Medical oncology

Medical oncology is a discipline that was born following the development of effective drug treatments for cancer. Medical oncologists are specialists in managing tumors with the exception of hematological malignancies, which pertain to blood diseases.

These specialists have an in-depth knowledge of the mechanisms underlying cancer development and mode of action of the drugs used to treat cancer, in addition to the potential complications associated with these drugs.

These drug treatments include:

• Chemotherapy
• Hormone therapy
• Immunotherapy
• New targeted therapies
• Gene therapy
• …

Medical oncologists play a major role at different times in the disease history.

Cancers diagnosed at a localized stage are most often successfully treated by means of surgery or radiation therapy.

However, drug treatment may also be employed before the tumor is removed or irradiated. This "neo-adjuvant" treatment allows for reducing the volume of the lesion and, in so doing, for actually resecting it, although surgery was initially deemed impossible or too heavy. Considering bone cancer, for example, neo-adjuvant chemotherapy is at times able to avoid amputation of a limb while enabling a more localized and less damaging surgical intervention.

In addition, in certain circumstances, it is indicated to complete the surgical or radiotherapeutic treatment using a complementary drug treatment, which is referred to as "adjuvant".

This adjuvant chemotherapy seeks to prevent cancer recurrence by eliminating micrometastases; it is often a significant step towards healing. Adjuvant drug therapy is prominent in many cancers, including breast, lung, and colon cancer.

At times, in the case of disseminated tumors, also called metastases, chemotherapy is even the first-choice treatment.

The prognosis of metastatic cancers has considerably improved with the advent of new chemotherapy molecules like taxane derivatives in breast cancer and, more recently, "targeted" drug treatments, which more effectively destroy cancer cells while preserving surrounding healthy tissue.

To illustrate, in colon cancer, using new chemotherapies, combined if necessary with targeted therapy, renders it possible, at least for some patients, to be treated for initially inoperable liver metastases, which, thus, increases their chances of recovery.

The role of drugs, whether chemotherapy or the so-called "targeted" therapies, is therefore essential in cancer management.

The medical oncologists of the King Albert II Institute establish, along with the other actors involved in the diagnostic and therapeutic approaches to cancer, the optimal attitude that should be adopted for each particular patient.

The combined skills of imaging and microscopy specialists, organ specialists, oncologists, surgeons, and radiotherapists are all instrumental in achieving the desired excellence level.

Chemotherapy treatments are mostly carried out on an outpatient basis, in the day hospital. These treatments do not require hospitalization. A special permanent intravenous catheter, called a port-a-cath, has been shown to improve the patient’s comfort.

However, the way chemotherapies are administered is changing, as intravenous injections are gradually giving way to oral tablets, which prove to be more comfortable.

In addition, new drugs are now being administered preventively to avoid untimely nausea and vomiting.

The King Albert II Institute of the Cliniques universitaires Saint-Luc was one of the first institutions to implement outpatient treatment.

Most chemotherapy treatments are now administered in day hospitals. This organization of care contributes to the patients’ comfort.

More intensive chemotherapies are administered in our conventional cancer inpatient unit. In this department, patients with complications related to treatment and disease are being taken care of.

Armed with their knowledge of cancer mechanisms, medical oncology specialists currently undertake research aimed to develop and evaluate new molecules whose mode of action, ever more refined, enables it to better counteract the behavior of cancer cells while preserving healthy cells.

The oncology laboratory is involved in several projects aimed at transferring discoveries made in basic research into clinical applications. These research projects focus on melanoma immunotherapy and on combining immunotherapy, chemotherapy, and radiotherapy for cancer treatment.

The studies they undertake, along with laboratory researchers, lead and have led to the discovery of new, more effective, and better tolerated molecules.

These cutting-edge treatments are initially applied in large international studies involving leading academic centers, such as our medical oncology unit, which permanently manages more than 60 research protocols.