A5.4 Toxicity on the physiological system

Topic

Oncological treatments act with varying degrees of specificity on the tumor, yet they inevitably affect the patient's overall physiological system—that is, the other organs and bodily systems unrelated to the tumor itself.

Toxicity is the clinical manifestation of this collateral damage to the patient's general physiology and can affect multiple organs and systems simultaneously: it may damage the heart (cardiotoxicity), kidneys (nephrotoxicity), peripheral nerves (peripheral neuropathy), the bone marrow responsible for blood cell production (myelosuppression), the liver (hepatotoxicity), or the hormonal system (endocrinopathies).

This toxicity is not an isolated effect but part of a complete cycle linking the patient's overall physiological system, the tumor, and the treatment: the patient's general physiological state provides the context in which the tumor exists and grows; the status of the tumor, in turn, determines the choice of oncological treatment; and that treatment, in the course of its action, produces side effects that ultimately damage the patient's general physiological system, thereby closing the cycle.

It is precisely this complete cycle that justifies the multidisciplinary approach of modern oncology: subspecialties such as cardio-oncology, nephro-oncology, endocrino-oncology, and neuro-oncology exist because there is a need to specifically address the interface between oncological treatment and the patient's general physiological system—at the precise point in the cycle where treatments, having acted upon the tumor, end up causing damage to the rest of the body.

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