Supporting cancer patients

For cancer patients, the trauma of diagnosis, protracted and sometimes toxic curative treatments, possible disease relapse, with progression to incurable and increasingly disabling or terminal disease, provokes intense, often distressing emotional and psychological reactions. These may include The cancer not only impacts on the patient personally, but also on family, friends, their work, and finances. Up to one-third of cancer patients suffer significant psychological morbidity. Appropriate...

Breast cancer screening

There have been at least seven randomized controlled trials of mammographic screening over the last 30 years. The HIP study of New York and the Two Counties Study from Sweden both showed a 30 reduction in mortality in the > 50-year-old age group who were screened with mammography. Meta-analysis of all the published trials confirms a significant benefit for the over-50s. None of the trials published so far have shown a mortality benefit for women under the age of 50 years, although two...

Myeloma

Myeloma (multiple myeloma, myelomatosis) is due to the unregulated proliferation of monoclonal plasma cells in the bone marrow. Their accumulation leads to marrow failure and, indirectly, to bone resorption resulting in osteoporosis and fracture. The cell of origin has not been conclusively identified but may be a memory B lymphocyte. The cause is unknown. An important mechanism is local production of interleukin 6, which stimulates plasma cell proliferation. Both paracrine and autocrine...

Management of early breast cancer

Early breast cancer is defined as disease that can be completely extirpated by surgery, that is T1 3, N0-1 tumours. The management of this disease comprises Treatment of the breast and axilla Pathological staging to direct adjuvant therapy Adjuvant therapy endocrine, chemotherapy, radiotherapy All patients require removal of the primary tumour with either wide local excision or mastectomy. Halsted mastectomy was the operation most extensively applied to breast cancer patients during the first...

Red cell transfusions in cancer patients

A low haemoglobin in a patient with cancer is also common and requires careful diagnostic evaluation. Elimination of obvious causes such as bleeding from a gastrointestinal malignancy are important before repeated red cell transfusions are given. A one-unit blood transfusion should raise the haemoglobin by approximately 1 g dl. Transfusion may reduce the platelet count, so platelet transfusion may be required before or after blood transfusion. Red cell transfusion should be based on clinical...

Highdose chemotherapy HDC with haematopoietic support

In the clinic, dose escalation within a 'conventional' range has an inconsistent effect on response rates, and with some exceptions, a negligible survival impact. Clinical dose escalation is complicated by a greatly increased toxicity, seen when these relatively non-specific toxins are administered to patients. Substantial advances in haematopoietic support have allowed investigation of very high doses of chemotherapy in the clinic. Autografting, using either autologous marrow or...

Thrombocytopenia in the cancer patient

Thrombocytopenia is commonplace in patients receiving cytotoxic chemotherapy. The trigger level to transfuse platelets is not always absolute. Spontaneous bleeding is unlikely if platelets are > 20 x 109 l, but the risk of traumatic bleeding is greater if < 40 x 109 l. Most clinicians would transfuse when platelets are < 10 x 109 l. However, if there is active bleeding, many clinicians would transfuse if < 50 x 109 l. Careful consideration of the patient's vascular status, clotting...

Melanoma

Melanoma can affect the uveal tract its most frequent location is the choroid. Often the patient presents having attended the optician for a routine visit and a pigmented lesion has been noted. The patient may present with visual loss. Biopsies should not be performed. Diagnosis should be made by an ophthalmologist with experience in this field. Management should ideally be carried out in a combined ophthalmic-oncology clinic. Treatment may be observation, radioactive eye plaque (ruthenium or...

Anal squamous cell carcinoma

There is wide geographical variation in the incidence of anal cancers around the world. Areas of high incidence include Recife in Brazil and the Philippines. Interestingly, those areas with a high incidence of anal cancer also tend to have a high incidence of cervical, vulval, and penile tumours. Epidemiological evidence has suggested that anal cancer may be associated with anal sexual activity. Male homosexual activity and HIV infection are strongly associated with the incidence of anal...

Ablation of endocrine glands

In men and premenopausal women the major sites of steroid hormone synthesis are the gonads. Castration decreases circulating testosterone in males by over 95 and oestrogens in premenopausal women by 60 (relative to follicular phase levels).These endocrine effects produce benefits in about 80 of men with metastatic prostate cancer and in 30-40 of unselected premenopausal women with advanced breast cancer. Oophorectomy is rarely beneficial in postmenopausal women because the postmenopausal ovary...

Adjuvant chemotherapy of colorectal cancer

Nearly half the patients undergoing apparently curative resection of bowel cancer are destined to relapse and eventually die with either locally recurrent or distant metastatic disease. This is due to the presence of residual micro-metastases invisible at the time of surgery. The aim of adjuvant chemotherapy is to eradicate these micro-metastases and thereby prevent future relapse. Current available chemotherapy does not completely eradicate bulky, advanced metastatic bowel cancer. It does...

Effective use of morphine

The keystone to using morphine for moderate to severe pain is in proper prescribing, patient reassessment, patient information, and prevention of side-effects. Ideally start with a quick-acting morphine preparation. This has onset of analgesia in 20-30 minutes, which peaks at 60 minutes, and, when the required dose for the individual's pain is reached, will last four hours. This information should be given to the patient. Morphine may relieve pain completely, partially, or not at all. It was...

Small cell lung cancerradiotherapy

Patients with small cell lung cancer (SCLC) are usually treated by primary chemotherapy because of its chemo-responsiveness and frequent dissemination at time of diagnosis. SCLC is, however, also the most radio-responsive variety of bronchial carcinoma and radiotherapy has an important role in its management. In patients with a localized tumour, thoracic irradiation (TI) and prophylactic cranial irradiation (PCI) improve disease control at these sites and lead to prolongation of survival when...

List of contributors

Ahmed Aberdeen Royal Infirmary, Aberdeen, UK J. W. Arndt Department of Diagnostic Radiology, Leiden University Hospital, Leiden, The Netherlands Dr Ahmed Awada Chemotherapy Unit, Jules Bardet Institute, Brussels, Belgium Professor Anne Barrett Professor of Radiation Oncology, Glasgow University and Beatson Oncology Centre, Western Infirmary, Glasgow, UK Professor H. Bartelink The Netherlands Cancer Institute, The Netherlands Professor H. Bismuth University of South Paris, Paris, France Dr...