Cancer Treatment Research

In recent years the field of cancer treatment has been burgeoning with ever expanding interest and commitments to research and therapy. Besides the large number of specialty journals and publications devoted to cancer related fields, nearly every general medical journal contains one or more articles related to cancer treatment and research. Another example of this expanding commitment and interest is reflected in the Internal Medicine subspecialty of Medical Oncology which, since its recognition as a subspecialty in 1973, has become the second most populated subspecialty, second only to cardiology. This burgeoning interest and commitment is obviously appropriate in view of the prevalence and incidence of the various cancers. These diseases constitute, after all, some of the most important and devastating problems of civilized man. It has been particularly gratifying to those involved with cancer research and therapy to observe the increasing interest in these diseases being translated into real improvements in patient care - improvements in length of survival, improvements in quality of survival, and improvements in palliative care. One need only look at Hodgkin's disease to observe the high rate of cure now routinely obtained whereas, in the past, many patients' disease continued to progress with fatal consequences. Some of these improvements came about through better staging techniques, and other improvements, as will be discussed in the chapter on Hodgkin's, came about from the application of early chemotherapy. Further research in Hodgkin's disease is still going on in order to improve results and decrease treatment related complications.

1: New Approaches to the Diagnosis and Classification of the Non-Hodgkin’s Lymphomas.- Lymphomas Originating from B Lymphocytes.- Localization of T Cells in Nodular Lymphomas Nodes.- Spleen.- Internodular Areas.- Well Differentiated Lymphomas.- Intermediate Differentiation.- Histologic Features.- Histochemical Features.- Burkitt’s Lymphomas.- Lymphomas of T-Cell Origin.- Lymphoblastic Lymphomas.- Large Cell Lymphomas.- Surface Markers.- Tumor Overgrowth or Recurrence.- T-Cell Markers.- Histiocytic Origin.- “Null” Cells.- Summary.- 2: Staging and Treatment of Non-Hodgkin’s Lymphomas.- Staging of Non-Hodgkin’s Lymphomas.- Clinical Manifestations.- Staging Procedures.- Blood Tests.- Radiology and Nuclear Medicine Studies.- Scans.- Other Tests.- Pathologic Examinations.- Final Impact of Staging.- Treatment of Non-Hodgkin’s Lymphomas.- General.- Surgery.- Radiotherapy.- Adjuvant Chemotherapy.- Total Body Irradiation.- Chemotherapy.- Re-staging.- Maintenance.- Conclusions and Recommendations.- Stage I &II Any Histology.- Stage IE Any Histology.- Stage III or IV DPDL, DM, DHL, NH.- Stage III or IV DWDL; NPDL, NM.- 3: Current Issues in the Management of Patients with Hodgkin’s Disease.- Combined Modality Approach to Hodgkin’s Disease.- Primarily Confined to Lymph Nodes.- Complications of Treatment.- Endocrine Complications.- Cardiovascular Complications.- Pulmonary Complications.- Reproductive Dysfunction.- Combination Chemotherapy Sequelae.- Thoughts for the Future.- 4: The Role of Radiation Therapy in the Management of Cancer of the Head and Neck.- Therapeutic Alternatives According to Site.- Oral Cavity.- Paranasal Sinuses.- Nasopharynx.- Oropharynx.- Hypopharynx.- Glottis.- Salivary Glands.- Other General Approaches.- Equipment for Radiotherapy.- Factors Determining Response to Radiotherapy.- Anoxia.- Size and Origin of Tumors.- Local Failure of Treatment.- Combined Modality Treatment.- General Considerations.- Radiotherapy and Surgery.- Radiation and Chemotherapy.- Summary.- 5: Systemic Chemotherapy in Advanced Head and Neck Cancer.- Single Agent Chemotherapy.- Methotrexate.- Bleomycin.- Cis-diamminedichloroplatinum II.- Other Drugs.- Combination Chemotherapy.- Other Areas of Investigation.- Immunotherapy.- Intraarterial (IA) Chemotherapy.- Combined Radiotherapy and Chemotherapy.- Conclusion.- 6: Carcinoma of the Thyroid.- Epidemiology.- Pathology.- Papillary-Follicular.- Anaplastic.- Medullary.- Metastases to Thyroid.- Prognostic Factors.- Pathogenesis.- Chronic Stimulation.- Irradiation.- Treatment of Well Differentiated Thyroid Carcinomas.- Treatment Alternatives.- Surgery versus Surgery + RAI.- Cytotoxic Drug Therapy.- Medullary Carcinoma of the Thyroid.- Sipple’s Syndrome.- Hormone Abnormalities in Medullary Carcinoma.- Patterns of Presentation.- Therapy of Medullary Carcinoma.- Screening for Medullary Carcinoma.- Summary.- 7: Computed Tomography in the Evaluation of Abdominal Malignancy.- Clinical Applications.- Liver and Biliary Tree.- Pancreas.- Adrenal Glands.- Kidneys.- Abdominal Lymphadenopathy.- Other Abdominal Tumors.- Summary.- 8: Management of Gastric and Pancreatic Cancer.- Gastric Carcinoma.- Prognostic Determinants.- Therapy for Locally Advanced Disease.- Radiation Therapy.- Chemotherapy.- Chemotherapy of Disseminated Disease.- General.- 5-Fluorouracil.- Mitomycin-C.- Nitrosoureas.- Anthracyclines.- Other Agents.- Combination Chemotherapy.- BCNU + 5-FU.- Methyl-CCNU + 5-FU.- 5-FU, Mitomycin-C and Cytosine Arabinoside.- 5-FU, Adriamycin and Mitomycin-C (FAM).- Future Directions for Gastric Cancer.- Cancer of the Pancreas.- Locally Advanced Carcinoma of the Pancreas.- Interstitial Irradiation.- External Beam Irradiation.- Chemotherapy and Radiation Therapy.- Other Radiation Therapy Approaches.- Therapy of Advanced Pancreatic Cancer.- General.- Single Agent Chemotherapy in Pancreatic Cancer.- Combination Chemotherapy in Pancreatic Cancer.- Conclusion.- 9: Chemotherapeutic Management of Bladder Cancer.- Indications for Chemotherapy.- Chemotherapy for Advanced Disease.- Adjuvant Chemotherapy.- Adriamycin.- Cis-platinum diammine dichloride.- Cyclophosphamide.- 5-Fluorouracil.- Other Agents.- Combination Chemotherapy for Transitional Cell Carcinoma of the Bladder.- Conclusions and Prospectus.- 10: Mammography.- Historical Perspective.- Radiation Dosage.- Technique and Dose.- Dose and Complications.- Indications for Mammography.- Indications for Initial Mammography.- Indications for Serial Studies.- Mammography for Screening.- Mammographic Features of Breast Cancer.- Mass.- Calcifications.- Duct Patterns.- Differential Diagnosis of Breast Cancer on Mammography.- Cysts.- Fibroadenoma.- Sclerosing Adenosis.- Breast Abscess.- Fat Necrosis.- Metastatic Disease to the Breast.- Biopsy Scars.- Mammographic Needle Localization.- Specimen Radiography.- Summary.- 11: Breast Parenchymal Patterns on Mammography and Their Relationship to Carcinoma.- Classification.- Correlation of Classification and Cancer.- Prevalent Versus Incident Carcinomas.- Distinction.- Correlation of Risk Factors and Incident Carcinoma.- Correlation of Parenchymal Patterns with Histopathology.- Conclusions.- 12: Initial Management of Carcinoma of the Breast with Radiation Therapy Instead of Mastectomy.- Radiologic Basis for Therapy.- Principles of Primary Radiation Therapy.- Results of Primary Radiotherapy.- Complications of Radiotherapy.- Relationship of Primary Radiation to Adjuvant Chemotherapy.- Conclusions.- 13: The Surgical Treatment of Primary Breast Cancer.- The Radical Mastectomy.- Historical Perspective.- Current Perspective.- Treatment of Axillary Nodes.- Predictive Value of Axillary Lymph Nodes.- Lesser Surgical Procedures.- Rationale.- Results of Prior Trials.- Multicentric Breast Cancer.- Anatomical Multicentricity.- Clinical Multicentricity.- Investigative Surgical Approach.- Adjuvant Chemotherapy.- Conclusion.- 14: Clinical Applications of Cell Kinetics to Chemotherapy of Human Malignancy.- Cell Kinetics and Prognosis.- Chemotherapeutic Perturbation of Cell Population Kinetics.- Scheduling for Normal and Tumor Cell Response.- Summary.- 15: Adjuvant Therapy in Childhood Neoplasms — An Overview.- Wilms’ Tumor.- Early Studies.- National Wilms’ Tumor Study Group.- NWTS-1.- NWTS-2.- Rhabdomyosarcoma.- Background.- Intergroup Rhabdomyosarcoma Study.- Planning for Special Sites.- Osteosarcoma.- Background.- Adjuvant Chemotherapy.- 16: An Overview of Adjuvant Therapy in Man.- The Management of Systemic Cancer.- Early Treatment vs Late Treatment.- How to Differentiate Systemic from Local Cancer.- Which Modality of Cancer Treatment is the “Adjuvant”?.- The Requirements for Inclusion of Chemotherapy in the.- Multimodal Management of Malignancy.- Adjuvant Therapy Lessons from the Treatment of Acute Leukemia.- Treatment of the Patient Who Has No Evidence of Residual Disease.- Summary.- 17: An Overview of Unconventional (Fraudulent) Treatments of Cancer.- Nutrition and Cancer.- Nutritional Misinformation.- Why Are People So Vulnerable to Exploitation in the Field of Nutrition.- The “Freedom of Choice” Argument is a Consumer.- Protection Trap.- The Unscrupulous and the Misguided Physician.- The Testimonial, the Anecdote, and the Placebo Effect.- The “Terminal” Argument.- The Unconventional (Fraudulent) Treatments for Cancer.- Laetrile.- Why Do People Place Their Lives, or the Lives of Their Loved Ones on a Treatment Which is Generally Rejected as a Fraud by Almost Everyone Trained and Experienced in Cancer Research and Treatment?.- How Unconventional (Fraudulent) Treatments of Cancer are Successfully Promoted — How Laypeople are Deceived — Laetrile as an Example.- “Scientific” Claims Without Supporting Data.- Testimonials for Clinical Evidence.- Claim is Made that Cancer Causation is Due to Diet.- Claim of Non-Toxicity.- Claim for Equality of Opinion.- Claim Persecution as Scientific Pioneers.- Claim “Establishment” Prejudice and a Conspiracy.- Lack of Scientific Publication.- Claim Public Figures as Supporters.- Claims for Political Support (In Contrast to Medical Support) 267 Claims (In Terms of Pseudo-Scientific Jargon) That the Method of Treatment Can Only be Done by Themselves.- The “Big” Lie.- Who Makes, or Should Make, Scientific Policy?.- Contributing Authors.