THE MANAGEMENT OF CANCER Management is more than t
THE MANAGEMENT OF CANCER Management is more than treatment
The traditional approach to cancer concentrates on diagnosis and active treatment. This is a very limited view that, in terms - of public health, may not have served society well. It implies a fatalistic attitude to the occurrence of cancer and an assump - tion that, once active treatment is complete, there is little more to be done. Prevention was forgotten and rehabilitation was ignored. - Abraham Vater , 1684–1751, Professor of Anatomy and Botany , and la Jacques Turcot , 1914–1977, surgeon, Hôtel-Dieu de Quebec hospital, Quebec, Canada. Henry Thompson Lynch , 1928–2019, Chair of Preventative Medicine, Creighton Univer John Law Augustine Peutz , 1886–1968, Chief Specialist for Internal Medicine, St John’s Hospital, The Hague, The Netherlands. Harold Joseph Jeghers , 1904–1990, Professor of Internal Medicine, The New Jersey College of Medicine and Dentistry , Jersey City , NJ, USA. Frederick Pei Li , 1940–2015, Professor of Medicine, Harvard University Medical School, Boston, MA, USA. Joseph F Fraumeni , b.1933, Director of Cancer Epidemiology and Genetics, The National Cancer Institute, Bethesda, MD, USA. ter of P atholog y and Therapeutics, Wittenberg, Germany . sity , Omaha, NE, USA.
Syndrome Gene(s) Inheritance implicated Familial adenomatous APC gene D polyposis (FAP) D DNA mismatch Hereditary non-polyposis repair genes colorectal cancer ( MLH1; MSH2; (HNPCC1), Lynch MSH6 ) syndrome 1 D HNPCC2 DNA mismatch repair genes (MLH1; MSH2; MSH6) Peutz–Jeghers syndrome STK11 D a Cowden syndrome PTEN D Retinoblastoma RB D Multiple endocrine Menin D neoplasia (MEN) type 1 MEN type 2A RET D MEN type 2B RET D Li–Fraumeni P53 D Familial breast cancer BRCA1; BRCA2 D Familial cutaneous CDNK2A; CDK4 D malignant melanoma Associated tumours and abnormalities Strategies for prevention/ early diagnosis Pr ophylactic Colorectal cancer under the age of 25 panproctocolectomy Papillary carcinoma of the thyroid Cancer of the ampulla of Vater Hepatoblastomas Primary brain tumours (Turcot syndrome) Osteomas of the jaw CHRPE (congenital hypertrophy of the retinal pigment epithelium) Color ectal cancer (typically in forties and Surveillance colonoscopies/ /f_i fties) polypectomies Non-ster oidal anti
in /f_l ammatory drugs HNPCC associated with other cancers of the gastrointestinal or reproductive system Bowel cancer; br east cancer; freckles round Surveillance colonoscopy; the mouth mammography Active surveillance Multiple hamartomas of skin, breast and mucous membranes Breast cancer Neuroendocrine tumours Endometrial cancer Thyroid cancer Surveillance of uninvolved Retinoblastoma eye Pinealoma Osteosarcoma Awareness of associations Parathyroid tumours and paying attention to Islet cell tumours relevant symptoms Pituitary tumours Regular screening of blood Medullary carcinoma of the thyroid pressure, serum calcitonin Phaeochromocytoma and urinary catecholamines Parathyroid tumours Prophylactic thyroidectomy Regular screening of blood Medullary car cinoma of the thyroid pressure, serum calcitonin Phaeochr omocytoma and urinary catecholamines Mucosal neuromas Prophylactic thyroidectomy Ganglioneuromas of the gut V ery dif /f_i cult, since pattern of Sarcomas tumours is so heterogeneous Leukaemia and varies between patients Osteosar comas Brain tumours Adrenocortical carcinomas Scr eening mammography; Breast cancer pelvic ultrasound Ovarian cancer PSA (in males) Papillary serous carcinoma of the peritoneum Pr ophylactic mastectomy; Prostate cancer prophylactic oophorectomy Cutaneous malignant melanoma Avoid exposure to sunlight, careful surveillance Continued
Robert Gorlin , 1923–2006, Professor of Dentistry , The University of Eugen von Hippel , 1867–1939, Professor of Ophthalmology , Göttingen, Germany . Arvid Lindau , 1892–1958, Professor of Pathology , Lund, Sweden. David Bloom , 1892–1985, dermatologist at the Skin and Cancer Clinic, New Y ork University , New Y ork, NY , USA, described the syndrome in 1954. Minnesota, Minneapolis, MN , USA.
Syndrome Gene(s) Inheritance implicated Basal cell naevus PTCH D syndrome (Gorlin) von Hippel–Lindau VHL D disease Neuro /f_i bromatosis type 1 NF1 D Neuro /f_i bromatosis type 2 NF2 D R Xeroderma pigmentosum De /f_i cient nucleotide excision repair ( XPA,B,C ) Ataxia–telangiectasia AT R Bloom syndrome BLM helicase R D, dominant; PSA, prostate-speci /f_i c antigen; R, recessive. a One of the few clinical syndromes named for the patient rather than the clinician. Rachel Cowden was, in 1963, the /f_i rst patient described with the syndrome. She died from breast cancer at the age of 20. TABLE 12.2 Environmental causes of cancer (and suggested measures for reducing their impact). Environmental/behavioural factor Tobacco Alcohol Ultraviolet exposure Ionising radiation Viral infections Human papillomavirus Associated tumours and abnormalities Strategies for prevention/ early diagnosis Careful surveillance, Basal cell carcinomas awareness of diagnosis (look Medulloblastoma for bi /f_i d ribs on x-ray) Bi /f_i d ribs Urinary catecholamines Clear cell renal cell carcinoma Phaeochromocytoma Haemangiomas of the cerebellum and retina A dif /f_i cult problem; maintain Astrocytomas a high index of suspicion Primitive neuroectodermal tumours concerning any rapid Optic gliomas changes in growth or Multiple neuro /f_i bromas character of any nodule Acoustic neuromas Spinal tumours Meningiomas Multiple neuro /f_i bromas Skin sensitive to sunlight. Early onset of Avoidance of sun exposure cutaneous squamous or basal cell carcinomas Active surveillance and early treatment Retinoids for chemoprevention Active surveillance Progressive cerebellar ataxia Leukaemia Lymphoma Breast cancer Melanoma Upper gastrointestinal tumours Active surveillance Sensitivity to ultraviolet light Leukaemia Lymphoma Associated tumours Strategy for prevention/early diagnosis Ban tobacco Lung cancer Ban smoking in public places Head and neck cancer Punitive taxes on tobacco Bladder cancer Avoid excess alcohol Head and neck cancer Surveillance of high-risk individuals Oesophageal cancer Hepatocellular carcinoma Melanoma Avoid excessive sun exposure, Non-melanoma skin cancer use high-factor sunscreen, avoid sunbeds Limit medical exposures to absolute Leukaemia minimum; safety precautions at Breast cancer nuclear facilities; monitor radiation Lymphoma workers Thyroid cancer Avoid unprotected sex Cervical cancer Vaccination Penile cancer Head and neck cancer Continued
A more comprehensive view considers the management of cancer as taking place along two axes: one is an axis of scale, from the individual to the world population; the other is an axis based on the development of the disease, from prevention through to rehabilitation or palliative care ( Figure 12.3 ).
Environmental/behavioural factor Viral infections – Human immunode /f_i ciency virus continued Hepatitis B Other infections Schistosomiasis Helicobacter pylori Inhaled particles Asbestos Wood dust Chemicals Environmental pollutants/chemicals used in industry Medical Alkylating agents used in cytotoxic chemotherapy Immunosuppressive treatment Tamoxifen Fungal and plant A /f_l atoxins toxins Obesity/lack of physical exercise
THE MANAGEMENT OF CANCER Management is more than treatment
The traditional approach to cancer concentrates on diagnosis and active treatment. This is a very limited view that, in terms - of public health, may not have served society well. It implies a fatalistic attitude to the occurrence of cancer and an assump - tion that, once active treatment is complete, there is little more to be done. Prevention was forgotten and rehabilitation was ignored. - Abraham Vater , 1684–1751, Professor of Anatomy and Botany , and la Jacques Turcot , 1914–1977, surgeon, Hôtel-Dieu de Quebec hospital, Quebec, Canada. Henry Thompson Lynch , 1928–2019, Chair of Preventative Medicine, Creighton Univer John Law Augustine Peutz , 1886–1968, Chief Specialist for Internal Medicine, St John’s Hospital, The Hague, The Netherlands. Harold Joseph Jeghers , 1904–1990, Professor of Internal Medicine, The New Jersey College of Medicine and Dentistry , Jersey City , NJ, USA. Frederick Pei Li , 1940–2015, Professor of Medicine, Harvard University Medical School, Boston, MA, USA. Joseph F Fraumeni , b.1933, Director of Cancer Epidemiology and Genetics, The National Cancer Institute, Bethesda, MD, USA. ter of P atholog y and Therapeutics, Wittenberg, Germany . sity , Omaha, NE, USA.
Syndrome Gene(s) Inheritance implicated Familial adenomatous APC gene D polyposis (FAP) D DNA mismatch Hereditary non-polyposis repair genes colorectal cancer ( MLH1; MSH2; (HNPCC1), Lynch MSH6 ) syndrome 1 D HNPCC2 DNA mismatch repair genes (MLH1; MSH2; MSH6) Peutz–Jeghers syndrome STK11 D a Cowden syndrome PTEN D Retinoblastoma RB D Multiple endocrine Menin D neoplasia (MEN) type 1 MEN type 2A RET D MEN type 2B RET D Li–Fraumeni P53 D Familial breast cancer BRCA1; BRCA2 D Familial cutaneous CDNK2A; CDK4 D malignant melanoma Associated tumours and abnormalities Strategies for prevention/ early diagnosis Pr ophylactic Colorectal cancer under the age of 25 panproctocolectomy Papillary carcinoma of the thyroid Cancer of the ampulla of Vater Hepatoblastomas Primary brain tumours (Turcot syndrome) Osteomas of the jaw CHRPE (congenital hypertrophy of the retinal pigment epithelium) Color ectal cancer (typically in forties and Surveillance colonoscopies/ /f_i fties) polypectomies Non-ster oidal anti
in /f_l ammatory drugs HNPCC associated with other cancers of the gastrointestinal or reproductive system Bowel cancer; br east cancer; freckles round Surveillance colonoscopy; the mouth mammography Active surveillance Multiple hamartomas of skin, breast and mucous membranes Breast cancer Neuroendocrine tumours Endometrial cancer Thyroid cancer Surveillance of uninvolved Retinoblastoma eye Pinealoma Osteosarcoma Awareness of associations Parathyroid tumours and paying attention to Islet cell tumours relevant symptoms Pituitary tumours Regular screening of blood Medullary carcinoma of the thyroid pressure, serum calcitonin Phaeochromocytoma and urinary catecholamines Parathyroid tumours Prophylactic thyroidectomy Regular screening of blood Medullary car cinoma of the thyroid pressure, serum calcitonin Phaeochr omocytoma and urinary catecholamines Mucosal neuromas Prophylactic thyroidectomy Ganglioneuromas of the gut V ery dif /f_i cult, since pattern of Sarcomas tumours is so heterogeneous Leukaemia and varies between patients Osteosar comas Brain tumours Adrenocortical carcinomas Scr eening mammography; Breast cancer pelvic ultrasound Ovarian cancer PSA (in males) Papillary serous carcinoma of the peritoneum Pr ophylactic mastectomy; Prostate cancer prophylactic oophorectomy Cutaneous malignant melanoma Avoid exposure to sunlight, careful surveillance Continued
Robert Gorlin , 1923–2006, Professor of Dentistry , The University of Eugen von Hippel , 1867–1939, Professor of Ophthalmology , Göttingen, Germany . Arvid Lindau , 1892–1958, Professor of Pathology , Lund, Sweden. David Bloom , 1892–1985, dermatologist at the Skin and Cancer Clinic, New Y ork University , New Y ork, NY , USA, described the syndrome in 1954. Minnesota, Minneapolis, MN , USA.
Syndrome Gene(s) Inheritance implicated Basal cell naevus PTCH D syndrome (Gorlin) von Hippel–Lindau VHL D disease Neuro /f_i bromatosis type 1 NF1 D Neuro /f_i bromatosis type 2 NF2 D R Xeroderma pigmentosum De /f_i cient nucleotide excision repair ( XPA,B,C ) Ataxia–telangiectasia AT R Bloom syndrome BLM helicase R D, dominant; PSA, prostate-speci /f_i c antigen; R, recessive. a One of the few clinical syndromes named for the patient rather than the clinician. Rachel Cowden was, in 1963, the /f_i rst patient described with the syndrome. She died from breast cancer at the age of 20. TABLE 12.2 Environmental causes of cancer (and suggested measures for reducing their impact). Environmental/behavioural factor Tobacco Alcohol Ultraviolet exposure Ionising radiation Viral infections Human papillomavirus Associated tumours and abnormalities Strategies for prevention/ early diagnosis Careful surveillance, Basal cell carcinomas awareness of diagnosis (look Medulloblastoma for bi /f_i d ribs on x-ray) Bi /f_i d ribs Urinary catecholamines Clear cell renal cell carcinoma Phaeochromocytoma Haemangiomas of the cerebellum and retina A dif /f_i cult problem; maintain Astrocytomas a high index of suspicion Primitive neuroectodermal tumours concerning any rapid Optic gliomas changes in growth or Multiple neuro /f_i bromas character of any nodule Acoustic neuromas Spinal tumours Meningiomas Multiple neuro /f_i bromas Skin sensitive to sunlight. Early onset of Avoidance of sun exposure cutaneous squamous or basal cell carcinomas Active surveillance and early treatment Retinoids for chemoprevention Active surveillance Progressive cerebellar ataxia Leukaemia Lymphoma Breast cancer Melanoma Upper gastrointestinal tumours Active surveillance Sensitivity to ultraviolet light Leukaemia Lymphoma Associated tumours Strategy for prevention/early diagnosis Ban tobacco Lung cancer Ban smoking in public places Head and neck cancer Punitive taxes on tobacco Bladder cancer Avoid excess alcohol Head and neck cancer Surveillance of high-risk individuals Oesophageal cancer Hepatocellular carcinoma Melanoma Avoid excessive sun exposure, Non-melanoma skin cancer use high-factor sunscreen, avoid sunbeds Limit medical exposures to absolute Leukaemia minimum; safety precautions at Breast cancer nuclear facilities; monitor radiation Lymphoma workers Thyroid cancer Avoid unprotected sex Cervical cancer Vaccination Penile cancer Head and neck cancer Continued
A more comprehensive view considers the management of cancer as taking place along two axes: one is an axis of scale, from the individual to the world population; the other is an axis based on the development of the disease, from prevention through to rehabilitation or palliative care ( Figure 12.3 ).
Environmental/behavioural factor Viral infections – Human immunode /f_i ciency virus continued Hepatitis B Other infections Schistosomiasis Helicobacter pylori Inhaled particles Asbestos Wood dust Chemicals Environmental pollutants/chemicals used in industry Medical Alkylating agents used in cytotoxic chemotherapy Immunosuppressive treatment Tamoxifen Fungal and plant A /f_l atoxins toxins Obesity/lack of physical exercise
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