Introduction

Cancer’s timeline 3 Epidemiology 4 Prevention 6 Screening 8 Diagnosis 10 Surgery 10

Radiotherapy 11 Chemotherapy 11 The future – getting innovation into practice 13 Conclusion 20 References 21

This book is written by many authors around one common theme – the optimal treatment of cancer. The problem at first seems relatively simple. There are about 1013 cells in the human body. From the fertilized egg to death in old age, a human being is the product of 1016 cell divisions. Like all complex systems, growth control can go wrong, resulting in the loss of normal territorial restraint, producing a family of cells that can multiply indefinitely. But it is not just the local growth of tumour cells that makes them so lethal. It is their spread, directly through invasion and by metastases to other sites of the body. Tumours that remain localized can usually be cured by surgery or radiotherapy, even when enormous. Patients with large, eroding basal cell skin cancers, for example, can be treated successfully, as these tumours seldom invade deep into the skin or spread to lymph nodes. Yet a breast lump less than 1 cm in diameter, which causes the patient no problems and is picked up in a screening clinic, can be lethal if metastases have already arisen from the primary site. It is this spread that provides the plethora of clinical problems. Just as no two individuals are alike, no two tumours behave in exactly the same way, although we can make some broad generalizations from clinical experience. The physical and psychological interactions of a patient with a growing cancer require careful analysis and action by those involved in the patient’s care.