Oncology Dead Man

1
Oncology Dead Mans party

• Biology of abnormal cells
• Cancer grading and stages
• Cancer statistics
• Chemotherapeutic agents
• Radiation treatments
• Bone Marrow and Stem Cell transplants
• Onco-gene therapy

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Oncology Objectives

• 1. Identify the different phases of cancer cell
  replication.
• 2. Compare the features of a benign versus
  malignant tumor
• 3. Recognize the TNM stage and grading system of
  cancer tumors.
• 4. Discuss the role of oncogenes and suppressor
  genes in cancer development.
• 5. Identify behaviors with corresponding
  primary and secondary nursing prevention for
  risks of cancer development
• 6. Recognize the different classes of
  chemotherapies.
• 7. Create appropriate nursing interventions for
  a case study of a patient with cancer.

3
Oncology Objectives

• 8. Identify appropriate testing for cancer
  patients.
• 9. Recognize signs and symptoms of chemotherapy
  side effects.
• 10. Recognize signs and symptoms of radiation
  therapy.
• 11. Prioritize nursing interventions for a
  patient with neutropenia.
• 12. Prioritize nursing interventions for a
  patient with thrombocytopenia.
• 13. Prioritize nursing interventions for a
  patient receiving bone marrow or stem cell
  transplant.

4
Oncology Objectives

• 14. List 4 risk factors for the development of
  leukemia.
• 15.Compare Leukemia and Lymphoma
  pathophysiology, etiology and clinical
  manifestations.

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Cellular Review

• Evolve 3D Cellular Differentiation on web site

6
Oncology

• Biology of abnormal cancer cells
• They have continuous or inappropriate, usually
  faster growth or larger growth patterns
• They have no specific morphology and often do not
  resemble their parent cells anaplastic
• They do not respond to signals for apoptosis
  programmed cell death

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Oncology

• Biology of abnormal cancer cells
• Have a large nuclear cytoplasmic ratio the
  nucleus may occupy most of the cell area
• They lose some or all of their normal cell
  functions
• They do not make fibronectin, and thus cannot
  connect easily and break off easily

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Oncology

• Biology of abnormal cancer cells
• They are able to migrate throughout the body
  metastasis
• They invade other tissues and types of cells.
• They are not controlled by contact
• They have more or less chromosomes than the
  parent cells aneuploid
• or a mutation of the genes

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Oncology

• Cancer development
• Initiation there are many theories as to when
  the genes in the cells are damaged, maybe in
  utero, from physical or chemical exposure, latent
  oncogenes, viruses, or a lack of suppressor genes
  from our parents, and at this point the cell is
  not dividing.

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Oncology

• Skin cells

11
Oncology

• Cancer development
• Promotion - the stage when the abnormal cell
  starts to divide, may be stimulated by
  environmental changes, hormones, drugs, or
  irritants

12
Oncology

• Cancer development
• Progression the phase when the abnormal cells
  have continued to grow into a Primary tumor, may
  produce angiogenesis factors which supply blood
  and vascular nourishment to the tumor. The tumor
  may have subcolonies of cells with different
  genes and features

13
Oncology

• Cancer development
• Metastasis
• the movement of cancer cells into other organs
  of the body, thus creating new tumor sites.

14
Oncology

• Cancer grading and staging
• Cancer is graded upon the resemblance to normal
  cells G
• (The higher the number, the worse the grade of
  cancer) i.e. G1, G2, G3, G4
• Staging is based upon
• the presence of a primary tumor T
• involvement in lymph nodes N
• and appearance of metastasis M
• Numbers of the stage range from
• x none to 3 or 4 for each letter

15
Oncology

• Is this a high grade or low grade cancer?
• Case study
• Julie has a breast lump in her right breast,
  and has also found one in her right armpit.
  Biopsy and lumpectomy were performed. The tumor
  was graded G3, T2, N2, M1.

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Is this a high grade or low grade cancer?

1. High
2. Low

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Oncology

• Julie opted to have a lymphectomy of her right
  arm lymph nodes, and started radiation treatment
  right away. Her doctor also suggested that she
  start Adriamycin IV chemotherapy to get any cells
  that the radiation might miss.

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Oncology

• Cancer Risks
• 1 advancing age
• 2 smoking tobacco
• Hormones Prempro caused a substantial increase
  in breast cancer on the HERS trial
• Genetic inheritance of oncogenes and autoimmune
  diseases
• Environmental exposure
• Excessive intake of dietary fats

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Oncology

• Cancer risks
• High alcohol consumption
• Low dietary vegetables and fiber (sources of
  antioxidants)
• Previous Viral infections
• Hepatitis B or C
• Herpes viruses
• Papilloma viruses (HPV)
• Retrovirus HTLV I

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Oncology

• Types of cancer cells are named for their site of
  origin
• Adenocarcinoma
• Carcinoma in situ (CIS)
• Squamous
• Basal cell
• Astrocytomas
• Melanomas
• Sarcomas
• Lymphomas

21
Oncology

• Symptoms of Cancer
• Cachexia weight loss,unexplained
• Anorexia
• Anemia
• Impaired immune response
• Pain when the cancer is large enough to
  compress nerves or organs
• Lymphadema when the tumor blocks lymph or
  circulatory flow
• Motor or sensory deficits

22
Oncology

• The 60 year old client with small cell lung
  cancer is concerned that his grown children also
  might develop the disease. What is the nurses
  best response?
• A. This disease is a random event and
  there is no way to prevent it.
• B. Because this disease is inherited as a
  dominant trait, your children have a 50 risk for
  developing it.
• C. Cigarette smoking is the main cause of this
  disease, and helping your children not to smoke
  will decrease their risk.
• D. Lung cancer can be avoided by decreasing
  dietary intake of fats and increasing the amount
  of regular aerobic exercise.

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Oncology

• Cancer statistics
• The top four cancers found in the United States
  are
• Lung
• Breast
• Prostate
• Colorectal

C
24
Oncology

• Cancer statistics
• Prostate cancer is the most common site of cancer
  and the 2nd most common cause of cancer death in
  the United States
• The first cause of death in males is Lung Cancer

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Oncology
26
Oncology

• Cancer statistics
• Lung cancer has annual
• new cases (incidence)
• of 173,770 people
• per year 93,110 males and
• 80,660 females
• Annual mortality 160,440 per year consisting of
  92,000 males and
• 68,510 females

27
Oncology

• Cancer statistics
• 28 of all cancer deaths are due to lung cancer
• This is the leading cause of cancer death in both
  men and women
• There are more deaths from lung cancer than
  prostate, breast, and colorectal cancers combined

28
Oncology

• Cancer statistics
• Risks for lung cancer
• Smoking (75-80 of cases)
• Occupational exposure
• Nutrition/Diet
• Genetic factors

29
Oncology

• Cancer statistics
• Prostate cancer is number two cause of cancer in
  men
• Breast Cancer is number two cause of cancer in
  women
• Most common non-malignant or non-fatal cancer is
  non-melanoma type skin cancers

30
Oncology

• The client says that she has heard that the
  origin of most cancers is genetic. What is the
  nurses best response?
• A. The development of most cancers is
  predetermined and not affected by
  environmental factors.
• B. Cancers arise in cells that have been
  damaged,which may be in the genes.
• C. The majority of cancers are inherited
• D. Cancer is more common among males than
  females.

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Oncology

• Lab tests for cancer
• Ultrasounds to determine size
• CT scan with contrast the golden standard
• Genetic markers BRCA 1 and BRCA 2
• Tumor markers
• CEA general carcinogenic antigen
• PSA prostate antigen
• CA-125 ovarian
• CA-25,27 breast
• HER 2 NEU breast tissue needed

32
Oncology

• Lab tests for cancer
• Liver function tests
• CBC with diff
• Renal function tests
• PET scan looks for metastasis using a
  radioactive glucose solution
• PT, PTT, Fibrinogen, Fibrin levels

33
Oncology

• Lab tests for cancer
• Pathology slide of tumor
• (Should be kept for a period of years)
• Determines type of tumor
• Source of tumor
• Aggression of tumor whether fast growing,
  differentiated, or non-differentiated
• Used to determine tumor growth factors and
  susceptibility to certain chemotherapies

34
Oncology

• Chemotherapy
• Prevention chemotherapy for high risk patients,
  precancerous lesions, or history of cancer
• Antioxidants, vitamins
• Aldara cream 3x weekly for precancerous skin
  lesions
• Aspirin
• Protease inhibitors

35
Oncology

• Chemotherapy - typically started after surgical
  dissection of tumor, unless the tumor is
  non-operative
• Usually given by a long term venous access
  device, i.e. PICC line, implanted ports, or
  direct catheratization to the tumor.
• Chemotherapy is usually potent and horribly
  scarring on normal veins

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Oncology

• Chemotherapy
• Biochemotherapy used as in-patient or
  outpatient settings for cancer, MS, and viral
  treatments
• Alpha interferon (IFN)- Alpha 2a,
• Roferon, Intron-A-
• used for leukemias, AIDS, Hep-C
• Beta interferon Beta 1b
• used for renal carcinoma, melanoma, AIDS,
  MS, Hepatitis A, B

38
Oncology

• Chemotherapy/Biochemotherapy
• Interleukin I (IL-1)
• Interleukin 2 (IL-2), Proleukin stimulates
  growth of T-cells and NK cytotoxic cells
• used investigationally for melanoma in Stage
  II to Stage IV cases on a monthly basis with a
  80 non-recurrence rate

39
Oncology

• Chemotherapy/Biochemotherapy
• Tumor necrosis factor (TNF) selectively targets
  abnormal cells, in nature is produced by NK cells

40
Oncology

• Chemotherapy/Biochemotherapy
• Vaccines
• HPV vaccine for cervical cancer
• Melanoma vaccine - for stage II only at this
  time, or malignant melanoma

41
Oncology

• Chemotherapy/Biochemotherapy Monoclonal
  antibodies used for treatment of cancer,
  rheumatoid arthritis, transplants, and other
  autoimmune diseases. Can be used to stimulate
  immune response or suppress it.
• Rituximab Treatment of CD20 positive
  non-Hodgkins B-cell lymphoma
• Gentuzumab treatment of CD33 positive AML in
  first relapse in patients who are not candidates
  for reg. chemo.

42
Oncology

• Chemotherapy/Biochemotherapy Monoclonal
  antibodies
• Adalimumab Humira
• new treatment for severe rheumatoid arthritis,
  given s.q every other week
• Alemtuzumab Campath
• - treatment of B-cell lymphoma who have failed
  traditional chemotherapy with fludarabine
• Basilixamab Simulect
• - immunosuppressive monoclonal antibody for
  renal transplants

43
Oncology

• Chemotherapy Alkylating agents
• Bisulfan oral
• Carboplatin (CBDCA) IV
• Chlorambucil (leukeran) oral
• Cisplatin IV
• Cyclophosphamide(Cytoxan) IV or PO
• Melphalan (Alkeran) oral
• Ifosfamide IV
• Thiotepa IV or PO

44
Oncology

• Chemotherapy/ Antibiotics
• given IV as chemotherapy
• Adriamycin (Doxirubicin)
• Bleomycin
• Dactinomycin
• Daunorubicin (actinomycin D)
• Idarubicin (idomycin)
• Mitomycin C
• Mithramycin

45
Oncology

• Chemotherapy anti-metabolites
• Cytorubine (Cytosar) IV
• Floxuridine (FUDR) IA or SQ
• Flourourcil (5FU) IV
• Fludara IV
• Hydroxyurea PO or IV
• Methotrexate IV or IM
• 6MP PO
• IRESSA PO
• Xeloda PO

46
Oncology

• Chemotherapy- Hormones
• Progestins uterine cancer
• Estrogens
• Testosterone - myelodysplasias
• Anti-hormones block hormonal activity in
  hormone sensitive cancers
• Leupron
• Eulexin
• Tamoxifen/Nolvadex
• Arimedex/Arista

47
Oncology

• Chemotherapy Plant alkaloids
• Vinblastine (Velban) IV
• Vincristine (Oncovin) IV
• Vindesine IV
• Eldisine IV
• The first doses of this are usually given in a
  hospital setting, are vesicants, and neurotoxic.
  Nurses must wear protective gear!

48
Which of the following are appropriate protective
gear for the nurse when hanging chemotherapy?

1. Splash goggles
2. Latex gloves
3. Rubber gloves
4. Paper gown
5. Special biohazard bags for disposal
6. Lead apron

49
Oncology

• Chemotherapy Antimitotics
• Dacarbazine (DTIC Dome) IV
• Leukovorin PO or IV
• Paclitaxol (Taxol) IV
• Topotecan IV
• Gemzar IV
• Docetaxol IV
• Camptothecan (CPT-11) IV
• Taxotere (Ormaplatin) IV

50
Oncology

• Side effects of Chemotherapy
• Alopecia
• Fatigue
• Anemia
• Leukopenia
• Thrombocytopenia
• Always Nausea,Vomiting, Diarrhea
• Neurotoxicity neuropathies
• Capillary leakage
• Headaches
• Fluid and electrolyte imbalances

51
Oncology

• Side effects of Chemotherapy
• Anorexia change in taste buds
• Back aches
• Joint aches
• Blood clots
• Oral mucositis (reduced significantly by
  L-glutamine amino acids orally)
• Supra opportunistic infections
• Septic DIC
• Tumor lysis syndrome
• Edema or pulmonary edema

52
Oncology

• Chemotherapy Nursing Interventions
• Evaluate and assess sites of chronic
  chemotherapy, ports, veins, skin area
• Accurate I Os
• Monitor for fluid overload or dehydration
• Monitor lab electrolytes before and after
  infusion
• Monitor BUN and Creatinine
• Monitor CBC with differential during the time of
  Nadir
• Monitor PT, PTT

53
Oncology

• Cancer Nursing Interventions
• Nutritional assessment and weights
• Dentition oral checks
• Monitor for signs of suprainfection, low grade
  temperatures, rash, etc
• Vital signs before, during, and after treatments
• Assess bowel status
• Assess pain level

54
Oncology

• Cancer Nursing Interventions
• Educate patients and family members
• side effects of treatments, meds
• care of port and IV sites
• oral hygiene
• symptoms to report, i.e. shortness of breath
  or signs of infection
• Increase fluid intake, suck on hard candies to
  reduce chemotherapy metallic tastes

55
Oncology

• Nursing Diagnoses
• Disturbance in self esteem, body image
• Altered nutrition, less than body requirements
• Risk for fluid volume excess or deficit
• Impaired skin integrity
• Pain, chronic
• Decreased cardiac output
• Self-care deficit
• Sexual dysfunction

56
Oncology

• Nursing Diagnoses
• Alteration in tissue perfusion
• Knowledge deficit
• Risk for injury
• Impaired physical mobility
• Sensory perception alterations
• Alterations in bowel patterns
• Alterations in mucous membranes
• Anxiety and Fear

57
Oncology

• Nursing Diagnoses
• Depression
• Grief
• Respiratory compromise
• Ineffective coping
• Spiritual distress
• Impaired social interactions
• Sleep pattern disturbance
• Altered family roles

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Oncology

• Pharmacological interventions
• Megace, Marinol for appetite stimulation
• Premedications for nausea, vomiting, edema,
  headaches usually on the protocol for chemo
• Antiemetics
• Zofran 24 hour control
• Tigan, Kytril, ativan, anzamet, Compazine,
  benadryl, reglan
• Corticosteroids

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Oncology

• Pharmacological interventions
• Analgesics
• IV electrolytes and fluid replacement
• Stool softeners to counteract constipation from
  opioids
• GSF for WBCs
• Epogen/Procrit for anemia
• Leukine/Prokine for leukopenia
• Neupogen for neutrophilia
• Neumega for thrombocytopenia
• Diuretics for edema

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Oncology

• Non-Pharmacological interventions
• Massage
• Reflexology
• Accupuncture
• Musical therapy
• Prayer
• Meditation
• Diversional acitivities
• Dietary counselling

61
Oncology

• Radiation therapy
• All types of cells are injured or destroyed by
  concentrated radiation. Rapidly dividing cells
  are the most sensitive.

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Oncology

• Radiation therapy
• Types
• Gamma knife
• Local beam treatment
• Local seeding
• ARC stereotactic
• Radioimmunotherapy
• Fractionation
• Total body irradiation
• Particle beam therapy, i.e. proton or neutron
  therapy

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Oncology

• Radiation therapy side effects
• Side effects depend on the amount and area being
  irradiated
• Fatigue
• Nausea and vomiting
• Mild anemia
• Leukopenia
• Diarrhea
• Pain

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Oncology

• Radiation therapy side effects
• Erythema/burns
• Fatigue
• Pneumonitis
• Esophagitis
• Dysphasia
• (Please educate your patients on
• these as doctors are notoriously
• bad at pre-educating their patients).

65
What side effects of radiation therapy would you
expect to see in a 48-year-old woman with breast
cancer?

1. Debilitating fatigue
2. Mucositis
3. hair loss
4. nausea and vomiting

66
What are some of the educational issues for
patients receiving radiation treatment

1. Burns
2. Anemia
3. Skin care
4. Diet
5. All of the above

67
Oncology

• Nursing interventions for radiation TX
• Assess incidence and severity of side effects
• Maximize radiation protection, all wastes will be
  radioactive if isotopes are injected
• Shielding for staff

68
Oncology

• Malignant Lymphomas 2 types
• Hodgkin's Lymphoma most common cancer in 10 to
  20 year olds (young adults). Associated with an
  inflammatory process related to EBV/mono
  infection.
• Diagnosis Classic Reed-Steinberg cell with two
  mirrored nuclei, CT scan
• Symptoms Extreme fatigue, enlarged lymph nodes
  that are painless. May progress to weight loss
  fevers, night sweats

69
Oncology

• Malignant Lymphomas 2 types
• Hodgkin's Lymphoma
• Treatment combined radiation and chemotherapy,
  stem cell transplants if resistant type or
  recurring
• 85 curable
• (90 in some institutions)

70
Oncology

• Malignant Lymphomas 2 types
• Non-Hodgkins Lymphoma 3 times more common than
  Hodgkins lymphoma, can either be T-cell
  lymphomas, or B-cell lymphomas
• Can be low grade or high grade disease. B-cell
  lymphomas 50 and usually are more aggressive
  tumors. Since they grow faster, they are also
  more sensitive to radiation and chemotherapy

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Oncology

• Malignant Lymphomas 2 types
• Non-Hodgkins Lymphoma
• Diagnosis bone marrow biopsy, CT scan, lymphoma
  panel with CD markers
• Symptoms- adenopathy, spleenomegaly with vague
  abdominal pain, back pain, and since immunity B
  or T-cell function is affected- the patient is
  more prone to infections. Subcutaneous T-cell
  lymphoma is a classic discoid rash on the upper
  body and trunk that does not respond to steroids
  or creams.
• NHL can progress rapidly to leukemia if untreated.

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Oncology

• Malignant Lymphomas 2 types
• Non-Hodgkins Lymphoma
• Treatments Monoclonal antibodies, chemotherapy
  with Fludara/Fludarabine, radiation therapy, and
  bone marrow implants

73
Oncology

• Leukemia hematopoeitic cancer of the stem cells.
  These stem cells proliferate into non-functional
  immature white cells.
• More children get leukemia than any other type of
  cancer and it is the 1 cause of death in
  children.
• Anyone can get leukemia at any age.

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Oncology

• Leukemia -4 types
• Acute lymphoblastic leukemia (ALL)
• Acute myelogenous leukemia (AML)
• Chronic Lymphocytic leukemia (CLL)
• Chronic myelogenous leukemia (CML)
• Anagram ALL AniMals are CLearLy
• CaMeLs

75
Oncology

• Leukemia ALL suspected cause is a T-cell virus
  (HTLV-1) 85 is seen in children, 25 in adults
  30-to-40 y.o.
• Diagnosis peripheral blood smear after
  abnormally high white count, bone marrow biopsy
  shows lymphoblasts gt50m may have decrease in
  platelets. Lumbar puncture to determine CSF
  involvement

76
Oncology

• Leukemia ALL
• Symptoms fatigue, anorexia, malaise, weight
  loss, bleeding, infections, headaches,
  adenopathy, spleenomegaly, gingival hypertrophy,
  hepatomegaly, bone or joint pain
• Treatment complete response is a bone marrow
  aspirate with lt 5 blasts. Chemotherapy
  vincristine, prednisone, danorubicin,
  methotrexate,
• Maintenance therapy 6 weeks of
• 6-mercaptopurine and methotrexate low dose therapy

77
Oncology

• Leukemia AML more common in patients with
  chromosomal genetic disorders, exposure to
  benzene or radiation. Use of alkylating agents
  for breast, ovarian, or myeloma are associated
  with a later malignancy of this type.
• Symptoms- are like ALL with the additions of
  anemia, thrombocytopenia, visual disturbances,
  epistaxis (nosebleeds), headache with vomiting,
  dysphagia, papilladema, menorrhagia (lots more
  bleeding problems)

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Oncology

• Leukemia AML
• Diagnosis peripheral blood smear shows Auer
  bodies (rods), platelets less than 20,000/mm3,
• bone marrow biopsy
• Prognosis poor prognosis if patient has already
  received radiation or chemotherapy, or has a WBC
  gt100,000

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Oncology

• Leukemia AML
• Treatment Cytaribine chemotherapy in combination
  therapy with Danorubicin or doxirubicin, works
  65 of the time.
• Bone marrow transplant or stem cell transplant.

80
Oncology

• Leukemia CLL staged 0-5
• chronic diseases have more mature cells, majority
  of CLL is B-cell proliferation 95. Only 5
  are T-cells, more common in people with
  autoimmune diseases, i.e. SJogrens, SLE,
  hemolytic anemia
• Symptoms skin and respiratory infections,
  fatigue, thrombocytopenia, anemia, spleenomegaly

81
Oncology

• Leukemia CLL
• Diagnosis- peripheral blood smear, bone marrow
  biopsy
• Treatments Gleevac drug of choice
  chemotherapy in combinations, spleenectomy,
  radiation therapy to spleen, bone marrow
  transplant, stem cell transplants

82
Oncology

• Leukemia CML (last is the CaMeL)
• - More common after radiation exposure, benzene
  exposure, less common than the other types of
  leukemia, and occurs most often between 50-60
  y.o.
• Diagnosis hallmark is the presence of the
  Philadelphia Chromosome, Chromosome 22 is
  missing part of the long arm which is
  translocated to Chromosome 9. This is present in
  95 of those patients with CML.
• WBC gt100,000 with proliferation of all types of
  mature and immature white cells.
• Bone marrow biopsy

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Oncology

• Leukemia CML
• Symptoms same as other leukemias with chronic
  fever, sternal tenderness and dyspnea usually
  due to severe anemias
• Treatments chemotherapy with Bisulfan and
  hydroxurea, other combination chemos,
• Interferon alpha 2b to suppress the expression of
  the Philadelphia chromosome.
• Bone marrow transplant or stem cells

84
Oncology

• Bone marrow and stem cell implants
• New treatments for
• Acute myelogenous leukemias (AML)
• Acute lymphoblastic leukemias (ALL)
• Myelodysplasia syndromes (MDS)
• Chronic myelogenous leukemias that do not respond
  to chemotherapy (CML)
• Blast crisis
• Pediatric acute leukemias
• Non-Hodgkins lymphoma
• Large B-Cell lymphoma
• Multiple myelomas

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Bone marrow and stem cell implants
86
Oncology

• Bone marrow and stem cell implants
• Procedure multiple punctures
• Marrow acquisition from donor or when patient is
  in remission, or stem cells from umbilical blood
  of a matching sibling or family member
• Marrow is filtered to purge tumor cells, fat and
  bone particles, then place in a blood bag for
  cryopreservation.

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Oncology

• Bone marrow and stem cell implants
• Preparing Recipient
• Marrow recipient is given high dose chemotherapy
  alone or in combination with radiation to
  suppress immune system, open spaces in the
  marrow, and kill remaining cancer cells.
• Bone marrow is thawed and infused through a
  central venous catheter

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Oncology

• Bone marrow and stem cell implants
• Preparing Recipient
• Stem cells are infused after thawing
• Post-procedure
• Patient is supported through the period of
  aplasia, 10 to 30 days, while in reverse
  isolation and on graft immunosuppressants,
• Observed for signs of Graft-versus-host disease
  and/or infection

89
Oncology

• The waves of the future
• Stem Cell Research
• Oncogene therapy now that cancer cells are
  being genetically tagged, we can tell which
  growth factors are present, and which enzymes
  turn off the gene. Soon all gene markers will
  have a pill that matches the enzyme, i.e. IRESSA
  is a tyramine kinase inhibitor, and stops the
  tumors growth that use tyramine kinase

90
Oncology

• Stem Cell Induction there are new drugs out for
  stem cell induction to immunosuppress the
  patient, even in deadly cancers, i.e. Multiple
  Myeloma. Recently, the combination of
  lenalidomide(Revalamid), bortezomib (Velcade) and
  dexamethasone produced a
• 98 response rate in patients

91
Oncology

• The waves of the future
• Cancer vaccines
• Oncology is the science of cancer and treatment
  of all cancer patients. It is one of the most
  demanding and rewarding fields in medicine.
• The future is open for a cure.

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Oncology