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Front Matter |
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Abstract
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Abstract
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Introduction and overview |
International Union Against Cancer |
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Abstract
In the past, most clinicians have focused their interest on the end stage of human cancer, i.e. diagnosis and treatment of the patient with an established cancer, usually (in over 50% of cases) progressing fairly rapidly to a terminal situation. With new knowledge, clinical oncologists of the next few years will need to have a much broader and more comprehensive view of cancer as an extremely long-term process usually lasting many years (see Fig. 1). In particular, clinicians will have to have a better understanding of “preventive oncology”.
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Epidemiology |
International Union Against Cancer |
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Abstract
Statistical investigations of neoplastic diseases are based on mortality and incidence statistics.
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Aetiology |
International Union Against Cancer |
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Abstract
We do not know the cause (or causes) of 85–90% of human cancers. The definite causes listed in this section account for only 10–15% of cancers. However, epidemiological research is identifying with certainty more and more carcinogens in our environment. Studies show that migrating populations tend to acquire the cancers that are characteristic of the countries to which they migrate, especially in the second and third generations. Because of these (and other) data, most epidemiologists are convinced that . play a dominant role in the causation of most cancers.
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Pathology |
International Union Against Cancer |
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Abstract
A neoplasm or tumour is a disturbance of growth characterized primarily by an excessive proliferation of cells without apparent relation to the physiological demands of the organ involved. Numerous varieties arise from all types of human tissues and the resulting tumours show marked variations in their biological behaviour. It is thus difficult to devise a simple definition of tumours that will be appropriate for all.
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Natural history of cancer |
International Union Against Cancer |
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Abstract
Laboratory studies of cancer spread should enable us to define the natural history of cancer exactly. The vast body of research into this biological phenomenon, on cells cultured both . and ., on grafted animal tumours, induced or spontaneous, and on experimental models, has contributed valuable information, but there are such variations in tumour type, animal species, cell environment and experimental technique that it is difficult to extrapolate the data to cancer in man.
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Mass screening and early detection |
International Union Against Cancer |
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Abstract
The routine periodic screening of large populations of persons without symptoms is an expensive undertaking with minimal yield and questionable benefit in most circumstances. Figure 9 shows the annual incidence of various common cancers in the USA. It is apparent that we are dealing with very few cases per 1 000 persons. Let us consider cancer of the cervix in some detail to illustrate costs . benefits as an example of some of the problems posed. Note that the . incidence is only 3 or 4 per 10 000 women. If half of the cases of cancer of the cervix were diagnosed following development of signs and symptoms . screening examinations, then the yield would be half the incidence—less than 2 per 10000.. In other words, one would have to screen over 10000 women to pick up 2 cases of cervical cancer. If one adds all the costs (personnel time, facilities, equipment, costs of work-up of false positives, etc.) and divides those costs by the number of cases diagnosed, treated and cured who would not have been cured without the screening programme, then the detection of a single case may well add up to US $ 50 000 or more. One may reduce the costs by identifying high-risk groups. and limiting s
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Diagnosis |
International Union Against Cancer |
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Abstract
The diagnosis of cancer depends on the patient’s consulting a physician. This in turn depends on the patient’s knowledge of health problems. He may know merely that if he has pain or bleeding the physician can give him relief, or he may know that he should see a physician when he experiences one of the cancer warning signals; or his education may be so sophisticated that he knows he has the best chance of cancer control by having routine periodic health examinations. The early diagnosis of a cancer, therefore, is directly related to the educational level of the public. In order to ensure early diagnosis, all physicians have the duty to make certain that the people of their community are given adequate cancer education.
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Evaluation of the extent of disease |
International Union Against Cancer |
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Abstract
Evaluation of the extent of spread of the cancer, using the various diagnostic procedures noted in the previous chapter, is essential before therapeutic decisions (discussed in the next chapter) are made. Radical treatment designed for cure (particularly surgical treatment) is usually not indicated if there is spread of the cancer beyond the limits of the proposed treatment field. Even when using chemotherapy, radiotherapy, or multi-modal therapy, there must be reason to believe there is a chance for cure (or major benefit) before radical treatment is proposed for what may be extensive disease. For most cancers, treatment will vary depending on the extent of disease. Therefore accurate assessment of spread is essential. This assessment is called “staging” and an increasingly elaborate set of rules has been developed over the years to make “staging” more accurate and meaningful.
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Principles of treatment |
International Union Against Cancer |
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Abstract
Human neoplasms form a large group of diseases of varying incidence, site, anatomical extent, pathology, clinical course and prognosis, suitability for surgery and responsiveness to ionizing radiation, chemical agents and hormones. This variability of features, characterizing diseases traditionally designated by a common term, and the variability of methods used for their diagnosis and treatment call for a collective approach to all problems connected with the clinical management of cancer.
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Psychological aspects |
International Union Against Cancer |
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Abstract
Of all diseases, cancer is the one that has the most formidable psychological impact. It spells not only death—the destiny of us all—but a progressive and painful approach to it, and mutilation, either natural or post-therapeutic. The risk of sudden death from cardiovascular disease is less frightening. The risk of infectious or diathetic disease is even less so because, rightly or wrongly, it is thought that the body, whether aided by treatment or not, can fight and overcome them. It is the legend of the incurability of cancer, or rather of its curability at the cost of mutilation, that strikes terror.
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Prognosis |
International Union Against Cancer |
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Abstract
After cancer has been diagnosed, the patient or a relative frequently asks for an opinion as to the probable outcome of the treatment that has been recommended. It is to be expected that the doctor concerned will have already asked himself the same question. In some favourable cases the result will clearly be good; in others, less favourable, the future is very uncertain and much will depend on the response to treatment; whilst in the worst group death must inevitably supervene before long. The opinion expressed must obviously be somewhat guarded in respect to the middle group, and all practising in the field of cancer must have been surprised on occasion by the behaviour of patients both in the first and last groups. After the successful completion of the planned treatment the same question will probably be put once again, and often, the precise nature and limits of the tumour having been defined or its early response to radiotherapy having been observed, a more accurate answer can be given. In all cases it is important that at this stage a near relative of the patient be told the truth, whether palatable or not, but to what extent the patient should be told will depend on many fa
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Abstract
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Skin excluding melanoma |
International Union Against Cancer |
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Abstract
Skin cancer is the most common cancer in many countries where the population is predominantly White, such as Australia (where it accounts for 50% of all cancers) and the USA. The incidence is low among people with more pigmented or black skin. It is rare in many African and Asian countries, and among Blacks in America and Australia. The highest incidence is in the 7th and 8th decades. The male: female ratio is 1.5: 1. The three main types are:
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Malignant melanoma |
International Union Against Cancer |
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Abstract
Melanoma is an infrequent tumour that has recently raised intense interest because of its rapidly increasing incidence, its wide variation in different ethnic groups, and its pathological and biological features. In most countries, the mortality rates have almost doubled over the past 20 years, and malignant melanoma has become increasingly more common in the trunk among men and in the lower limbs among women. The highest mortality rates are observed in Australia and New Zealand (5–6 per 100 000), and the lowest are in Japan and Hong Kong (0.2 per 100 000). In Europe, the highest rates are observed in Scandinavia and the lowest in southern countries; whereas in the USA, the rates increase as one moves from north to south.
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Head and neck |
International Union Against Cancer |
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Abstract
Tumours arising from the different organs and structures of the head and neck (excluding the brain and meninges) are grouped together since they are pathologically similar and arise from regions and sites which are anatomically and functionally related.
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Eye |
International Union Against Cancer |
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Abstract
Tumours of the eye are divided into tumours of the lids, conjunctiva, cornea, sclera, intra-ocular tumours (uvea and retina) and tumours metastasizing to the eye.
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Lung |
International Union Against Cancer |
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Abstract
Lung cancer deserves special emphasis because:
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Alimentary tract |
International Union Against Cancer |
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Abstract
Cancer of the oesophagus accounts for about 2% of all malignant tumours; its incidence has been stationary in the last 40 years. Epidemiological studies show that the geographical distribution of oesophageal cancer is far from uniform; in some countries, the incidence is very high in men (60 per 100 000 in Turkmenistan, 46 per 100 000 in Japan) whereas the figures are much lower in other areas (10 per 100000 in the USA). Oesophageal tumours are relatively frequent in Egypt, Saudia Arabia, Iran and China, and their incidence is increasing even in some areas of East Africa.
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发表于 2025-3-21 17:50:04
