The definition of cancer

As humans we are made up of many millions of cells. Some cells are specific to certain tissues, e.g. epithelial cells are found throughout the gastrointestinal tract, bladder, lungs, vagina, breast and skin. It is this group of cells that accounts for about 70 of cancers (Venitt, 1978 Corner, 2001). However, any cell has the potential to undergo malignant changes and lead to the development of a carcinoma. The 'tumour' cells are not only confined to localized 'overgrowth' and infiltration of...

A diagnosis of cancer

Volumes are now written and spoken upon the effects of the mind on the body. Much of it is true. But I wish a little more was thought of the effect of the body on the mind Florence Nightingale (1859 - cited in Price, 1990, p. xii) Almost 150 years have passed since Florence Nightingale wrote these words. Cancer is a protracted illness, always raising uncertainty in the minds of those affected, and their families, as to whether the disease can be successfully treated. Historically, the...

The NHS Cancer Plan

Back in 1995 a document was published by the Department of Health known as A Framework for Commissioning Cancer Services (DoH, 1995), commonly referred to as the Calman-Hine report. This document recommended the establishment of specialist cancer networks in England and Wales, and these networks would be responsible for coordinating the care provided in primary, secondary and tertiary care, to ensure that all individuals receive equity of access and a uniformly high standard of cancer care,...

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...

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...

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...

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...

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,...

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,...

Quasiexperiments casecontrol studies and cohort studies

A case-control study may be used to investigate a problem related to a cause of disease. Patients with a particular condition (cases) are compared with an identical group of individuals who do not have the condition (controls). Both groups should be identically matched except for the condition under study. Case-control studies are generally retrospective, and accounts of past history and exposure are investigated to ascertain the common lifetime exposures, linking these to possible causation of...

Immune system in patients undergoing chemotherapy and radiotherapy

All the immune cells of our body (e.g. neutrophils, lymphocytes, monocytes, NK cells) are developed from stem cells in the bone marrow. In the bone marrow, there is about one stem cell for every 100000 blood cells. Neutrophils, which are the largest fraction of white blood cells, account for about 54-63 of all white blood cells and they are the first immune cells to arrive at the site of infection and the first line of defence against invading pathogens. Their numbers in circulation do not...

The application of research methodology to cancer research

Unfortunately the impressive list of advancements in the science of medicine appears to have led to a decline in the art of medicine. Patients complain increasingly that high tech' medicine dehumanises them. In the eternal quest for a new and better treatment for every known ailment we have started to forget the other important needs of sick people The preceding chapters of this book have focused principally on the 'scientific' advances in cancer treatment that have been primarily led by...

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...

The immune surveillance theory

The immune surveillance theory put forward by Thomas in 1959 and redefined by Burnet (1967) states that the immune system is constantly patrolling the body for tumour (abnormal) cells, which are recognized as foreign, and mounts an immune response that results in their elimination before they become clinically detectable (Burnet, 1967). Although this concept remains controversial, a wide range of evidence supports it. First, cancer patients with tumours infiltrated by many immune cells (e.g....

Adaptive acquired specific immune response

In many situations, the non-specific immune responses described above (e.g. phagocytosis, NK cell activation, inflammation), with which we are born and that occur in the first few hours of infection, may be sufficient to overcome the pathogens. If not, disease can ensue and the body may recover after the activation of adaptive immune responses against the invading pathogens (see Figure 7.1). There are two types of adaptive immune responses, namely antibody-mediated immune (AMI) responses and...