Discovery of Natural Product Anticancer Agents

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

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50 Things About 50 Cancers

This ebook from medical practitioner and family doctor Dr. Parajuli gives you all of the signs and symptoms that you need to know in order to catch cancer in the very early stages and protect yourself from it. You don't have to worry about if you have cancer anymore, and better yet you don't have to spend thousands of dollars to make sure of that either! All it takes is a bit of knowledge and you are on your way! This book also teaches about other aspects of cancer patients, such as how to live with different kinds of cancer, how to prepare yourself mentally to accept this reality if it IS a reality for you, and how to deal with doctors and insurance companies. This book is easy to read and in PDF format, so you don't have to worry at all about reading it. Make it easy on yourself!

Do I Have Cancer Overview

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Signal Pathway Profiling of Human Cancer Using RPMA

Recent case studies demonstrate the utility of RPMA for the analysis of surgically obtained tissues and thereby demonstrate the potential of this format for aiding in therapeutic decision-making by providing information about the activity of signalling proteins. The first published demonstration of RPMA analyzed human prostate surgical specimens, and revealed that members of the PI3 kinase pro-survival protein pathways are activated at the invasion front during prostate cancer progression (Paweletz, et al. 2001). In another study, the investigators examined the differences in pro-survival signalling between Bcl-2+ - lymphomas (Zha, et al. 2004). Comparison of various pro-survival proteins in Bcl-2+ and Bcl-2- follicular lymphoma subtypes by reverse phase protein microarrays suggested that there are pro-survival signals independent of Bcl-2. RPMA analysis has also been applied to evaluation of cellular signalling within the stromal and epithelial compartments from patient-matched...

The Future of Penile Cancer Research and Clinical Care

Much of the research in penile cancer has been driven by interested clinicians, usually with smaller patient data sets from a wide referral base with little or no designated research funding. Progress in our knowledge of this condition has been hampered by a combination of factors including Rarity of penile cancer in the developed nations, particularly in the United States Absence of penile cancer lobby in matters of health policy

Pain Control in Cancer

Stakes are high in improving quality of life in terminally ill children. Thus, it is not surprising that most of the interventional literature describes the gratification that comes from controlling intractable cancer pain. Although most children with cancer can find relief with appropriately managed opioids, the spread of tumor to the nerves can cause extraordinarily resistant pain. One series reported that about 3 of children dying of cancer had pain that was unmanageable with systemic opioids alonen It is for these children that regional techniques are most powerful. Choices include spinal or epidural analgesics, which may be administered as single injections or as infusions, and the percutaneous destruction of peripheral nerves, nerve plexuses, and nerve roots.

Penile Cancer Useful Organisations and Links

University College London Hospital is one of the largest penile cancer centres in Europe with a well-established clinical and research programme. All aspects of penile cancer management are undertaken including minimally invasive surgery for inguinal and pelvic lymph nodes and penile reconstruction following amputation. Dept. of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital Plesmanlaan 121, 1066 CX Amsterdam The Netherlands www.nki.nl The NKI has centralised the management of penile cancer in The Netherlands and has been at the forefront of developing the technique of sentinel lymph node biopsy for penile cancer. www.orchid-cancer.org.uk Orchid is the UK's only registered charity specialising in all three male specific cancers - testicular, prostate, and penile tumours. Orchid works to improve the lives of people affected by male cancers through educational campaigns and raising awareness, a range of support services and a pioneering, world class research...

Penile Cancer Staging Modifications to the 6th Edition TNM Staging System

The TNM staging system is a widely accepted staging tool. However, deficiencies in the 6th edition of the American Joint Committee on Cancer (AJCC) were highlighted in a report of 513 cases treated over a 50-year period at a single center.1 They described no difference in survival between stages T2 and T3 and nodal stages N1 and N2. Importantly based upon their own data they recommended changes in the staging system (i.e., the existing sixth edition TNM) with more meaningful prognostic stratification. This modified TNM system was relevant in that the variables examined were a part of routine clinical staging in distinction to the 6th edition TMN which is in essence a pathologic system. On January 1, 2010, the 7 th edition of the unified TNM staging for penile cancer became standard.4 This represents a consensus between representatives of the American Joint Committee on Cancer (AJCC) and Union Internationale Contre le Cancer (UICC). This is the first change in the official TNM penile...

Evaluation of Books About Prostate Cancer

The following, listed alphabetically by author, are assessments of forty-seven books about prostate cancer published in the past seven years (asterisks indicate those I have found most valuable). Also included are a few volumes published earlier that are of special interest. Books on prostate health in general are not included. Alterowitz, Ralph, and Alterowitz, Barbara. The Lovin' Ain't Over The Couples Guide to Better Sex After Prostate Disease. Westbury, N.Y. Health Education Literary Publisher, 1999. Written by a man who has had prostate cancer and his wife, this book focuses exclusively on impotence. It explains the complexities of erections and orgasms and outlines options for couples faced with varying degrees of impotence. Barrett, David M. (ed.) Mayo Clinic on Prostate Health. Rochester, Minn. Mayo Clinic, 2000. This slim (166-page) book is inadequate in most respects. Only half of it is about prostate cancer a little bit about everything, not enough about anything. Its...

Prostate Cancer Support

Prostate Cancer Support Group Prostate Cancer Survivor's Support Group Prostate Cancer Support Group San Jose Prostate Cancer Support Group Burntress Auditorium, Cancer Center of Santa Barbara, Santa Clara County African American Prostate Cancer Support Group Santa Cruz County Prostate Cancer Support Group Dominican Hospital, Katz Cancer Resource Center UCSF Comprehensive Cancer Center Silicon Valley Prostate Cancer Support Simi Valley US TOO Prostate Cancer Support Group Affiliation American Cancer Society Diversified Health Care Services, 510 West Park, Champaign, IL 217-352-3042 Affiliation American Cancer Society, St. Vincent Hospital Cooling Auditorium at St. Vincent Hospital. 2001 W. 86th St., Affiliation American Cancer Society, Man to Man Wells County Council on Aging, 225 W. Water St., Affiliation America Cancer Society May Bird Perkins Cancer Center, 4950 Essen Lane, VFW Prostate Cancer Support Group of DelMarVa West Michigan Cancer Center, 200 N. Park St., Kalamazoo, MI...

Arkansas Cancer Research Center Neuro Oncology Program Strategy

Metastatic Brain Tumours

What follows is a description of our current treatment philosophy and priority ranking in the Neuro-Oncology Program at the Arkansas Cancer Research Center. A breakdown of our case distribution for each treatment modality over the past 3.5 years according to tumor number and the tumor location relative to eloquent brain is given in Figure 55-6. All patients with breast cancer and solid brain tumor metastases receive WBRT at our institution. A single brain metastasis as the only evidence of residual disease (isolated metastasis) is extremely rare with breast cancer, as compared with the situation with non-small cell lung cancer, melanoma, or renal cell carcinoma. We reserve additional measures to maximize local control, such as surgical resection or SRS, in an effort to increase life expectancy for patients with a KPS score of 70 or greater who have controlled or controllable disease (defined as a reasonable chance of at least a 6-month life expectancy if the CNS disease were not...

Diagnostic and Staging and Classification Systems Worktip ior Prostate Cancer

The prognosis for patients with prostate cancer depends on the histologic grade, tumor size, and local extent of the primary tumor. The most important prognostic criterion appears to be the histologic grade because the degree of differentiation ultimately determines the stage of disease. Poorly differentiated tumors Table 92-4 Staging and Classification Systems for Prostate Cancer mHitan Joint CcmnWee fanra-lntf naliior> al llnton Against Cancer. During 1996 to 2003, 5-year overall survival rates were estimated at 99 for whites and 95 for African Americans.1 For this same period, the survival rates for localized or regional disease (100 ) and distant disease (31 ) in white males were about the same as the survival rates for localized or regional disease (100 ) and distant disease (26 ) in African American males.1 A 4.1 decline in age-adjusted mortality has been documented for the period 1994 to 2004. 10-year cancer-specific survival is estimated as 95 for stage A1, 80 for stages A2...

Recommendations for the Use of Levothyroxine in Thyroid Cancer

The consensus recommendation currently is that TSH suppressive therapy should be given postoperatively to all patients with differentiated thyroid cancer. The exact definition of appropriate TSH suppression to suppress tumor growth adequately remains unclear. Studies with very large numbers and follow-up would be required to detect significant differences. The true efficacy of ablative 131I has never been established in a controlled clinical setting.228,229 In the postoperative setting in the cases believed to be high risk (the older male patient with a tumor larger than 4 cm with either capsular or angioinvasion if follicular or extensive lymphadenopathy if papillary), T4 replacement therapy is avoided for 4 to 6 weeks. This allows maximal TSH stimulation to occur and permits a valuable assessment of postoperative thyroglobulin levels (because thyroglobulin levels increase as serum TSH levels increase in patients with remnant normal thyroid tissue or metastatic thyroid cancer after...

Differentiated Thyroid Cancer of Follicular Cell Origin

The minimal test for determining the diagnosis of a thyroid nodule is fine-needle aspiration cytology with or without ultrasonography. Use of these two tests enables one to discriminate benign from malignant thyroid tumors in about 85 of patients. The remaining 15 of thyroid malignancies are follicular cancer, Hiirthle cell cancer, and some follicular variants of papillary thyroid cancer. Various imaging techniques are used for detecting regional and or distant metastasis and identifying local invasion of adjacent structures. Ultrasonography for Papillary Cancer Since the advent of high-resolution ultrasonography, it is sometimes possible to establish the diagnosis of papillary cancer with only ultrasonography, and fine-needle aspiration cytology is used to confirm the diagnosis.14 Papillary cancer is most frequently thyroid cancer ( 80 ). The presence of calcification, irregular shape, absence of a halo and hypo-echogenicity, and local invasion suggest it is a malignant nodule....

Breast Cancer in the Twentyfirst Century

Breast cancer fits into a twenty-first century phenomenon. . . . The critical shared issue of our time is moving from an age of extinctions to an age of renewal and sustainability. One of the principal hopes for this is the environmental health movement. . . . the role of the breast cancer movement as a vanguard of the environmental health movement is not just of parochial interest to breast cancer patients it is core to the future of life on earth. MICHAEL lerner, Breast Cancer and the Environment Breast cancer, as Michael Lerner declared at the International Summit on Breast Cancer and the Environment in 2002, is a twenty-first-century phenomenon. By this the founder of Commonweal (the highly respected cancer and environmental health center in Bolinas, California) meant not that breast cancer is a disease new to the twenty-first century but, rather, that breast cancer engages twenty-first-century issues of environmental health that are crucial to the future of life on earth. In...

Thyroid Stimulating Hormone Suppression and Thyroid Cancer

Controversy exists in thyroid cancer management about the extent of surgery, the use of 131I ablation therapy, the place of thyroglobulin assay in follow-up, and the role and level of TSH suppressant treatment. Further, there is debate about the degree of TSH dependence of differentiated thyroid carcinomas and the importance of other thyroid growth factors. Their protein products presumably replace known specific growth regulators, growth factor receptors, and signal transducers. TSIs and fibroblast growth factor function as circulating growth factors. The protooncogene c-erb B2 (HER-2 new) is a plasma membrane receptor and the ras oncogene a signal transducer for thyroid growth.192 c-erb B2 is a surface growth receptor that has been shown to be frequently overexpressed in a proportion of breast and ovarian cancers and to correlate with poor prognosis.193 Oncogenes, whether natural (protooncogenes) or viral, encode protein products, which act in either the nucleus or cytoplasm. Both...

General Principles of Reconstructive Surgery for Head and Neck Cancer

Current treatment of head and neck cancer follows a multidisciplinary approach. The principle of this combined approach is to provide the patient with the optimal cancer treatment for the stage of disease, and to maximize the quality of life for the patient, with preservation or restoration of form and function. Reconstructive surgical procedures developed over the past several decades have substantially contributed to attain these objectives. Currently, reconstructive surgery is considered an integral part of the multidisciplinary treatment of patients with cancer of the head and neck. Excision of head and neck tumors may result in exposure of vital structures such as the brain, eye, aerodigestive tract or major neurovascular structures. If inadequately reconstructed, such defects may result in significant complications and or impairment in the performance of routine daily functions, such as speech and swallowing. In addition, esthetic disfigurement may be very significant to the...

Relationship between infertility and testicular cancer

Theoretically, any cause that adversely affects testicular function can result in infertility and testicular tumorigenesis. Many studies evaluating testicular cancer have documented an increased risk for abnormal semen analysis parameters in patients who have testicular tumors. Of 15 patients presenting with germ cell tumors, 10 (66 ) had evidence of abnormal spermatogenesis, including poor motility, low sperm concentration, or low semen volume 5 . Conversely, studies have been published documenting an increased risk for testicular cancer in patients presenting with infertility. This connection is clearly documented in a large population-based study in Denmark including 32,442 men who underwent semen analysis from 1963 to 1995. Men who had abnormal semen analyses had a 1.6-fold increased risk for developing testicular cancer compared with the general Danish population. In evaluation of specific semen analysis parameters, a low sperm concentration, decreased motility, and increased...

Sexual Experiences Following Treatment for Penile Cancer

Once surgery has taken place, the fears that initially dominated, namely the fears for recurrence and survival are gradually replaced by concerns regarding rehabilitation, particularly regarding urinary and sexual function. A number of studies have investigated sexual function following surgery for penile cancer, but the literature regarding voiding function is extremely limited. Studies investigating patients who have undergone a partial or total penectomy for penile cancer have been limited to small retrospective studies. A Norwegian study of 30 men who had been treated for penile cancer assessed sexual function by using a semistructured interview together with a number of self-administered questionnaires.5 The median age of the patients was 57 years and all had undergone treatment at least 11 months previously (median delay 80 months). Unsurprisingly, those patients (n 4) who had undergone the most radical surgery (namely, total penectomy) had the worst sexual function, as...

Psychological Effects in Men Who Have Undergone Treatment for Penile Cancer

The psychological effects of penile cancer surgery have been poorly researched, although it is relatively easy to speculate on the relevant issues. Mental illness has been observed in 20 of men who have undergone treatment for penile cancer, most commonly related to anxiety disorders. 1 3 The central theme relates to the patient's perception that masculinity has somehow been lost or diminished.4 There will be a notable change in the appearance of the penis, and a probable loss of length for those who have undergone penile surgery. As described earlier, penile size has historically been associated with attributes such as strength, virility, endurance, ability, courage, intelligence, and knowledge, and the psychological effects of any form of excisional surgery should not be underestimated. Men who undergo surgery for penile cancer also have concerns in relation to the appearance of their penis in front of other men, as might be experienced in a urinal or in the communal showers of a...

Cancer Chemotherapy and Treatment

Define the tumor, nodes, metastases (TNM) system of cancer staging. 3. Classify each drug used in the treatment of cancer, and compare and contrast the mechanisms of action, uses, and side effects. 4. Outline actions for all health care providers to prevent medication errors with cancer treatments. 5. Describe the role of the health care practitioner in the care of cancer patients. The word cancer covers a diverse array of tumor types that affect a significant number of Americans and are a significant cause of mortality. Numerous cellular changes occur in the genetic material of the cancer cell so that programmed cell death, or apoptosis, does not occur. Proliferation of cancer cells goes unregulated. Many tumors are staged according to the tumor, nodes, metastases (TNM) system. Metastases are cancer cells that have spread to sites distant from the primary tumor site and have started to grow. The most frequently-occurring sites of metastases of...

Penile Cancer and Its Precursor Lesions 141 Penile Cancer and Adjacent Lesions

Penile cancers are thought to arise from the progression of precursor lesions and can be subdivided into HPV-positive and HPV-negative cases. The HPV prevalence differs significantly by histological subtype. Similar to vulvar and head and neck carcinomas, squamous cell carcinoma of the basaloid and warty type display the strongest association with hrHPV (ranging from 66 to 100 ) and their etiological relationship with hrHPV infection is most plausible.4 19,32,33 The remaining penile squamous cell carcinomas demonstrate about 30 positivity for hrHPV DNA.4,7,17,18,34,35 Verrucous penile carcinoma seems to have a weaker association with HPV positivity, showing a prevalence of 22.4 .19 Despite the similarities between penile and vulvar cancer including the presence of HPV (mainly HPV-16) and their precursor lesions, the clear bimodal age distribution that is found for vulvar cancer is not clearly seen for penile cancer.36 Cubilla et al. observed a lower age for patients (average age 55...

Iciety Fdr Control Of Cancer

Breast cancer treated early, according to this poster, led to a 70 percent cure rate, whereas breast cancer treated late resulted in a cure rate of only 10 percent. Other posters proclaimed don't fear cancer fight it and Don't Fight Cancer Alone. Another series of posters promoted surgery, radium, and x-rays as the treatments offered by reputable physicians and cautioned that other methods of treatment are experimental or quackery. In the early 1930s the ASCC expanded its campaign of public and professional outreach and education. Clarence Cook Little, the new managing director of the ASCC (appointed by the board of directors) divided the United States into four regions and hired one physician to communicate the ASCC's cancer control message to physicians in each region. These ASCC-affiliated physicians organized exhibits, spoke at medical meetings, distributed literature written by the ASCC for physicians, and gave lectures at medical schools.74 Little also approached...

Historical Perspective On Clinical Trials In Breast Cancer

Scientific understanding of the biology of breast cancer has changed radically in the past 50 years. Results of large randomised trials have played a major role in this transition. From the nineteenth century and up into the 1970s, breast cancer was understood to be a local regional disease that spread by direct extension along lymphatic pathways to distant sites. This concept gave rise to the surgical methods promoted by W.S. Halsted14-16 around the turn of the twentieth century, i.e., extensive resection of the breast, regional lymphatics, lymph nodes and muscle. This surgical technique, known as radical mastectomy, remained the principal approach to treatment of breast cancer throughout the first half of the century, sometimes combined with radiotherapy. When the concept of large-scale randomised clinical trials to investigate alternative therapies was proposed in the 1960s, controversy arose among breast cancer researchers as well as in other medical fields. In a heated exchange,...

From Speculations to Reality and Beyond Some Implications of a Darwinian View of Cancer Progression

The confirmation of Nowell's model came from the discovery that the acquisition of the resistance of cancer cells to chemotherapy was similar to other well-known evolutionary phenomena described in medical therapy. In 1978, Robert Schimke discovered a genetic mechanism that provides the condition for a selection of cancer cells resistant to methotrexate (MTX). He showed that resistance of mouse cells to MTXresults from a selection of cells of higher contents of a specific enzyme, due to an increase in the number of copies of the gene coding for this enzyme, that to gene amplification. The properties of the resistance of cultured cells to MTX, including (i) a stepwise selection of progressively resistant cells (ii) an increase in a specific protein present at low levels in sensitive cells, which, when present in larger amounts, results in resistance and (iii) stable and unstable resistance in the absence of selection pressure, have analogies both in antibiotic and insecticide...

Predisposing factors to developing cancer

As society becomes more affluent, so the incidence of cancer can be demonstrated to rise. There could be a number of explanations for this, including increased wealth and improved health care enabling individuals to achieve a greater life expectancy than their grandparents (Gabriel, 2001). People are also surviving previously life-threatening illnesses, such as infectious diseases, major accidents, etc., only to live longer and possibly to develop cancer later in life. We also know that more affluent societies consume higher amounts of convenience foods, alcohol and tobacco, as well as being exposed to higher levels of chemicals and pollutants compared with people living in some less developed parts of the world. All these factors can contribute to an individual developing a malignancy (Venitt, 1978 Cartmel and Reid, 2000 Corner, 2001). Other factors can include past exposure to ionizing radiation, viruses and a genetic disposition (Cartmel and Reid, 2000 Yarbro, 2000a). This chapter...

Cancer of the Head and Neck

Strong Chair in Head and Neck Oncology Memorial Sloan-Kettering Cancer Center Professor of Surgery, Weill Medical College, Cornell University New York, New York Clinical Research Associate Head and Neck Service Memorial Sloan-Kettering Cancer Center New York, New York 2001 American Cancer Society

Nanotechnology and Cancer Treatment

Nanotechnology allows the opportunity to deliver powerful cytotoxic agents to specific cancer cells without deleterious effects to other organ systems. However, lack of progress in avoiding degradation in vivo before achievement of therapeutic benefit has impeded major advances to date. Nonetheless, some examples exemplify the exception to this. Liposomal delivery systems have now overcome take-up by the reticuloendothelial system, which has historically compromised effectiveness.23 Nanotechnologies have utilized key differences in physiological parameters of the malignant environment. Liposomal delivery of chemotherapy has been utilized in the overexpression of fenestrations in cancer neovasculature to increase drug concentrations at the site of the tumor.24 This strategy has been used in the treatment of Kaposi's sarcoma for over a decade24 and more recently in breast cancer.25 Liposomal drug delivery can be enhanced in a number of ways including local hyperthermia with thermostable...

Small Cell Lung Cancer

Therapy, the cancer usually recurs within 6 to 8 months, and survival time following FIGURE 90-2. Small cell lung cancer treatment overview. (CAV, cyclophosphamide, doxorubicin, vincristine EC, etoposide carboplatin EP, etoposide cisplatin IC, irinotecan, cisplatin.) (From Ref 21.) FIGURE 90-2. Small cell lung cancer treatment overview. (CAV, cyclophosphamide, doxorubicin, vincristine EC, etoposide carboplatin EP, etoposide cisplatin IC, irinotecan, cisplatin.) (From Ref 21.)

Effects of Treatment for Penile Cancer on Quality of Life

Penile Cancer

Data regarding quality of life following surgery for penile cancer has been reviewed.17 The authors in this review identified 128 men from 6 separate studies in whom quality-of-life data had been collected, of which 5 were retrospective studies. Control groups were rarely assessed. They found that any conclusions from the data were limited by the many and varied instruments used to assess quality of life, by the methodology used to collect the data, and the small numbers of patients studied and it is perhaps not surprising that contradictory results were often obtained. Although we might assume that conservative treatments for penile cancer will be associated with a less marked effect upon quality of life further work in this area is still required. We need prospective studies with a larger sample size, using appropriately validated instruments that assess both general aspects of quality of life as well as disease specific. Fig. 15.1 A penile cancer nurse specialist provides...

Penile Cancer Prognostic Index

Fig. 10.6 Kattan Nomogram predicting 5-year cancer-specific survival according to pathological findings of primary tumor and clinical stage of lymph nodes Fig. 10.7 Kattan Nomogram predicting 5-year cancer-specific survival according to pathological findings of primary tumor and pathological stage of lymph nodes

Introduction Complement And Cancer

Although complement provides a rapid and efficient mean to protect the host from invasive microorganisms (for review see Walport, 2001a, b) its role in anti-cancer immune response remains vague and has even been questioned. Treatment of cancer patients with microbial vaccines, dating back to the 19th century, was attempted in a hope to stimulate the immune system to arrest the malignant process. The anti-cancer effect of Corynebacterium parvum and Staphylococcus aureus protein A could be correlated with the activation of the alternative complement pathway and with macrophage infiltration (reviewed in Cooper, 1985). Although complement activation with subsequent deposition of complement components in tumor tissue has frequently been demonstrated in cancer patients (Lukas et al., 1996 Niculescu et al., 1992 Yamakawa et al., 1994 Bernet-Camard et al., 1996 Niehans et al., 1996), its role as the principal factor behind positive anticancer effects was not clearly shown. In clinical...

Case Study 5fu Plus Leucovorin In Colon Cancer

As is clear, the history of clinical trials in GI cancer is long and has been very successful. As an example illustrating several facets of both the past history of GI clinical trials and issues that will likely be faced again in future studies, here we present a case study of the development, establishment and replacement of what was once the US standard of care for advanced colorectal cancer and, as of 2002, remains the standard for adjuvant stage 3 colon cancer, the 'Mayo Clinic' bolus regimen of 5-FU and leucovorin delivered for 5 consecutive days every 4 or 5 weeks. The activity of fluorinated pyrimidines in the treatment of GI cancers has been reviewed Prior to the early 1980s, 5-FU was primarily administered as a single agent. Administered in this fashion, it was associated with limited activity and moderate toxicity. Response rates for metastatic colorectal cancer were low, in the neighbourhood of 10 , and these responses were short-lived, lasting on average a few months.61...

How Cancer Pain Undermines Health and Treatment

To be struck with cancer, or to have a loved one afflicted with cancer, is one of the most frightening events imaginable. To endure the dehumanizing pain of cancer without relief is overwhelming. To helplessly witness that anguish in a loved one is heartbreaking. To discover later, however, that the suffering might have been prevented is perhaps the worst of all. Uppermost in the minds of many cancer victims are fears and anxiety about pain. We are now finally entering an era in which these fears may finally be put to rest. Today we are equipped with a modern arsenal of drugs and techniques capable of eradicating cancer pain in most cases. Around the country, in doctors' offices and pain clinics, many patients are successfully being properly treated and relieved of most of the suffering from cancer and cancer treatment. Yet, tragically, many cancer patients are not appropriately treated for pain and side effects too many people are unaware that modern approaches to treating pain are...

The application of research methodology to cancer research

The preceding chapters of this book have focused principally on the 'scientific' advances in cancer treatment that have been primarily led by scientists and consequently mostly lie within the biomedical domain. This never-ending search for a greater understanding of what causes cancer, the biological effect of cancer on the body, and the search for new drug regimens to improve survival or even cure cancer are essential and give hope to us all. Indeed the recent improvements in cancer survival rates demonstrate the advances made through such clinical research. Many patients' lives have been extended and enhanced through the introduction of new treatment regimens. Nevertheless, it is important not to forget the individual in all of this, who has to cope with the consequences of treatment, live with the knowledge of a life-threatening illness and the devastating psychological effects that this brings to the patient and family. In the past decade it has been encouraging to see this aspect...

Rehabilitation and Quality of Life Assessment in Head and Neck Cancer

Of all disease states, the role of quality of life (QOL) assessment is most persuasively essential in patients with cancer. Stressing this importance, the National Institutes of Health and the Food and Drug Administration implemented several initiatives to encourage the more routine inclusion of the QOL assessment in oncology trials. As a result, the number of quality of life related studies in oncology burgeoned in the medical literature (see Figure 23-1). In sequence, QOL also became important in the management of head and neck cancer (HNC), particularly given the multitude of QOL-associated problems and the absence of survival differences between therapeutic modalities used in the treatment of these patients.3-5 The comment made by Hays Martin in the 1940s remains valid today In deciding a method of treatment we should not, in our eagerness to achieve cure, lightly disregard the crippling that may result from our surgical endeavors.3-5 In conformity with this statement, studies...

Oncogenesis in Thyroid Cancers of Follicular Cell Origin

The thyroid-stimulating hormone (TSH) receptor is a transmembrane glycoprotein that is G protein coupled. TSH, acting through its receptor, is the main regulator of thyro-cyte function and growth. Its function is mediated via the adenylate cyclase and phospholipase C intracellular pathways.5 Constitutively activating mutations in the TSH receptor occur in the transmembrane segment and intracy-toplasmic loop in hot thyroid nodules ( 30 ) but are usually absent in cold thyroid nodules or thyroid cancers (Table 31-1).510 Unfortunately, the frequency of TSH receptor-activating mutations observed in hot thyroid nodules has been variable, ranging from 3 to 82 .5-12 This discrepancy is likely due to several factors such as small sample size, screening of only part of the TSH receptor gene, less sensitive screening techniques (single-strand conformation polymorphism), inaccurate characterization of thyroid nodule function, and the quality of DNA in tissue samples studied.12 In general, TSH...

NIS and Thyroid Cancer

As previously mentioned, the treatment of patients with WDTC includes three modalities thyroidectomy, radioiodine (131I) ablation, and TSH suppression. Unfortunately, about 25 of WDTCs are initially resistant and about 50 of recurrent thyroid cancers are resistant to 131I treatment. These patients have a worse prognosis, and many studies have attempted to enhance radioiodine uptake in thyroid cancer cells in such patients. 1,2'34'37'3S Thyroid cancer has not been shown to involve the mutations seen in congenital ITD. Russo and colleagues51 performed direct sequencing of NIS cDNA from five papillary and two follicular thyroid cancers and found no mutations in the NIS gene. The proposed mechanism of reduced radioactive uptake in thyroid cancer has been associated with decreased expression of the NIS gene. Bidart and associates52 showed that NIS protein immunostaining is increased in Graves' disease and reduced in Hashimoto's and thyroid cancer. Our own studies have confirmed that NIS...

Chemotherapy for Thyroid Cancer

As with salivary gland tumors, thyroid cancer constitutes a spectrum of histologic subtypes and clinical Table 22-10. COMBINATION CHEMOTHERAPY IN SALIVARY GLAND CANCER sumption of an iodine-rich diet, inadequate levels of thyroid stimulating hormone (TSH), or persistence of a significant amount of native thyroid cancer may all affect the efficacy of RAI treatment for the tumor. For RAI-refractory disease, initial observation is appropriate for selected patients, as the tumor may grow slowly. If chemotherapy is indicated, doxorubicin is the most studied and widely used drug, with response rates in the 30 to 40 percent range.148,149 Cisplatin, carboplatin, methotrexate, and etoposide also have activity.150 Combination chemotherapy may improve response rate but has unproven benefit in terms of palliation and survival. Chemotherapy and radiation have been combined for the treatment of compelling local disease with good local effect in most patients.151152 The possible use of agents...

Cancer of the Hypopharynx and Cervical Esophagus

The esophagus is a mucosa-lined muscular tube that serves as a conduit between the pharynx and the stomach. For the purposes of classification, staging, and reporting of cancer cases, it is divided into the following subsites cervical, upper thoracic, mid-thoracic, and lower thoracic.2 Approximately 5 percent of cases of esophageal carcinoma arise within the cervical esophagus.3 The cervical esophagus extends from the inferior border of the cricoid cartilage to the thoracic inlet.2 The wall of the esophagus is comprised of an inner mucosa of squamous epithelium, a prominent submucosa, a muscular layer and an adventitia without serosa.2,4 The submucosa contains mucous glands, blood and lymphatic vessels, and a plexus of nerves.4 The muscular layer contains an inner circular layer surrounded by an outer longitudinal layer.4 Although the lower two-thirds of the esophagus is composed of smooth muscle, the most proximal end is exclusively striated and the remainder is mixed.5

Fallopian Tube Cancer

Primary tumors of the fallopian tube are extremely rare entities, accounting for less than 1 of gynecologic malignancies.37 These tumors appear to behave in a manner similar to ovarian cancer and are classified and treated in much the same way. Some fallopian tube neoplasms may be prone to early blood-borne micrometastasis, resulting in poor long-term disease-free survival and contributing to the formation of brain metasta-sis.37,47 The few cases of such brain metastases reported in the irradiation literature were treated with brain irradiation and systemic chemotherapy because of the presence of active pul-

How common is prostate cancer

There are more than 100 different types of cancer. In the United States, a man has a 50 chance of developing some type of cancer in his lifetime. In American men, (excluding skin cancer) prostate cancer is the most common cancer. Prostate cancer accounts for about 33 (234,460) of cases of cancer (Table 2). More than 75 of the cases of prostate cancer are diagnosed in men older than 65 years. Based on cases diagnosed between 1995 and 2001, it is estimated that 91 of the new cases of prostate cancer are expected to be diagnosed at local or regional stages (see staging of prostate cancer), for which 5-year survival is nearly 100 . It is estimated that prostate cancer will be the cause of death in 9 of men, 27,350 prostate cancer related deaths. In the United States, deaths from prostate cancer have decreased significantly by 4.1 per year from 1994 to 2004. Most notably, the death rate for African American men in the United States has decreased by 6 . Table 2 Cancer Statistics for Men in...

Chemotherapy for Salivary Gland Cancers

Major and minor salivary gland cancers represent approximately 5 to 10 percent of head and neck malignancies.134 135 In general, surgery and or radiation have been the principle treatment modalities, with chemotherapy primarily used in the recur-rent metastatic disease setting. As a single modality, chemotherapy is not curative. Because of the relative rarity and heterogeneity of these tumors, the available data on the efficacy of systemic therapy is often of poor quality. Many series are small, are developed in a retrospective manner, and combine different salivary gland cancer subtypes even though drug activity may vary among them.136 Single-agent activity has been shown for doxorubicin, cisplatin, 5-fluorouracil, and selected other drugs.137-142 The minority of patients will have a major response. In general, the response rates associated with combination therapy are higher than those with a single agent. Selected combination regimens are summarized in Table 22-10. The combination...

Outcome Studies Of Interpleural Analgesia In Cancer Pain

Interpleural analgesia may also be a useful addition to systemic analgesic medications in the treatment of moderate or severe cancer pain. There have been published reports of successful results from interpleural analgesic therapy for both nonmetastatic and metastatic cancers of the gastrointestinal tract, including the pancreas, kidney, breast, and lung as well as lymphoma, sarcoma, histiocytoma, and myeloma.11 1113 113 11531 11511 11551 11561 This evidence describing the use of interpleural analgesia has primarily been in the form of case reports and case series. Using CT guidance, Waldman and colleagues1151 placed a subcutaneously tunneled, right-sided, interpleural catheter in a 33-year-old patient who had intractable abdominal pain secondary to colon cancer with extensive hepatic metastasis. After receiving 12-mL boluses of 0.5 bupivacaine administered every 8 hours, the patient experienced marked improvement of the pain with decreased opioid requirements, which lasted 6 weeks....

Molecular Biology of Penile Cancer

Much of the research into penile cancer has been based upon clinicopathologic factors as predictors of metastasis or survival. Focus is now shifting toward genetic and epigenetic events in penile cancer. Recently, an excellent review on this topic was published by Muneer et al.26 They discuss the complexity of interaction of HPV within the cell, much of which is derived from cervical cancer research in women. In a systematic review of 31 papers published between 1986 and 2008, constituting data from 1,466 cases, the majority HPV subtypes were HPV-16 and HPV-18.27 The incidence of HPV depends on the histological subtype, ranging from 76 being detected in basaloid SCC to as low as 25 in verrucous SCC. Overall 52 of invasive penile cancers out of 145 cases from Denmark are associated with HPV.28 HPV appears to inhibit the action of p53 on cell regulation. Interestingly, HPV-negative penile cancer is usually associated with mutation of p53. This may explain why cases of penile cancer that...

Creativity in Response to Cancer

One of the most prevalent illnesses in adulthood is cancer. Currently it is estimated that about one out of every three women and one out of every two men will develop this illness during their lifetime. Like the general population, artists get a variety of cancers but for the following individuals, the illness becomes a challenge that they face with creativity in a variety of ways. Some artists change their way of working or use the work specifically to address their emotional response to illness, while others like Vincent Desiderio (American, b. 1955) find that having been sick has strengthened them emotionally. Desiderio, who had an aggressive type of nasal pharyngeal cancer, said that the ordeal of illness and treatment with chemotherapy and radiation was grueling but it changed him. He stated he now lives in the present moment and has developed greater internal strength because he no longer requires 'validation from outside.' Although they had different types of cancer, Darcy...

Research ethics relating to cancer

Research is surely a good thing it is not immediately obvious that there are any ethical considerations beyond some sort of imperative to undertake it. After all, there would be no reliably effective treatment and care were it not for research and the evidence base of health-care interventions would simply not exist. Effective cancer care and treatment, perhaps more than any other discipline, rely on previous and current research and we hope that future endeavours will provide hitherto elusive, curative treatment for some of the most serious cancers. Although strongly supporting research, this chapter aims to elucidate necessary limits on the enterprise. These limits may be identified by considering issues such as the motives of the researcher, the value of the research and, most importantly, the welfare of participants. In simple terms, these limits highlight the differences between research (which might actually provide extremely useful knowledge) and ethical research. research...

Michael Milkens Prostate Cancer Foundation

Ironically, both Giuliani and Milken were subsequently diagnosed with prostate cancer and became friends and national advocates for prostate cancer sufferers. Milken was diagnosed with prostate cancer in 1993, shortly after his release from prison. Just 46 years old, he had a Gleason score of 9, a PSA of 24, and the cancer had already spread to his lymph nodes. He was treated with beam radiation and hormones and began a very strict diet thirteen years later he remains in remission. Milken approached prostate cancer in the same manner he had approached Wall Street securities. ''I decided that I had to change the course of history,'' he recalls, and proposed ''a Manhattan Project'' for prostate cancer to discover the causes and better treatments.5 He pledged 25 million of his own funds and in 1993 began CaPCURE (cancer of the prostate cure), a foundation that in 2003 was renamed the Prostate Cancer Foundation (PCF). Milken has accomplished a remarkable...

List of Links Related to Cancer Pain Resources

National Cancer Institute Information Resources Pain Control Program from Cancer Supportive Care http www.cancersupportivecare.com pain.html Pain Management in Children with Cancer Handbook Patt Center for Cancer Pain and Wellness Based in Houston, Texas, this Web site provides medical care for patients suffering from cancer pain or chronic pain, http www.cancerpain.org Persistent Pain After Breast Surgery Includes articles about cancer pain, discussion boards, and Ask the Expert, http Publishes Cancer Pain Relief, second edition (1996), available in English, Spanish, and French, and Cancer Pain Relief and Palliative Care in Children. WHO Publications Center USA 49 Sheridan Ave Albany, NY 12210 518-436-9686 Fax 518-436-74 33

Patients Experiences Prior to and at the Time of Diagnosis of Penile Cancer

Psychology undoubtedly plays a role in the delay in diagnosis that is commonly seen in this disease as evidenced by the frequency with which patients present with advanced cancer, and the significant delay that commonly occurs between the development of symptoms and the presentation to a physician. For instance, in one series of 700 men, over 50 had at least T2 disease at the time of diagnosis and treatment1 while in a second series of men with a localized tumor of the penis, treated by laser therapy, over a third of patients experienced a delay of more than 6 months between the appearance of symptoms and the definitive diagnosis being made.2 While some of the delays undoubtedly reflect medical misdiagnosis, it has been suggested that between 15 and 50 of men delay seeking treatment for penile cancer for psychological reasons.3 These reasons include fear, embarrassment, and symptom denial despite the abnormality being clearly visible and palpable. While there is a suggestion that this...

The Prostate Cancer Research Program

The Prostate Cancer Research Program is run by the U.S. Army under the Department of Defense. Its origins are a classic Washington tale. In 1992, women's advocacy groups for breast cancer research were putting pressure on the federal government to increase funding. Representative Patricia Schroeder, at that time, chaired the House Armed Services Committee, overseeing spending by the Department of Defense. Since expenditures for the National Cancer Institute were restricted by federal regulations, Schroeder arranged to give 25 million to the Army to coordinate additional breast cancer research. Over the next three years, Congress added 390 million more and asked the Institute of Medicine to evaluate the program. The evaluating committee published its report in 1997, calling the Department of Defense breast cancer research ''a unique and valuable entity,'' especially for its ''potential to focus on innovation, in ways that go beyond what traditional institutions like the National...

Hereditary Colorectal Cancer

About 10 of the general population has a first-degree relative with colorectal cancer (CRC) this history increases personal lifetime risk for CRC to 9 to 16 . Many guidelines recommend early screening for these individuals by age 40, or 10 years earlier than the age at diagnosis of a family member. Early detection and removal of adenomatous polyps have made determining family history more difficult. Patients should be asked about removal of polyps in relatives, and those who have adenomatous polyps should be encouraged to tell their families. A family history that contains many relatives with CRC, adenomatous polyps, or endometrial cancer, especially in more than one generation or with early-onset (age < 50) suggests an autosomal dominant pattern of inheritance. Two relatively common, autosomal dominant, hereditary colorectal cancer syndromes account for about 3 to 5 of all CRC cases. Lynch syndrome, or hereditary nonpolyposis colon cancer syndrome (HNPCC), occurs in about 1 in 200...

Hereditary Breast and Ovarian Cancer

A family history of premenopausal breast cancer in a first-degree relative doubles personal breast cancer risk. These women may benefit from earlier screening and should be counseled about the benefits of early detection. An autosomal dominant pattern of inheritance is seen in a much smaller number of families, perhaps 5 of women with breast cancer, known as hereditary breast and ovarian cancer (HBOC) syndrome. Current USPSTF guidelines suggest that physicians should recognize individuals from such families Women with BRCA mutations may have up to an 80 lifetime risk of breast cancer and a 40 risk of ovarian cancer depending on the mutation. The risk of other cancers is also greater, although less so. It is important to recognize that males with a BRCA mutation develop breast cancer at much higher rates than the general population. In fact, a diagnosis of male breast cancer should lead to a careful review of family history. Personal risk depends on the specific gene variant involved...

Differentiated Thyroid Cancers

The two primary types of differentiated thyroid cancers are papillary and follicular. Several variants exist and include a follicular variant of papillary carcinoma, a tall cell variant of papillary carcinoma and a Hurthle cell carcinoma which is a variant of follicular carcinoma. The latter two subtypes are more ominous lesions. Primary surgery is the initial treatment approach. The surgical therapeutic decisions are based on prognostic variables. At Memorial Sloan-Kettering Cancer Center, those patients who are felt to be at high risk are assessed based on GAMES, for example (1) Grade high, (2) Age > 45 years, (3) Metastasis positive, (4) Extracapsular extension positive, (5) Size > 4 cm.89 The patients at low risk do well irrespective of the extent of surgery. The surgical goal is to remove all gross disease that is clinically detectable. The different operations represent the variations in the volume of the thyroid gland that is resected and include partial thyroidectomy and...

Colorectal Cancer Prevention

Strategies to prevent colorectal cancer can be done with pharmacologic or surgical interventions and involve either preventing the initial development of colorectal cancer (primary prevention) or preventing cancer in patients that demonstrate early signs of colorectal cancer (secondary prevention). The most widely studied agents for the chemoprevention of colorectal cancer are agents that inhibit COX-2 (aspirin, NSAIDs, and selective COX-2 inhibitors) and calcium supplementation.19 COX-2 appears to play a role in polyp formation and COX-2 inhibition suppresses polyp growth. In 1999, the FDA approved the use of celecoxib to reduce the number of colorectal polyps in patients with FAP, as an adjunct to usual care. This may delay the need for surgical intervention in these patients but the results cannot be extrapolated to the general population. The dose of celecoxib for this indication is 400 mg orally twice daily and the risk of cardiovascular damage from COX-2 inhibition needs to be...

Paraneoplastic Retinal Degeneration or Cancer Associated Retinopathy

Sera from patients with paraneoplastic retinal degeneration or cancer-associated retinopathy contain antibodies binding antigens that are both a photoreceptor cell-specific protein and a protein expressed by small cell lung cancer. y Pathologically, widespread degeneration of the outer retinal layers with relative preservation of the other retinal layers occurs. This syndrome is usually associated with small cell lung cancer but is also observed with other tumors, including melanoma and cervical cancer. The distinctive clinical triad consists of photosensitivity, ring scotomatous visual field loss, and attenuated caliber of retinal arterioles. U

Penile Cancer Imaging

As regards neoplasms of the penis, it has been demonstrated that lymphotropic nano-particle-enhanced magnetic resonance imaging (LNMRI) with ferumoxtran-10 can accurately predict the pathological status of regional lymph nodes.33,34 Ferumoxtran-10 is made up of superparamagnetic iron oxide nanoparticles, which are phagocytosed by macrophages in normal lymph nodes and these show homogeneous uptake of ferumoxtran-10 and appear dark on T2-weighted MR images. However, lymph nodes containing metastases lack these macrophages and subsequently do not accumulate the nanoparticles and appear bright on T2 imaging. Using this technique it is possible to detect subcentimeter metastases in morphologically normal lymph nodes and also to accurately differentiate malignancy from enlarged reactive lymph nodes. In seven patients with penile cancer, MRI with lymphotrophic nanoparticles was 100 sensitive and 97 specific for lymph node metastasis.33

Nonsmall Cell Lung Cancer

The first step in treatment of NSCLC involves confirmation of the clinical stage and determination of resectability of the tumor. This decision should always be made by a thoracic surgeon who routinely performs lung cancer surgery. Treatment options depend on the advancement of disease (i.e., local, locally advanced, or metastatic), PS, and eligibility for resection.

Cancer Prevention And Environmental Risk

In a speech that she gave at a community forum in 1996 entitled The Politics of Breast Cancer, Nancy Evans, then president of BCA, quoted this passage, which she attributed to a speech delivered by Sandra Steingraber in Santa Fe, New Mexico, in 1994. I quote it here partly to illustrate the way discourses traveled within the culture of environmental cancer activism. 2. I began doing participant observation of the TLC in October 1994, shortly after its formation. Most of the information on the history of the TLC comes from my notes on those meetings and from my participation in early events, including the 1994 demonstration at Race for the Cure. The information about the first two meetings of the TLC is based on interviews with cancer activist Judy Brady and on the public recounting of this history at various events. I conducted participant observation research with the TLC from 1994 to 1999. 3. Quotation taken from AstraZeneca International, Community and Company Projects US Breast...

Biological Cancer Treatments

The Gerson regimen is an example of an old alternative cancer treatment that remains popular today. Developed by Max Gerson in the 1930s, it involves eating raw fruit and vegetable juices, eliminating salt from the diet, taking many supplements such as potassium, vitamin B12, thyroid hormone and pancreatic enzymes, and using coffee enemas to detoxify the liver and stimulate metabolism. Scientific research does not support any of these ideas. Moreover, despite proponents' claims of recovery rates as high as 70 to 90 , case reviews by the U.S. National Cancer Institute (NCI) and the New York County Medical Society found no evidence of usefulness for this regimen. An NCI-sponsored study of Gonzalez therapy, which is similar to the Gerson diet and popular today, showed that patients with inoperable pancreatic cancer who underwent standard gemcitabine chemotherapy survived three times longer and had better quality of life than those who chose Gerson-type therapy with pancreatic enzymes,...

Cancer as a Post Traumatic Stress Disorder

When people believe the diagnosis of cancer is a life-threatening event, they may be thrown into a series of psychological changes that are similar to those triggered by combat, rape, physical, sexual abuse, or other traumatic events that are outside the range of everyday experience. These psychological changes are collectively called post-traumatic stress disorder (PTSD), and in the cancer patient may include attempts to avoid all thoughts or feelings associated with the illness forgetfulness about what the doctor has said a sudden loss of interest in things that used to be meaningful, such as young children or a job one loved feeling and acting estranged from others inability to have or express loving feelings and a sense of a suddenly foreshortened future.

The Cancer Counselling Center of Ohio

The Cancer Counselling Center of Ohio has worked mainly with persons who have a life-threatening or chronic illness. Loss (of job, of money, of physical mobility, etc.) and possible death are constants in the treatment process. Zimpfer's (1992) holistic model includes perspectives that focus on the body, mind, spirit, and emotions. A spirit of harmony among these dimensions is sought, whether one strives to maintain a life amid losses, or whether one anticipates death. The model is based on the concept of wellness Our experience with persons who have cancer is that they are often isolated. Their associates at work, their neighbors, relatives, even fellow churchgoers, will 'write them off' as already dead and interact with them no longer. A spouse may abandon the ill one on the premise that he she didn't get married to take care of an invalid. Sometimes spouses or friends exert pressure to 'get well', or accuse the ill one of not trying hard enough. This only compounds the desolation,...

The Typical Distress of Cancer Patients

From the moment a lump is spotted, a mysterious and insistent pain nags, or sudden weight loss is noticed, almost everyone experiences some anxiety. First, an unspoken fear nags that it could be cancer. If a doctor confirms it, new fears arise concerns about treatment, pain, disfigurement, and even death. The anxiety can mushroom into panic or chronic anxiety that can threaten the patient's ability to cope and comply with treatment recommendations. Some people react to cancer by detaching themselves from decisions about their medical treatment, discussions about their illness, and, in the advanced stages of cancer, thoughts of death and dying. This detachment is another form of denial and serves as a buffer for the patient and to protect family members. Like the other negative emotions discussed here, this is normal up to a point. This form of denial may be just another step in coming to terms with a very unpleasant situation, but if it persists, professional counseling can help....

Psychological Responses to Cancer

As we've said, about half of cancer patients adjust normally to being ill with cancer, leaving about half whose psychological problems may become debilitating. Of those, about two-thirds suffer from reactive anxiety and depression that is, new anxiety and depression that are a direct response to the illness. However, when in pain, patients are about twice as likely to develop anxiety and depression than those whose pain is well controlled.1 Undergoing chemotherapy may be a particularly emotional time often more so than during radiation treatments or surgery, because of concerns about unpleasant side effects that may or may not occur. Often the first chemotherapy treatments and those with very high chances of success are first associated with upbeat and hopeful feelings. If the cancer advances, the frequency of psychiatric problems among cancer patients increases, as might be expected. It is, of course, always difficult to know whether some of these symptoms (poor appetite and sleep,...

Insights Gained in the Role of EGFR in Cancer

Abnormalities in egfr copy number are frequent in cancer. In a report that investigated egfr and EGFR expression (by fluorescent in situ hybridization FISH and immunohistochemistry IHC , respectively) in 183 NSCLC patients, trisomy, polysomy and gene amplification were observed in 40 percent, 13 percent and 9 percent of the cases, respectively (50). EGFR over-expression was observed in 62 percent of the cases and correlated with increased gene copy number. Increased EGFR gene copy number detected by FISH is associated with improved survival after gefitinib therapy in patients with NSCLC (51). In this report, amplification or high polysomy of the egfr (documented in 33 of 102 patients) and high protein expression (observed in 58 of 98 patients) were significantly associated with better response (36 versus 3 , mean difference 34 , 95 CI 16.6 to 50.3 P < 0.001), disease control rate (67 versus 26 , mean difference 40.6 , 95 CI 21.5 to 59.7 P < 0.001), time to progression (9.0 versus...

Cancerous Hens and Constipated Mice

For the moment, Ken did not need any treatment because he had no detectable disease. The cells that had been scattered around his abdomen when the tumor ruptured had not yet formed new cancers. But Ken knew that time would change the situation. Sooner or later, his abdomen would become full of GIST tumors, and they would kill him if they were not stopped in their tracks. The story about how GIST was identified, how Gleevec might ameliorate it, and the start of the present cancer treatment revolution has its roots in the nineteenth century when a strange cancer epidemic was repeatedly sweeping through U.S. poultry farms where hens were packed tightly together. Typically the affected birds would develop swollen bellies and gasp for breath. When the hens were cut open, their abdomens were full of masses of cells cancers. Or, less commonly, the birds would grow large tumors on their wings. In most outbreaks the tumors seemed to be masses of white blood cells, but some of the time the...

Treatment Options For Recurrent Cancer

There are two goals in treating prostate cancer that has spread (1) improve the quantity of the man's life, and (2) improve the quality of the man's life. The dilemmas in treatment arise when attempts to improve quantity make the quality worse, not better. Honest assessments of treatment options are crucial to resolving these dilemmas. The mainstay for treating recurrent prostate cancer is hormone therapy, as described in Chapter 5. Prostate cancers use testosterone to grow, so blocking testosterone slows the growth. Prostate cancers contain cells that are sensitive to testosterone and other cells that are not sensitive. Over time the testosterone-insensitive cells become predominant and hormone therapy becomes ineffective. The cancer is then called androgen independent. The average duration of effectiveness for hormone therapy for a prostate cancer that has already metastasized is approximately two years,10 but during that time men often have comfortable remissions. One of the two...

The Future of Epithelial Cancer Therapy

He goal of cancer research is to improve our ability to prevent and cure epithelial cancers like breast cancer. Though our achievements in cancer prevention are less than impressive, Mario's and Joan's stories show that we have made great progress in curing patients. But even in childhood leukemia and stage 3A breast cancer, two types of cancer that are very responsive to modern treatment, we only cure 80 percent of those who are afflicted. That is a huge increase in the cure rate over the nearly fifty years of my experience, but it isn't good enough. We need much more understanding of epithelial cancer biology if we are to develop the treatments that will capture the last 20 percent. Fortunately, we are gaining that vital knowledge. Cancer is an acquired genetic disease, and we are learning a vast amount about the human genome. As a result, we know much more about the genetic changes that cause cancer. From that knowledge we will gain new and much smarter therapeutic options and have...

What Happens if the Cancer Spreads or Comes Back

Living with prostate cancer, said one man, is ''like being trapped inside a cage with a baby lion.'' In the beginning, the lion is small and nonthreatening, but you know that the lion will grow and may eventually devour you. This man's cancer did spread and in the end did ''devour'' him.1 Prior to the PSA era, by the time of diagnosis the prostate cancer would have already spread beyond the prostate in the majority of cases. By the 1990s, this number had been reduced to one third, and by now it is presumably significantly lower than that. Prostate cancers that have spread at the time of diagnosis present many of the same treatment problems as cancers that recur after the initial treatment. In some cases, the recurrence is expected because of a Gleason score of 8 to 10, a PSA over 20, or other indicators of a large and serious cancer. In other cases, the recurrence of the cancer is unexpected, as when a man has a low Gleason score, a low PSA, and a small tumor. Some of these men are...

The immune system and cancer

The interrelationship of immune response, old age and high incidence of cancer In recent years several factors have been associated with the development of human cancers, including smoking, dietary factors, infectious agents (viruses and bacteria), chemicals, radiation and hereditary factors (see Chapter 2). The treatment of normal cells with these factors results in the mutation of a wide range of genes such as tumour suppressor genes or genes coding for growth factor, growth factor receptors, and motility and invasion factors. Such As the incidence of cancer increases rapidly in old age, ageing is another important factor associated with human cancers. Around 65 of all cancers are diagnosed in people over the age of 65. Although the increasing accumulation of mutations in genes with time can be one factor that contributes to the high incidence of cancers in old age, recent evidence suggests that malfunction of the immune system may also contribute to the high incidence of cancers in...

Cancer Treatmentrelated Pain

Up to a third of women develop pain as a result of treatment of breast cancer.173 The pain is often described as a general burning and aching sensation referred to the axilla, the medial upper arm, the chest, or all of these areas. There may be paroxysmal episodes of shooting and lancinating pain. In addition, some women report phantom breast pain, mainly in the nipple. The pain may be exacerbated with arm movement, leading to a frozen shoulder as the patient attempts to

The Role of Radiotherapy in the Management of Urethral Cancer

External beam radiotherapy (EBRT) and brachytherapy implants or a combination of both have been used in the management of urethral tumors. Historically EBRT has been used in the adjuvant setting following surgery for male urethral cancer but is often a primary treatment for urethral cancers in females. A number of studies have shown that the outcomes following radiotherapy alone are poor.3 3 However, these studies involve selected patients who may have presented with poor prognostic features or a poor performance status, hence prevented radical surgery being undertaken. However, the nonuniformity of the patients and the treatments given in these studies does not lend itself to providing recommendations. Advanced urethral cancers fared worse with the survival rate declining to 34 .1,27 In locally advanced tumors the use of radiotherapy alone again shows poor results. There is some evidence to suggest that a combination of brachytherapy with EBRT with the aim of increasing the overall...

NonMEN Familial Hyperparathyroidism and Parathyroid Cancer

Both parathyroid cancer and NMFH are rare parathyroid disorders. The association of these rare conditions suggests a common cause. Until 2002, 29 patients with NMFH and parathyroid cancer in 22 families were reported.16,21,23,27*33,35,43 Sixteen of these families have NMFH-JT or FIH-JT, and about one fourth of reported NMFH families have one or two affected members suffering from parathyroid cancer. Endocrinologists and surgeons should be aware of this association for proper management of these patients. Reviews of 15 cases of NMFH and cancer were reported before 1993. The mean age of the patients with NMFH and parathyroid cancer at initial diagnosis was 30 years (range, 14 to 43 years), which is considerably younger than that of other patients with parathyroid cancer (50 years) (Table 55-3).41 Seven males and eight females were affected. The clinical manifestations among these patients were similar to those of other patients with parathyroid cancer. The mean serum calcium level was...

The Diagnosis and Investigation of Urethral Cancer

The management of urethral cancer depends on the anatomical location of the tumor and the staging of the primary lesion and the status of the inguinal lymph nodes. Examination of the penis may reveal a discrete nodular lump in the anterior urethra. More distal tumours progressively infiltrate the glans spongiosum and eventually extend out of the urethral meatus (Fig. 8.2). The physical examination should also include a bilateral inguinal examination in order to detect the presence of palpable lymphadenopathy. Cytological examination of the urine may detect the presence of malignant cells, although it is noted that voided urine cytology has a high sensitivity

The Clinical Presentation of Male Urethral Cancer

The diagnosis of early urethral cancer is difficult and the presentation is often delayed by which time the tumor is obvious. Urethral bleeding, urethral discharge, and hematuria are common presenting symptoms as are urinary frequency and obstructive voiding symptoms (Table 8.5). Recurrent urethral strictures, penile pain, and even a palpable mass in the penile urethra may also be a presenting feature. In the later stages periurethral abscesses, urethrocutaneous fistulae, and incontinence may also occur.

Staging of Urethral Cancer

The most commonly used staging system utilizes the TNM classification as indicated in the 2010 AJCC cancer staging handbook (Table 8.3).13 Table 8.5 Reported frequency of the presenting symptoms for patients with urethral cancer Table 8.5 Reported frequency of the presenting symptoms for patients with urethral cancer

Risk Factors for the Development of Urethral Cancer

The risk factors associated with the development of urethral cancer include advancing age, chronic inflammation of the urethra, and urethral stricture disease. Previous urethral surgery and radiotherapy are also risk factors as are immunosuppression and smoking. Infection of the distal urethra with HPV-16 has also been implicated.2,14 A study by Cupp et al. reported that all six of their patients diagnosed with distal urethral carcinomas and one at the penoscrotal junction was HPV-16 positive whereas no HPV-16 DNA was detected in the remaining nine proximal urethral carcinomas.14 This suggests that the pathogenesis in the development of distal and proximal urethral carcinomas may differ.

Future applications of cancer genetics chemosensitivity and gene therapy

Aside from the applications of genetic screening in the small number of familial cancers, genetic technologies will have more and more applications in the research and treatment of cancer. By defining the genetic abnormalities and alterations in specific types of cancer, we have massively increased our understanding of how these tumours develop, helping us to understand how to target and fight them, and at the same time discovering new drug targets. The closer that specific tumour cells have been studied, the more genetic abnormalities and differences in their genetic profile have been discovered, even in cells that are supposedly from the same tumour type. Techniques such as DNA microchips are allowing us simultaneously to profile many of the genetic changes from tumour to tumour. The more we understand how certain tumours with certain molecular profiles behave, the more we will be able specifically to tailor treatments for them. Eventually we will be able to tailor specific drug...

Genetic screening of cancer

As cancer has a strong genetic basis, genetic screening should have potential applications for determining prognostic information. In classic monogenic (one-gene) familial genetic disorders such as Huntington's disease, screening of potentially affected family members can allow people to know what their chances are of developing a disease. Screening can also allow potential parents to know what the likelihood is of any future offspring developing the condition. Unfortunately in cancer studies this is not as straightforward, as a result of the complexity of cancer genetics. Inherited cancer syndromes that act similarly to classic genetic diseases cause only about 1 of human cancer. A further 5-10 of all cancers (depending on how strictly defined) have a more general familial basis (Ponder, 2001). In these families several cases of common cancers are found, usually falling into general groups of cancers (e.g. breast and ovary, or colon, endometrium and urinary). Only these rarer...

Relationship With Specific Systemic Cancers

In patients with an unknown primary site and brain metastases, the lung represents the most common primary tumor site discovered antemortem, accounting for between 45 and 83 of identifiable primary sites (see Table 60-2). The lung also appears to be the most common primary site regardless of whether it becomes known early (within 2 months) or late (after 2 months) after the diagnosis of brain metastases.33,46 In contrast, when the primary site is discovered only after autopsy, there does not appear to be a predominant organ of origin.14,26,30 In the general population of patients with brain metastases, the lung is identified as a primary site in 50 to 70 of patients and is followed in frequency by breast cancer metastases in women.24,34,49 By comparison, the breast appears to be under-represented as a primary tumor site in patients in whom the site these studies, the abdominal and pelvic organs are typically the second most common primary site. This difference may be a result of the...

Screening Guidelines for Early Detection of Cancer of the Breast

The National Cancer Institute recommends that women begin receiving screening mammograms every 1 to 2 years starting at 40 years of age and every year once they reach 50 years of age, continuing for as long as a woman is in good health. Screening mammography involves taking low-dose radiographs from two views of each breast, typically from above (craniocaudal view) and from an oblique or angled position (mediolateral-oblique view). Mammography can detect approximately 85 of breast cancers. If the mammogram indicates an abnormality, the woman will most likely be urged to undergo further breast imaging (i.e., with spot-view mammogra-phy, ultrasonography, or other imaging tests). If further imaging confirms or reveals an abnormality, the woman may be referred for a biopsy to determine whether she has breast cancer. Screening mammography can miss 10 to 15 of breast cancers. These tumors can be missed (1) if the tumor is very small (2) if the tumor is in an area not easily imaged (e.g., in...

Cancer The Conventional View

Our bodies are amazing in the way trillions of cells are made and distributed throughout a complex network of systems. Normal cells grow, reproduce, and die in response to internal and external signals from our body. When normal cells mutate or change into cancer cells, then the problem begins. Cancer is the abnormal growth, reproduction, and spread of body cells. These cells do not obey the normal signals of the body that control other cells, and behave independently instead of working in harmony with your system. Sometimes cancer cells reproduce and form a lump or tumor. If the tumor is self-contained and doesn't spread, it's called benign and is usually surgically removed. If tumor cells grow, divide, damage the normal cells around them, and invade other tissue or travel through your bloodstream, the cells are called malignant or cancerous. Metastasis refers to a malignant tumor's cells that enter the bloodstream. The danger comes from the spread of these cancer cells to other...

Role of androgen in prostate cancer

In order to appreciate the therapeutic relevance of these mechanistic distinctions, an understanding of the cellular heterogeneity and responsiveness of prostate cancer cellular subtypes is required. Androgen ablation therapy, whether by surgical or medical means, induces the elimination of only testosterone-dependent prostate cancer cells since these cells require a critical level of physiological androgen for their continuous proliferation and survival (Gao and Isaacs 1998 Gao etal. 2001 Kyprianou etal. 1990). Unfortunately, androgen ablation is not curative because, once clinically detected, prostate cancers are heterogeneously composed of clones of androgen-dependent cancer cells and also malignant clones which are androgen-independent (Isaacs 1999). These latter cells are androgen-independent since androgen occupancy of their nuclear AR is not required for their survival (Isaacs 1999). There are two basic subtypes of such androgen-independent prostate cancer cells. One subtype...

Conversion of paracrine to autocrine mechanism of androgen action during prostatic carcinogenesis

While it is clear that prostate cancer arises from the epithelial compartment, the identification of the specific epithelial cell subtype which the carcinogenic process initiates has only recently been the focus of study. Currently, the precursor for most peripheral zone prostatic carcinomas is thought to be high-grade prostatic intraepithelial neoplasia (HGPIN) (McNeal and Bostwick 1986). It is believed that HGPIN arises from low-grade PIN, which in turn is thought to stem from normal prostate epithelium. The cell type of origin for HGPIN, however, is still incompletely understood. A widely held view of carcinogenesis is that the common carcinomas generally arise in self-renewing tissues in which dividing cells acquire somatic genetic alterations in growth regulatory genes. In normal human prostate epithelium, most cell divisions take place in the basal cell compartment where the tissue stem and presumably the transit amplifying cells reside (Bonkhoff etal. 1994 1998). The majority...

Locally Advanced and Inflammatory Breast Cancer

Current data suggest that patients with advanced stage III disease who are at least T3 (> 5 cm in maximal diameter), T4 (extension to chest wall or skin), or N2 (fixed or matted axillary lymphadenopathy) are best treated with preoperative chemotherapy or hormonal therapy, followed by surgery and then local-regional fractionated radiation therapy. Limited data support the addition of adjuvant chemotherapy or hormonal therapy postoperatively and after radiation therapy. Excellent local control can be achieved in 80 to 90 of women, and approximately 30 of women with stage IIIb disease (direct invasion of skin or chest wall) or inflammatory breast cancer remain free of cancer after 1 year.24,68

Cancer as a genetic disease

It is known that cancer is linked to harmful genetic alterations of cells and many genes have been linked to various forms of cancer, but the genetics of cancer is very complicated and less well understood than classic genetics. No single cancer-causing gene has ever been discovered that is mutated in all cancers, and even in specific tumour types there can be several possible genetic mechanisms and genes involved in the formation of the tumour. In some families an inherited disposition has been shown to play a role in cancer formation, but these familial cancers make up only a small proportion of cancer cases. Cancer is a collection of disorders sharing the common feature of uncontrolled cell growth, leading to the formation of a mass of cells known as a 'neoplasm' or 'tumour'. Malignant neoplasms have the ability to invade adjacent tissues and often metastasize to more distant parts of the body, a process that is the cause of 90 of cancer deaths (Sporn, 1996). There are more than...

Clinical Trials In Lung Cancer

Three US randomised screening studies failed to detect an impact of screening high-risk patients with chest radiographs or sputum cytology on mortality, although earlier stage cancers were detected in the screened groups.3-5 These studies have been criticised for a number of potential methodological and statistical problems, such as over-diagnosis and analysing data by survival rather than mortality.6 Recently, several clinical studies have demonstrated that early stage lung cancers can be detected with the use of spiral CT that would not have been detected by routine chest X-ray.7 Spiral CT is a CT scan which does not evaluate the mediastinum and thus does not use contrast or require the presence of a radiologist, employs low doses of radiation and can be completed within one patient 'breath'. Because it can be done rapidly and does not require a radiologist to be present, it is being used in some centres to screen for lung cancers in high-risk populations. However, it has not been...

Impact and Sequelae of Cancer

Treatments of pediatric cancer include surgery, chemotherapy, radiation, and various combinations of these elements, depending on the histology and stage of the malignancy (Ludwig 2008). All of these treatments have the immediate impact of being strange and often frightening for pediatric patients and their families. Most treatment protocols also involve discomfort or pain, removal from familiar environments, and interference with usual developmental tasks, such as school and peer relationships. In addition to the acute impact of treatment, cancer diagnosis and treatment have long-term effects that are life altering physically and emotionally for the family and child. We consider first what is known about the acute emotional and physical impacts of pediatric cancer on child and family and then discuss the long-term emotional and physical sequelae. Table 15-2. Cancer death ratesa in U.S. children ages 0-19 years by sex, 2002-2006 Table 15-2. Cancer death ratesa in U.S. children ages...

Oral cancer morbidity

The number of deaths from oral cancer has been rising over the last 30 years. The death to registration ratio is 0.4, which is higher than many other cancers and similar to cancer of the uterine cervix and breast. The site in the mouth is an important prognostic indicator, with the tongue having the poorest prognosis and highest mortality (Table 17.2). Cancer surveillance group 1998

Aetiology of oral cancer

The aetiology of oral squamous cancer is complex. The main factors associated with this disease are tobacco and alcohol consumption. Each of these factors increases the likelihood of oral cancer and both show a strong dose-related increase in incidence. It would seem that heavy smoking and heavy drinking have a synergistic effect, leading to an exponential rise in relative risk (Fig. 17.1). Tobacco is the main aetiological agent associated with oral cancer. The risk of oral cancer is related to the number of cigarettes per day and the length of time the This formulation allows a calculation of the relative risk of each patient. The relative risk returns to that of a non-smoker 10 years after the cessation of smoking. Topical tobacco, particularly, when mixed with areca nut, slaked lime, and betel and placed as a quid in the buccal sulcus, is a potent carcinogen. On the Indian subcontinent, where the practice of chewing tobacco is common, oral cancer makes up 40 of the total incidence...

Nonsmall Cell Lung Cancer Staging

Metastatic spread of NSCLC is very common, with bone, adrenal, and brain being the most common sites.14 Brain metastases occur in approximately 33 of patients. Solitary metastases are noted in approximately 30 of cases. NSCLC stages are typically designated I to IV, including subsets IIA, IIB, IIIA, and IIIB. Staging is determined using standard tumor, node, and metastasis (T, N, M) criteria. The extent of staging tests performed depends on a number of factors, including the presenting symptoms, the extent of disease, and the exact tumor type. A thorough medical history and physical examination are the most important steps in the staging and subsequent work-up of a patient with suspected lung cancer. Clinical symptoms suggestive of brain metastasis include headache, seizures, or focal neurologic deficits. If a thorough medical history and physical examination demonstrate no evidence of extrapulmonary metastases, and a chest computed tomography (CT) scan sug Patients with stage IV lung...

Brain Metastasis From Nonsmall Cell Lung Cancer

Brain metastases from tumors arising outside the central nervous system are exceptionally common. There are an estimated 75,000 to 100,000 cases of brain metastasis each year in the United States. Approximately 30 to 60 of all brain metastases originate in a primary lung cancer. In light of the marked frequency with which this illness is encountered in general oncology practice, a thorough understanding of the principles of diagnosis and treatment is essential for all practitioners. Lung cancers are primarily classified as either small cell or non-small cell lung cancer (NSCLC), with NSCLC representing more than 80 of cases. These two classes each have a distinct biologic activity and response to various forms of therapy and should therefore be considered as distinct entities from a clinical perspective. Only NSCLC will be considered in this chapter.

Locally Advanced Penile Cancer

Traditionally patients with penile cancer have been surgically managed using one of three procedures, circumcision for preputial tumors, partial penectomy for distal tumors involving the glans penis or distal penile shaft, total penectomy combined with a perineal urethrostomy for more extensive tumors infiltrating into the proximal penile shaft. These techniques have been utilized in order to ensure clear tumor margins which traditionally have been defined as being 2 cm. However, studies have challenged this and demonstrated that smaller resection margins do not appear to compromise oncological control.1,6,7 More recently penile-preserving surgery such as glansectomy or wide local excisions with grafting have been employed in order to maintain penile length resulting in a more acceptable functional and cosmetic outcome. Partial penec-tomy and total penectomy procedures are now reserved for cases where penile-preserving surgical options are not suitable due to the extent of the disease.

Presentation and Evaluation of Patients with Advanced Penile Cancer

Muneer et al. (eds.), Textbook of Penile Cancer, The nature of penile cancer combined with the pattern of disease dissemination means that patients with a delayed presentation often have unsightly fungating inguinal disease together with impaired urinary and anorectal function. The majority of these patients will have some functional impairment in voiding as the primary tumor obstructs the penile urethra. These patients may present with urinary retention but commonly dribbling incontinence is the main feature. More proximal involvement of the membranous urethra and prostate will cause urinary incontinence.

Hormonedependent cancers

The relationship between physical activity and breast, ovarian or uterine cancers has been investigated in more than 20 studies. Most of the cohort studies suffer from methodologic problems involving the assessment of physical activity, lack of statistical power and a very long follow-up period. The latter increases misclassifi-cation because of true changes in behavior since the baseline measurement. A recent Norwegian study included 25624 women with 351 cases of breast cancer 93 . After adjustment for age, BMI, number of children and socioeconomic background, the physically active at work had only half the rate of the physically inactive and in the analysis of physical activity in leisure time, the active had a 0.63 lower rate. However, more good studies are needed before sound conclusions can be drawn about the relationship between physical activity and these types of cancers. In men, the association between physical activity fitness and risk of prostate and testicular cancers has...

Look Into The Future Of Childhood Cancer Research

Despite the progress of the last half century there remain a number of challenges in childhood cancer. The focus of research in certain patient subsets with very high cure rates will be on quality of life endpoints. For example, retinoblastoma is curable in nearly 100 of cases, so preservation of sight and reduction of second malignancies (not survival) are now considered to be the primary goals and endpoints, and trials avoiding enucleation and eliminating external beam therapy are now the norm. One would hope that future therapies for childhood cancer will be developed which would be more rational, less empirical and less toxic, relying more on strategies for growth control (e.g., anti-angiogenesis) and regulation of gene expression and cell proliferation, and or induction of apoptotic pathways or blocking of anti-apoptotic signals, than on cytotoxic or ablative treatments. Assuming that deregulated and or mutated cellular proto-oncogenes or loss of tumour suppressor genes are the...

Of Trials In Children With Cancer

The tragic death of an 18-year-old research subject in 1999 in a gene-transfer trial at a major research university in which human subjects were not protected, adverse events had not been reported and financial conflicts of interest were involved, served to trigger several new federal initiatives to further strengthen protections of human research subjects in clinical trials,46 including the imposition of sanctions on investigators who fail to adhere to regulations. As this chapter goes to press, the federal Office for Protection from Research Risks (OPRR) has been reorganised, expanded and renamed the Office for Human Research Protections (OHRP) and transferred to the Office of the Secretary, Health and Human Services (HHS) and the National Biothetics Advisory Commission, at the request of the President, has undertaken a sweeping examination of the ethical and policy issues in the oversight of human research in the United States (see www.bioethics.gov). As a result, the ethical and...

Study Design For Childhood Cancer Trials

Because childhood cancer is rare and the response to conventional treatment good, most children never experience recurrent disease and are thus POG, Pediatric Oncology Group CCG, Children's Cancer Group INSS, International Neuroblastoma Staging System NA, not applicable. Source Reproduced from Castleberry,60 (pp. 926, 930), with permission from Elsevier. are of the highest priority for cancers common among adults. These studies typically ask a randomised question about either survival or event-free survival (the time from study entry to the earliest of induction failure, relapse, second cancer, or death of any cause). Intent-to-treat40 is the analysis of choice for efficacy, with other analysis done as secondary supportive inference. For treatment questions where the randomised divergence is considerably after study entry or where a significant number of failures are expected to occur before divergence, a delayed randomisation is typically done as close to the divergence point as...

On Important Paediatric Cancer Clinical Trials

Statistically and clinically significant improvements have been achieved in all major forms of childhood cancers through conduct of well-organised single institution and cooperative group clinical trials which have resulted in sequential and steady improvement in survival rates since the 1960s when curative treatments were first devised. SEER data document that the overall childhood cancer mortality rates have consistently declined throughout the 1975-95 time period.1 Documentation of the overall progress achieved by POG investigators has been reported, demonstrating significant improvements in overall survival (OS) and event-free survival (EFS) for 8 of 10 disease areas, in a sample of over 7000 children and adolescents treated between 1976 and 1989.4 Similar results have been achieved by CCG and by European national paediatric cooperative clinical trials organisations. There is also evidence that children and adolescents with acute lymphocytic leukaemia (ALL), non-Hodgkin's lymphoma...

HPV Infection and Penile Cancer

Much of our understanding of how HPV infection may lead to premalignant lesions and invasive tumors is based on studies of carcinogenesis in cervical cancer. However, while almost 100 of cervical SCCs are related to sexually transmitted HPV infection, rates of HPV in penile cancer are reported between 30 to 100 .1-6 The reasons for this wide range include geographical variations and different cultural attitudes towards sex between the reporting centers, as well as technical differences in the methodology used for HPV detection. A recent systematic review of established PCR techniques has found HPV DNA in approximately 50 of all penile SCCs.7 In this respect, penile tumors are more similar to vulval carcinomas, which also share a similar pathogenesis and histology.5,8 The marked difference in the prevalence, age of peak incidence, and rate of progression of both cervical and penile tumors may underlie either differing pathogenic mechanisms or differing tissue susceptibility and...

Molecular Carcinogenesis

The pathogenesis of radiation-induced thyroid cancer has not yet been elucidated. Gene rearrangements may play an important role in the process. Nikiforova and associates found that radiation-induced tumors had a 4 prevalence of BRAF point mutations and a 58 prevalence of RET PTC rearrangements, and sporadic papillary thyroid cancers demonstrated a 37 prevalence of BRAF point mutations and only a 20 prevalence of RET PTC rearrangements.34 Similarly, RET PTC3 rearrangement was found in aggressive tumors that occurred less than 10 years after the Chernobyl accident.35 Elisei and coauthors also found a prevalence of 38 of RET PTC rearrangements in adenomas found within radiation-exposed glands, implying that this rearrangement is not restricted to the malignant phenotype but may be a step in the development of malignant transformation of radiation-induced thyroid tumors.36

Weak Opioid Medications for Cancer Pain

The following drugs are most commonly prescribed for moderate cancer pain when nonopioid drugs (NSAIDs) are no longer sufficiently effective. However, doctors often will maintain the use of a nonopioid medication to be used in combination with a weak (or strong) opioid because they relieve pain by different mechanisms thus, when used together pain-relieving effects are typically enhanced. As a result, lower doses of the opioid may be used with fewer concerns about side effects. Many of the medications listed here may require triplicate prescription forms in the states that require such forms. An allergy (very rare) or side effect to one does not predict that another will be poorly tolerated.

Cancer Services Collaborative

The Cancer Services Collaborative (CSC) is part of the NHS Modernization Agency. The objective of the CSC teams, which are linked to individual networks, is to look at the provision of specific cancer services within an organization, e.g. breast cancer, and 'map' the patient journey. The results of this mapping exercise identify where the delays are for the patient. Before the publication of The NHS Cancer Plan (DoH, 2000a), nine cancer networks were already taking part in CSC projects. The results from these early projects clearly highlighted that many of the delays in patients' treatment were a result of the way the 'systems' for delivering their care were organized. Through working with all the staff involved, the 'systems' could be redesigned to expedite patients' journeys, e.g. pre-booking patients at the time of referral for diagnostic tests, based on the information contained in their referral letter (DoH, 2000a).