Article

What Is Oncology and How Can MRI Help?

What Is Oncology?

Oncology is the branch of medicine that studies, diagnoses, and treats cancer. Within this branch, there are three major disciplines: medical, surgical, and radiation.1,2,3 These disciplines represent what the average person may think of as different steps to the treatment process. However, the three work together to determine the best course of action for the patient. There is often a care team that includes all three oncologists, as well as an oncology nurse, a patient navigator, an oncology social worker, and a registered dietitian or nutritionist.4,5,6 Each cancer center has their own version of these teams, which may include more people, such as psychiatrists or clergymen.

A medical oncologist specializes in diagnosing and treating cancer through the use of different types of therapy, including chemotherapy. This is the doctor who provides primary and supportive care for the patient. Chemotherapy is the treatment of cancer using medicine, which is administered orally, topically, or intravenously.7,8

A surgical oncologist deals with the surgical parts of diagnosis and treatment. They are trained to perform a biopsy and remove cancerous tissue. Biopsies help to determine if cancer is present and, if so, what the extent of the cancer is. It is important to remember that a biopsy being ordered does not mean the patient has cancer.

A radiation oncologist treats cancer with radiation therapy. Radiation therapy uses high-energy particles or waves, such as x-rays, to eliminate cancer cells. This process typically requires a number of sessions and focuses only on the cancerous areas affected by cancer.

An oncology nurse provides care, administers medicines, informs the patient of any side effects, coordinates care, and supports and educates the patient and their family. Nurses take on these tasks to ease the burden for both the doctors and the patients.

A patient navigator helps patients work through challenges with insurance and guide the patient through the process. They also may offer paths to people who can provide other kinds of support, such as financial support. Patient navigators can be people with a variety of roles which vary depending on the center.

An oncology social worker helps patients cope with their diagnosis and any challenges on the way through treatment and beyond. These are the people who provide counselling and support the family of cancer patients. They work with the patient as well as their loved ones.

A registered dietitian or nutritionist will help cancer patients with their diet and hydration. They also answer questions regarding all issues that are food related, from trouble swallowing to weight loss or gain. Cancer patients may experience these issues as side effects of their treatment. Dietitians and nutritionists work with patients to determine what can and can't be eaten, as well as providing recipes or menu suggestions.

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How Is MRI Used in the Diagnosis and Treatment of Cancer?

MRI is used to evaluate and treat cancer along with other imaging procedures.9,10,11,12 This is due to the fact that an MRI can show tumors that may not appear on other types of imaging, because it depicts organ tissue throughout the cancerous area. MRI uses magnets and radio waves to produce images instead of radiation, so it is typically one of the safer procedures for a patient to undergo. Doctors then use MR to evaluate and stage cancer, determine tumor behavior, and create and monitor a treatment plan.

Conventional MRI shows cancer in most areas of the body. They show the tumor and can measure the size and progression. Whole-body MRI's can be used to find areas where cancer has taken hold and monitor for metastasis. Metastasis is the process of cancer spreading beyond the area that was initially affected. For prostate cancer, for example, metastasis would be the cancer spreading outside of the capsule. For breast cancer, it would be the cancer spreading from the breasts into nearby areas of the body. Oncologists may order a whole-body MRI if they are concerned the cancer is spreading.

Additionally, a doctor may request a dynamic contrast-enhanced (DCE) MRI, which uses intravenous contrast to highlight different characteristics of tumors.13,14 DCE MRI is used to diagnose and stage tumors, as well as monitor chemotherapy. DCE MRI can help monitor the angiogenesis in malignant tumors. Angiogenesis, or the generation of new blood vessels, plays a crucial role in tumor monitoring. The tumor will hold the contrast for longer than the surrounding area, allowing the radiologist to measure its growth.

Diffusion weighted imaging (DWI) has also made its way into diagnosing and monitoring cancer.15,16 Diffusion is the random movement of water molecules due to heat. The MRI measures this movement under different types of pulse sequences to create a virtual image of the white matter tissue and its integrity in the body. DWI images can show additional tumors that may not have shown up on conventional MRI.  Mapping the tissue and its integrity allows doctors to monitor the effectiveness of treatments as well. In addition, DWI is a quicker exam that may or may not include breath-holds depending on the area of the body affected. If it is necessary, DWI could feasibly be done in a single breath-hold. Oncologists can use DWI to image the whole body, making it a valuable tool in testing for metastasis, or cancer spreading beyond the affected organ.

All three types of oncologists use MRI to diagnose, treat, and monitor tumors throughout the body with the help of the oncology team. In particular, oncologists find DCE MRI a great way to measure angiogenesis throughout the tumor to determine its characteristics. DWI MRI, on the other hand, allows them to see the tumors structure and size, which helps them find and stage additional tumors that don't show up on conventional MRI. Both DCE and DWI MRI help oncologists to monitor the effectiveness of chemotherapy and radiation therapy to provide better, more precise results for their patients.

References

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2. Tallahassee Cancer Institute. "What is a Medical Oncologist?" TallahasseeCancer.com. Web. Accessed 9 October 2018. <http://www.tallahasseecancer.com/hematology-oncology/what-is-a-medical-oncologist>.

3. National Cancer Institute. "NCI Dictionary of Cancer Terms." cancer.gov. Web.  Accessed 9 October 2018. <https://www.cancer.gov/publications/dictionaries/cancer-terms/>.

4. Memorial Sloan Kettering Cancer Center. "Your Cancer Care Team." mskcc.org. Web. Accessed 15 October 2018. <https://www.mskcc.org/cancer-care/diagnosis-treatment/your-care-team>.

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6. Cancer.Net Editorial Board. "The Oncology Team." Cancer.Net. Web. Accessed 15 October 2018. <https://www.cancer.net/navigating-cancer-care/cancer-basics/cancer-care-team/oncology-team>.

7. UPMC Hillman Cancer Center. "The Difference Between Chemo and Radiation." UPMC HealthBeat. 25 July 2016. Web. Accessed 9 October 2018. <https://share.upmc.com/2016/07/chemotherapy-and-radiation/>.

8. Cancer.Net Editorial Board. "Understanding Radiation Therapy." Cancer.Net. May 2018. Web. Accessed 9 October 2018. <https://www.cancer.net/navigating-cancer-care/how-cancer-treated/radiation-therapy/understanding-radiation-therapy>.

9. Mario Morone, et al. "Whole-Body MRI: Current Applications in Oncology." American Journal of Roentgenology. December 2017. Web. Accessed 9 October 2018. <https://www.ajronline.org/doi/full/10.2214/AJR.17.17984>.

10. "MRI Scan." cancerresearchuk.org. Web. Accessed 9 October 2018. <https://www.cancerresearchuk.org/about-cancer/cancer-in-general/tests/mri-scan>.

11. American Cancer Society. "MRI for Cancer." cancer.org. Web. Accessed 9 October 2018. <https://www.cancer.org/treatment/understanding-your-diagnosis/tests/mri-for-cancer.html>.

12. Cancer.Net Editorial Board. "Magnetic Resonance Imaging (MRI.)" cancer.net. February 2017. Web. Accessed 9 October 2018. <https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/magnetic-resonance-imaging-mri>.

13. Anwar R. Padhani. "Dynamic contrast-enhanced MRI in clinical oncology: Current status and future directions." Journal of Magnetic Resonance Imaging. 25 September 2002. Web. Accessed October 9 2018. <https://onlinelibrary.wiley.com/doi/full/10.1002/jmri.10176>.

14. Baris Türkbey, et al. "The role of dynamic contrast-enhanced MRI in cancer diagnosis and treatment." Diagn Interv Radiol. 2 November 2009. Web. Accessed 9 October 2018. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518910/>.

15. D.-M. Koh and A. R. Padhani. "Diffusion-weighted MRI: a new functional clinical technique for tumour imaging." The British Journal of Radiology. March 2006. Web. Accessed 10 October, 2018. <https://www.birpublications.org/doi/full/10.1259/bjr/29739265>.

16. Russell N. Low. "Diffusion-weighted MRI (DWI) in the oncology patient: Value of breathhold DWI compared to unenhanced and gadolinium-enhanced MRI." Journal of Magnetic Resonance Imaging. 2 March 2007. Web. Accessed 10 October 2018. <https://onlinelibrary.wiley.com/doi/abs/10.1002/jmri.20864>.