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5.4 Cancer immunity and immunotherapy 471 ESSENTIALS The development of a cancer in an immunologically intact host leads to an interaction between the host immune system and the tumour mass. The three phases of tumour/​host interactions (Elimination, Equilibri...

5.5 Clinical features and management 487 ESSENTIALS Patients with cancer may present after detection of an abnormality in a screening programme, with vague symptoms, or with advanced disease. The commonest symptoms are local, directly related to the anatomical...

5.6 Systemic treatment and radiotherapy 497 ESSENTIALS Cancer therapy is underpinned by a detailed understanding of cancer biology and the complex interaction of tumour and host. Systemic therapies and radiation therapy are being used in many early stage cance...

5.7 Medical management of breast cancer 505 ESSENTIALS Early breast cancer Most patients with breast cancer are offered surgery, the main op- tions being modified radical mastectomy, with or without immediate or delayed breast reconstruction, or breast-​conser...

6.1 Ageing and clinical medicine 511 6.1 Ageing and clinical medicine Claire Steves and Neil Pendleton ESSENTIALS In 2017 there were, for the first time, more people older than 65 years than children under the age of 5 years. Despite the recent exponential inc...

6.10 Neurodegenerative disorders in older people 601 ESSENTIALS Neurodegenerative disorders are associated with a progressive loss of structure and function of neurones that leads to neuronal death. Their aetiology combines ageing, genetic susceptibility, and ...

6.11 Promotion of dignity in the life and death of older patients 612 ESSENTIALS Respect for the dignity of patients is a traditional part of medical codes. Dignified care is key to a holistic person-​centred approach, with participation of the individual, com...

6.2 Frailty and sarcopenia 521 6.2 Frailty and sarcopenia Andrew Clegg and Harnish Patel ESSENTIALS Sarcopenia and frailty are inter-​related expressions of ageing which identify people at risk of important adverse health events such as falls, disability, and ...

6.3 Optimizing well- being into old age 532 ESSENTIALS Healthy ageing, well-​being in later life, quality of life, and disability-​ free life are ideas that drive policy and practice in our ageing society. Their meanings overlap in sometimes confusing ways, bu...

6.4 Older people and urgent care 539 ESSENTIALS Older people, especially those with frailty, are increasingly be- coming the main users of urgent care services, despite efforts to promote care at home; this is a global issue. Older people with frailty will usu...

6.5 Older people in hospital 548 ESSENTIALS Older people usually present to hospital because of a crisis: a sudden change in health, function, or circumstances that causes worry, dis- tress, or overwhelms independence or care provision. Crises may relate to th...

6.6 Supporting older peoples’ care in surgical and oncological services 563 ESSENTIALS The clinical profile of patients presenting for elective and emer- gency surgery and for oncological treatment is changing. Patients are now older and more complex with coex...

6.7 Drugs and prescribing in the older patient 571 ESSENTIALS The use of pharmacological agents is often a central component of medical therapy for older people. Medications can relieve symp- toms, improve function, and prevent illness, but they also have the ...

6.8 Falls, faints, and fragility fractures 579 ESSENTIALS Falls and their complications are the fifth leading cause of deaths in older adults. They typically result from the interplay of the envir- onment, co​morbidity, and age-​related changes in postural sta...

6.9 Bladder and bowels 589 ESSENTIALS Urinary incontinence Urinary incontinence is not an inevitable consequence of ageing. Its impact on social, psychological, and physical well-​being is com- parable to that of other chronic conditions such as diabetes and d...

7.1 Introduction to palliative care 623 ESSENTIALS Palliative care shifts the focus of care from managing the underlying pathophysiological processes to one that looks at the individual and the impact of life-​threatening illness on them and those important to...

7.2 Pain management 629 ESSENTIALS Pain occurs in more than 50% of patients with advanced disease, interferes with daily functioning and quality of life, and is often undertreated. Patients can find it difficult to articulate the character of their pains, but ...

7.3 Symptoms other than pain 634 ESSENTIALS Common symptoms in life-​limiting illness include pain, fatigue, anorexia, nausea, constipation, and dyspnoea. These may be due to disease or disease progression, treatment side effects, an inter- current acute probl...