8.

CANCER MANAGEMENT

Curing cancer requires eliminating all cancer cells. The major modalities of therapy are:
1. 2. 3. 4. 5. 6.

Surgery and radiation therapy (for local and local regional disease) Chemotherapy for systemic disease) Hormonal therapy (for selected cancers eg prostate, breats, endometrium) Immunotherapy (monoclonal antibodies, interferons and other biologic response modifiers and tumor vaccines) Differentiating agents such as retinoids and Agents that exploit the growing knowledge of cellular and molecular biology

Some useful cancer terminology: Terms Cure Complete remission / Complete response Partial response Definition permanent absence of signs or symptoms of a disease. disappearance of clinical evidence of disease > 50% reduction in the size of tumor mass or masses. A partial response may lead to significant palliation and prolongation of life but inevitably the tumor regrows. Indicates disease is neither improving nor worsening Reflects interval between disappearance of cancer and relapse Time of diagnosis to death

Stable disease Disease free interval / Disease free survival Survival time

Disease free interval often serves as an indicator of cure and varies with cancer type. For example lung, colon, bladder and testicular cancers are usually cured if 5-yr disease free interval occurs. Breast cancer may recur after 5 years; thus a 10-yr disease free interval is more indicative of cure.

Treatment decisions should weigh the likelihood of adverse effects against the likelihood of benefit. This requires frank communication and involvement of a multidisciplinary cancer team. A patient's preference for how to live out the end of his life should be established early in the course of cancer treatment despite the difficulties of discussing death at such a sensitive time.