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Medical imaging techniques are an important element in early detection for many cancers. They are also essential for determining the location, extension and stage of the lesion in diagnosis, for guiding treatment and therapeutic interventions, and for assessing tumour response during and after treatment. Imaging methods range from anatomically based methods (ultrasound, conventional plain X-rays,...
Malignancy may uncommonly present with a paraneoplastic syndrome rather than as a direct result of the primary tumour or its metastases. Paraneoplastic syndromes are a heterogeneous group of syndromes that represent the non-metastatic systemic effects of malignant disease. Pathogenesis varies among syndromes but several humoral and immune mediators are implicated. Although some syndromes are rare,...
The historical use of chemotherapy relied on the systemic use of cytotoxic agents to disrupt mitosis in rapidly dividing cancer cells, with foreseeable dose-limiting haematological toxicities. Targeted therapies affect specific cellular molecular mechanisms promoting cancer cell survival and proliferation, enabling treatment tailored to specific tumour characteristics. The key pathways include the...
Adjuvant therapy is used following radical treatment to reduce the risk of cancer recurrence and improve survival. The rationale for its use is its potential to treat local and/or distal occult microscopic disease. However, it can be associated with significant adverse effects. The potential benefit of treatment must therefore be assessed on an individual basis, considering both tumour and patient...
The development of a new treatment in cancer generally involves its assessment in Phase I, II and III prospective clinical trials. This article gives an overview of these phases of clinical trial, through which almost every new treatment will need to pass on the journey from its discovery on the laboratory bench to its routine use in clinical practice. The aim of the Phase I trial is to establish...
Breast cancer is the most common cancer to affect women, with a recent estimate of lifetime risk being one in eight. The number of women found to have breast cancer in the UK has risen to 52,250 in 2011 with the highest rise being in the 50–69-years age group. This is probably attributable to several lifestyle factors such as diet, alcohol consumption, lack of exercise and late pregnancies. Because...
Prostate cancer is a major health problem. In the UK, it is the commonest male cancer and the second commonest cause of male cancer death. Increasing age is its strongest predeterminant. Virtually all cancers are adenocarcinomas, the grade being indicated by the Gleason score. There are often no presenting symptoms. Investigations such as serum prostate-specific antigen, digital rectal examination,...
Radiation therapy utilizes high-energy radiation from X-rays, γ-rays, neutrons, electrons, protons and other sources to kill cancer cells and shrink tumours. External-beam radiation therapy (EBRT) is delivered by a machine outside the body, while brachytherapy or internal radiation therapy comes from radioactive material placed in the body near or within the tumour. EBRT is by far the most common...
Bladder cancer is the most frequently occurring tumour of the urinary tract and the eighth most common cause of cancer death in the UK. It is characterized by a high recurrence rate, pathological progression and poor survival in advanced metastatic disease. Owing to the long follow-up period and associated costs of disease monitoring, it is one of the most expensive cancers to manage. Local therapy...
Hormone therapy is an effective and non-toxic therapy for oestrogen and progesterone receptor-positive breast cancer and prostate cancer. Serum levels of oestradiol and testosterone are controlled by the hypothalamic–pituitary–gonadal pathway. Oestradiol is produced in premenopausal women from the ovaries and in postmenopausal women by peripheral conversion of adrenal androgens by aromatase. In premenopausal...
Radiotherapy is involved in the treatment of at least 40% of cancer patients. Whereas palliative radiotherapy is typically given over 1–10 treatments, radical treatments can extend over 4–8 weeks. Radiation is delivered by external-beam machines or by inserting radioactive isotopes. Modern imaging, computing and delivery systems have led to dramatic improvements in external-beam radiotherapy. Treatment...
Chemotherapeutic drugs exert their effects by interfering with the processes involved in cell division. Their therapeutic use stems from their ability to cause a greater proportion of cell kill in cancer cells than normal cells. In this review we discuss the clinical uses of chemotherapeutic agents, their mechanisms of action, important toxicities and patterns of resistance.
Cancer is a genetic disease. Most common cancers are caused by acquired mutations in somatic cells. In contrast, specific germline mutations account for rare hereditary cancer syndromes. In general, cancer-associated genes can be divided into two groups: oncogenes and tumour suppressor genes (TSGs). Oncogenes undergo activation and are phenotypically dominant, while TSGs undergo inactivation and are...
Cancer screening is a source of much debate. At the interface between public health, specialist care, economics and public health policy, it creates tensions between professional groups, politicians, the media and the public. A screening test may be cheap, but applying it to a population (with rigorous quality control and effective processing of patients with abnormal results) creates a huge workload...
Over the last 28 years there has been a burgeoning development of genetic risk assessment and ‘family history’ clinics to deal with the ever-increasing demand from individuals at increased risk of cancer by virtue of their family history. Risk of inherited cancer can be divided into known syndromes, such as familial polyposis, and increased risk of common cancers due to family history alone. Risk...
Cytotoxic chemotherapy remains an important component of anti-cancer therapy. However, newer ‘targeted agents’ are emerging as more effective agents in certain cancer types as determined by their molecular phenotype.
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