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3.8 The evolution of therapeutic antibodies 296 ESSENTIALS The development of rodent monoclonal antibodies opened the door to the creation of antibodies specific to soluble and cell-​surface antigens. ‘Humanized’ therapeutic antibodies have emerged as blockbus...

3.9 Circulating DNA for molecular diagnostics 299 ESSENTIALS Short fragments of cell-​free DNA are released into the plasma when cells die. In patients with cancer some of this circulating DNA is re- leased by tumour cells; in pregnant women some is derived fr...

30.1 Acute medical presentations 6591 Sian Coggle, Elaine Jolly, and John D. Firth ESSENTIALS This chapter provides concise details of the clinical features, immediate management, key investigations, and further man- agement of all of the common acute medical ...

30.2 Practical procedures 6644 Elaine Jolly, Sian Coggle, and John D. Firth ESSENTIALS Key practical clinical procedures are described in this chapter, along with clear anatomical diagrams to enable the reader to fully under- stand the processes involved. Thes...

4.1 The innate immune system 307 ESSENTIALS The innate immune system comprises evolutionarily ancient mech- anisms that mediate first-​line responses against microbial patho- gens, and are also important in priming and execution of adaptive immune responses, a...

4.2 The complement system 315 ESSENTIALS The complement system, consisting of soluble and membrane-​ bound proteins, is a major effector mechanism of host defence against infection and inflammatory responses. It has an important role in the removal of immune c...

4.3 Adaptive immunity 325 ESSENTIALS Following the innate immune response, which acts very rapidly, the adaptive immune response plays a critical role in host defence against infectious disease. Both types of immune response work together in order to achieve i...

4.4 Immunodeficiency 337 ESSENTIALS Immunodeficiency is caused by failure of a component of the im- mune system and results in increased susceptibility to infections. The possibility of an underlying immunodeficiency should be considered if a patient has: (1) ...

4.5 Allergy 368 ESSENTIALS Allergy is common and becoming commoner: it now affects about one-​third of the UK population. This is being driven by environ- mental changes, which are also leading to an increase in both the complexity and severity of the conditio...

4.6 Autoimmunity 379 ESSENTIALS Autoimmune diseases occur when a sustained, specific, adaptive im- mune response is generated against self-​components, and results in tissue damage or dysfunction. They probably affect more than 3% of Western populations, more ...

4.7 Principles of transplantation immunology 392 ESSENTIALS The survival of transplanted organs remains limited by the body’s immune responses, which are designed to discriminate between ‘self’ and ‘non-​self’ or ‘altered-​self’, and many of the complications ...

5.1 Epidemiology of cancer 411

5.2 The nature and development of cancer: Cancer mutations and their implications 445 ESSENTIALS Cancer is a genetic disease in which progressive accumulation of mutations in the genome of somatic cells induces abnormal bio- logical capabilities. Cancer-​induc...

5.3 The genetics of inherited cancers 456 ESSENTIALS All cancer can be termed ‘genetic’ as the disease is caused by somatic cell mutations (alterations in the DNA code), which result in abnormal cellular growth and/​or proliferation. Most of these mu- tations ...

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...