group, chemotherapy treatment is conducted in cooperation with partner hospitals (within a single building complex). Thus, patients have the chance to access comprehensive cancer treatment within a single location.

The Affidea NU-MED Group operates specialized oncology centers, including:

• Centrum Radioterapii i Onkologii - Elbląg  (Center for Radiotherapy and Oncology - Elbląg)
• Centrum Diagnostyki i Terapii Onkologicznej - Katowice (Center for Oncological Diagnosis and Therapy - Katowice) 
• Specjalistyczny Szpital Onkologiczny - Tomaszów Mazowiecki (Specialised Oncology Hospital - Tomaszów Mazowiecki)
• Centrum Diagnostyki i Terapii Onkologicznej - Zamość (Center for Oncological Diagnosis and Therapy - Zamość)