The management of MALIGNANT disease – a major health problem, since successful management requires close liaison between the patient, surgeons, physicians, oncologists, haematologists and sometimes other specialists such as paediatricians. Diagnosis may involve various investigations and often requires a BIOPSY. Once a diagnosis has been established, treatment may involve surgery, radiotherapy or chemotherapy (or various combinations of these) – see below (see also INTERVENTIONAL ONCOLOGY).
may be the most common and even the only treatment, for some gastrointestinal tumours, soft-tissue tumours, gynaecological tumours and advanced cancers of the head and neck.
uses ionising radiation to kill tumour cells. Radiation is by naturally occurring isotopes (see ISOTOPE) or artificially produced X-RAYS. Germ-cell tumours (see SEMINOMA; TERATOMA) and malignant lymphomas (see LYMPHOMA) appear to be particularly sensitive to irradiation, and many head and neck tumours, gynaecological cancers, and localised cancers of the PROSTATE GLAND and URINARY BLADDER are curable with radiotherapy. It is also a valuable means of reducing pain from bone metastases (see METASTASIS). Unpleasant side-effects are common: chiefly lethargy, loss of appetite and dry, itchy skin.
is also an important treatment in germ-cell tumours (see above); in some forms of LEUKAEMIA and lymphoma; in ovarian cancer (following surgery – see OVARIES, DISEASES OF); and in small-cell lung cancer (see LUNGS, DISEASES OF). It is also used in some breast cancers (see BREASTS, DISEASES OF); advanced myeloma (see MYELOMATOSIS); sarcomas (see under CANCER); and some childhood cancers (such as WILMS’ TUMOUR).
More than 20 substances are in common use, the major classes being ALKYLATING AGENTS (e.g. cyclophosphamide, chlorambucil, busulfan); ANTIMETABOLITES (e.g. methotrexate); VINCA ALKALOIDS (e.g. vincristine, vinblastine); and antitumour ANTIBIOTICS (e.g. actinomycin D). Choice of agent and the appropriate regimen requires expert guidance. Common side-effects include nausea and vomiting, bone-marrow suppression and ALOPECIA, each substance having its own spectrum of unwanted effects.
Equally important is PALLIATIVE treatment, for example to control pain or nausea. (See also CANCER; ONCOLOGIST; PAIN; PALLIATIVE CARE.)