Molecular oncology
Molecular oncology is a specialized field that focuses on understanding the molecular mechanisms underlying the development and spread of cancer. This area encompasses various subspecialties, including medical oncology, molecular genetics, and molecular virology, and is relevant to many types of cancers, such as those affecting the brain, breast, gastrointestinal system, lungs, as well as leukemias and lymphomas. The main objective of molecular oncologists is to investigate the disruptions in cell division regulation that lead to cancer, often collaborating with medical professionals to diagnose and recommend treatments based on specific genetic defects and molecular characteristics of tumors.
Training in molecular oncology typically involves rigorous academic research, with pathways including predoctoral and postdoctoral programs. Though primarily a research discipline, it can intersect with clinical training, resulting in professionals who possess both medical and doctoral degrees. Molecular oncologists play a crucial role in analyzing cancer samples to identify chromosomal abnormalities and surface proteins, which can inform treatment strategies, such as the use of specific hormone therapies in breast cancer cases. Additionally, the field addresses hereditary cancer risks linked to mutations in specific genes, such as BRCA1 and BRCA2, potentially allowing for preventative measures or early detection in at-risk individuals. As a multidisciplinary field, molecular oncology attracts interest from various related specialties, including hematology and pediatric oncology, emphasizing the need for advanced training to explore the molecular underpinnings of cancer across different contexts.
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Molecular oncology
ALSO KNOWN AS: Molecular biology of cancer
DEFINITION: Molecular oncology is a field in which physicians and researchers study and address the molecular basis for the development and metastasis of cancer.
Subspecialties: Medical oncology, molecular genetics, molecular virology
Cancers treated: Most forms of neoplastic disease, including neoplasms of tissues and organs, such as brain, breast, gastrointestinal, and lung cancers, as well as leukemias and lymphomas
Training and certification: Molecular oncology is primarily an area of research rather than a medical specialty. Development of expertise in the field may involve either predoctoral or postdoctoral training. Predoctoral training involves the development of a research project addressing a question in molecular oncology and the ensuing research that will ultimately result in a doctoral degree. Postdoctoral training involves advanced research carried out following the receipt of a doctorate. Postdoctorates train, or in a sense apprentice, under the auspices of an expert in the molecular field at a university or medical school.
Some medical programs provide concurrent training in research and clinical training. The result, usually in a three- to four-year Doctor of Medicine (MD) or Doctor of Philosophy (PhD) program, is that the individual earns both a medical degree and a doctorate. Applicants for such programs have completed an undergraduate program at an accredited university.
Certification in a clinical specialty may be established after completing a terminal degree. The specialty reflects the individual's clinical interest and may be in fields such as hematology, immunology, pediatrics, or medical microbiology. Interest in the molecular mechanisms underlying cancer can result in research within the specialty.
Services and procedures performed: The main aim of molecular oncology is to research the underlying cause of cancer. Most cancers have a basis in the disruption of regulation of cell division. However, as specific genetic defects may result in cancer development, molecular oncologists may work with the physician in charge or with the cancer team in the diagnosis of the disease and to provide recommendations on the best course of treatment. For example, an analysis of pathology samples obtained from a patient with leukemia may determine whether any obvious chromosomal abnormality is present.
Microscopic analysis of chromosomes may provide evidence for a particular form of leukemia or lymphoma but does not directly address the molecular mechanism underlying the disease. To do this, the molecular oncologist would research to understand the disruption of cell cycle regulation and the progression by which the cell ultimately undergoes cell division. Defects may involve any of the steps in regulation, including overproduction of growth factors or other oncogene factors or mutations involving receptors or signal mechanisms within the cell.
Analysis of the type of surface proteins found on cancer cells may provide clues as to the course of treatment. For example, certain forms of breast cancer develop or are characterized by estrogen receptors on the surface of cells. The molecular oncologist, as part of the medical team, may recommend the use of estrogen analogs or inhibitors as one course of treatment for the disease.
Although the cause of most forms of breast cancer is unknown, approximately 5 to 10 percent of such malignancies have a genetic basis and are associated with mutations in one of two specific genes: BRCA1 and BRCA2. Areas of molecular oncology address the molecular basis by which mutations in these genes produce a high risk for cancer. Screening of women for the presence of these genes may allow for early intervention or monitoring in hopes of either preventing the disease or catching it at an early stage in women at risk.
Related specialties and subspecialties: Hematology is the clinical field addressing blood disorders, including leukemias and lymphomas. Although some forms of such cancers may be associated with infectious agents—for example, viruses are known to be the etiological agents for certain T cell lymphomas and Burkitt lymphoma—in general, blood cancers result from molecular disorders that disrupt normal regulation of cell division. Hematologists who research such disorders are trained in molecular biology or biochemistry.
Pediatric oncology is a specialty dealing with cancers in children. Physicians in this area who are interested in researching the molecular basis for such diseases have undergone advanced training in the molecular field. Much the same may be said of researchers in cancer relevant to any specialty. The medical degree establishes the specialty of interest, while further training is necessary for research into cancer's molecular or biochemical basis.
Bibliography
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"Molecular Oncology Laboratory." Johns Hopkins Hospital, www.hopkinsmedicine.org/research/labs/m/molecular-oncology-laboratory. Accessed 20 June 2024.
Pecorino, Lauren. Molecular Biology of Cancer. 5th ed. Oxford UP, 2023.
Pelengaris, Stella, and Michael Khan. The Molecular Biology of Cancer. 2nd ed. Wiley, 2013.
Schulz, Wolfgang Arthur. Molecular Biology of Human Cancers. 2nd ed., Springer, 2023
Tannock, Ian, et al. The Basic Science of Oncology. 6th ed. McGraw, 2021.
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