When Cancer Crosses Disciplines: A Physician's Handbook

Cancer and the Epidemiologist......Page 6
Contributors......Page 12
Oncology: Beyond the Oncologist......Page 26
Required Reading......Page 27
Cancer Care in the 21st Century: The Information Age Meets Team Oncology......Page 28
Abstract......Page 30
1.1 Causation proven......Page 31
1.2 Multiple target organs......Page 32
2.1 Lung cancer is a different disease in smokers......Page 34
3. Prospects for Population-Based Screening......Page 35
3.1 Current status of computed tomography (CT) screening......Page 36
3.2 Genetic profiling of pre-malignant tissue......Page 37
5. Passive Smoking......Page 38
5.1. Chemical composition......Page 39
5.2 ETS and cancer causation......Page 40
6.1 The effects of smoking on survival......Page 41
6.2 Smoking as a risk factor for increased cancer stage at diagnosis......Page 42
6.3.1 Surgery and wound healing......Page 43
6.3.2 Radiation therapy and chemotherapy......Page 45
6.6 Future directions/further research......Page 46
7.1 The individual......Page 48
7.2 Cancer patients......Page 51
7.4 A global perspective......Page 52
References......Page 53
Abstract......Page 62
2.1 Health professional advice......Page 63
2.2 Telephone helplines......Page 64
2.3 Psychological methods......Page 65
2.5.1 Nicotine replacement therapy......Page 66
2.5.2 Bupropion sustained release......Page 67
2.5.3 Varenicline......Page 68
3. Effectiveness of Cessation Interventions in Cancer Patients......Page 69
References......Page 72
Abstract......Page 78
1. Introduction......Page 79
2.1 Body fatness......Page 81
2.1.2 Recent literature......Page 82
2.1.3 Mechanisms of carcinogenesis......Page 83
2.2 Plant foods......Page 84
2.2.1 Study designs......Page 85
2.3 Animal foods......Page 86
2.3.2 Recent literature......Page 87
2.3.3 Mechanisms of carcinogenesis......Page 88
2.4.1 Study designs......Page 89
2.4.3 Mechanisms of carcinogenesis......Page 90
2.5.1 Study designs......Page 91
2.5.2 Recent literature......Page 92
2.5.3 Mechanisms of carcinogenesis......Page 93
2.6 Physical activity......Page 94
2.6.2 Recent literature......Page 95
2.6.3 Mechanisms of carcinogenesis......Page 96
3. Conclusion......Page 97
References......Page 98
Abstract......Page 108
1. Introduction......Page 109
2. Ambient Solar Radiation and Cancer Incidence and Mortality......Page 110
3.1.1 Sun exposure......Page 112
3.1.2 Vitamin D......Page 113
3.2.1 Sun exposure......Page 116
3.3.1 Sun exposure......Page 119
3.4.1 Sun exposure......Page 120
3.4.2 Vitamin D......Page 124
3.5.1 Oesphageal and gastric cancers......Page 125
3.5.2 Pancreatic cancer......Page 126
3.5.4 Skin cancers......Page 127
3.5.7 All cancers......Page 128
5. Conclusions......Page 130
References......Page 135
Abstract......Page 140
1. Introduction......Page 141
2.1 Oral contraceptives and breast cancer......Page 142
2.2 Oral contraceptives and ovarian cancer......Page 143
2.4 Oral contraceptives and cervical cancer......Page 144
3. Hormone Replacement Therapy......Page 145
3.1 HRT and breast cancer......Page 147
3.2 HRT and ovarian cancer......Page 149
3.3 HRT and endometrial cancer......Page 150
3.4 HRT and cervical cancer......Page 151
4. Conclusions......Page 153
References......Page 154
Abstract......Page 160
1. Cancers That Should be Prevented......Page 161
2. Occupational Cancer: Prevention is Achievable......Page 162
2.1 Carcinogens identified......Page 164
2.2 Hazardous workplaces and occupations......Page 166
2.3 Achieving prevention......Page 168
2.4 The task is ongoing......Page 169
3.1.1 Air......Page 170
3.1.2 Water......Page 174
3.2.1 Spatial aggregation studies......Page 175
3.2.2 Point sources......Page 176
4.1 Diverse findings......Page 178
5. Cancer Clusters: Prevention Impossible......Page 180
References......Page 182
IIa: Beyond Cancer Treatment......Page 7
Abstract......Page 190
1. Introduction......Page 191
2. The Symptoms of Cancer or Its Recurrence After Therapy......Page 192
2.3 Fatigue......Page 193
3. Local Symptoms of Cancer in Specific Organs......Page 194
4. The Side Effects of Chemotherapy......Page 196
4.1.2 Extravasation......Page 197
4.1.3 Emesis......Page 198
4.1.4 Bone marrow suppression......Page 199
5.1 Organ toxicities......Page 200
5.2 Second cancers......Page 202
5.3 Reproductive function......Page 203
References......Page 204
1. Introduction......Page 208
2.3 Late RT effects......Page 210
2.4.1 Radiotherapy dose and fractionation......Page 211
2.5 Acute/Late grading scoring system......Page 212
3.1 Head and neck radiotherapy......Page 213
3.2 Lung radiotherapy......Page 216
3.3.1 Breast cancer RT......Page 218
3.4 Prostate radiotherapy and rectal toxicity......Page 220
3.5 Central nervous system (CNS)......Page 223
4.1 Effects on fertility......Page 225
4.3 Radiation-induced malignancy......Page 226
Acknowledgements......Page 227
References......Page 228
Abstract......Page 230
1.1.2 Causes......Page 231
1.1.3 Management......Page 232
1.2.2 Causes......Page 233
1.2.4 Management......Page 234
1.3.2 Prevention......Page 235
1.3.3 Treatment......Page 236
2.1.3 Investigations......Page 237
2.1.5 Management......Page 238
2.2.2 Physical examination......Page 239
2.2.5 Management......Page 240
3. Febrile Neutropenia......Page 241
3.2 Physical examination......Page 242
3.3 Investigations......Page 243
3.4.1 Initial management......Page 244
3.4.2 Antibiotic treatment duration......Page 245
3.4.4 Management of persistent febrile neutropenia......Page 246
3.4.6 Management of low risk neutropenia......Page 247
3.4.7 Use of colony stimulating factors......Page 249
4.4 Causes......Page 250
5.1 Investigations......Page 251
6.2 Physical examination......Page 252
6.5 Management......Page 253
7.3 Investigations......Page 254
8. Conclusion......Page 255
References......Page 256
Abstract......Page 260
1. Overview......Page 261
2.1 Safety of chemotherapy in pregnancy......Page 262
2.4 Long term implications of chemotherapy for the child......Page 263
2.5 Pharmacokinetics and drug dosing in pregnancy......Page 265
2.7 Use of growth factors in pregnancy......Page 266
2.9 Radiation therapy......Page 267
3.2 Diagnosis of breast cancer in pregnancy......Page 268
3.3 Pathology of breast cancer in pregnancy......Page 269
3.5 Treatment of breast cancer in pregnancy......Page 270
3.6 Surgical treatment of breast cancer in pregnancy......Page 271
3.7.2 Chemotherapy drugs used in breast cancer in pregnancy......Page 272
3.8 Radiation therapy for breast cancer in pregnancy......Page 279
3.9 Prognosis of breast cancer in pregnancy......Page 280
4.3 Treatment of lymphoma in pregnancy......Page 281
4.3.1 Treatment of Hodgkin lymphoma in pregnancy......Page 282
4.3.2 Treatment of non-Hodgkin lymphoma......Page 283
References......Page 285
Abstract......Page 296
2. Causes of Weight Loss in Cancer Patients......Page 297
3. Evidence Based Nutrition Guidelines......Page 298
3.1 Identifying malnutrition — Nutrition screening and assessment......Page 299
3.3 Nutritional intervention......Page 302
3.3.1 Nutritional prescription......Page 303
3.3.2 Implementation of nutritional care......Page 304
4. Summary and Conclusions......Page 308
References......Page 309
Abstract......Page 314
1. Introduction......Page 315
2. Herb-Drug Interactions......Page 316
2.1 Asian ginseng (Panax ginseng)......Page 319
2.2 Black cohosh (Cimicifuga racemosa)......Page 320
2.3 Celery (Apium graveolens)......Page 321
2.5 Echinacea (Echinacea purpurea)......Page 322
2.7 Feverfew (Tanacetum parthenium)......Page 323
2.8 Garlic (Allium sativum)......Page 324
2.10 Ginkgo (Ginkgo biloba)......Page 325
2.12 Green tea (Camellia sinensis)......Page 326
2.14 Liquorice (Glycyrrhiza uralensis)......Page 327
2.15 Milk Thistle (Silybum marianum)......Page 328
2.16 St Johns Wort (Hypericum perforatum)......Page 329
2.17 Saw palmetto (Serenoa repens)......Page 330
2.19.1 Evening primrose oil......Page 331
2.19.2 Herbal medicines containing phyto-oestrogens......Page 332
3. Conclusion......Page 333
References......Page 334
Abstract......Page 346
1. Introduction......Page 347
2. Who Seeks Health Information......Page 348
3. Trends in Seeking Health Information......Page 351
3.1 Using the internet......Page 352
3.3 Consequences of accessing online information and support......Page 354
4. Preferred Sources of Patient Information......Page 355
5. Communication and Patient Satisfaction......Page 357
6. Communication About Complementary and Alternative Therapies......Page 359
7. Summary......Page 362
References......Page 363
IIb: Cancer and the Surgeon......Page 8
Abstract......Page 372
2.1 Case 1......Page 373
2.2 Epidemiological data......Page 374
2.3 Clinical presentation......Page 375
2.4 Investigation and imaging......Page 376
2.5 Medical therapy......Page 377
2.6 Case 2......Page 378
2.7 Neurosurgical procedures......Page 379
3. Deep Vein Thrombosis and Pulmonary Embolism in Patients with Intracranial Metastatic Disease......Page 381
4. Neuro-Cognitive Outcomes in Patients with Intracranial Metastatic Disease......Page 383
5. Spinal Metastatic Disease......Page 384
5.1 Clinical presentation and diagnosis......Page 385
5.3 Medical management of spinal metastases......Page 387
5.4 Surgery and radiation therapy in the management of metastatic spine disease......Page 388
6. Conclusion......Page 389
References......Page 390
Abstract......Page 396
1. Introduction......Page 397
2. Diagnosis......Page 398
2.2 Fiberoptic bronchoscopy......Page 399
2.4 Video-Assisted Thoracic Surgery (VATS)......Page 400
3. Staging......Page 401
3.1.2 Positron Emission Tomography (PET) scanning......Page 405
3.2 Invasive staging......Page 406
3.2.2 Extended mediastinoscopy and anterior mediastinotomy......Page 407
3.2.4 Endoscopic Ultrasound (EUS) and Endobronchial Ultrasound (EBUS)......Page 408
4. Preoperative Assessment......Page 409
5. Treatment......Page 410
6. Summary......Page 412
References......Page 413
16. Cancer and the Oesophageal Surgeon Urs Zingg, Reginald V. Lord and David I. Watson......Page 424
1.2 Aetiology......Page 425
1.3 Pathology......Page 426
2.1 Diagnosis......Page 427
2.1.1 Staging......Page 428
2.3 Neo-adjuvant therapy and restaging......Page 431
2.5 Preparation for surgery......Page 432
3.1.1 Open surgery......Page 433
3.1.2 Minimal invasive surgery......Page 436
3.1.3 Endoscopic surgery......Page 437
3.3 Recurrent disease after esophagectomy......Page 438
4.2 Surgical complications and management......Page 439
4.3 Adjuvant therapy......Page 440
5.1 Outcome after surgery......Page 441
5.4 Surveillance......Page 442
7. The Future in (Surgical) Oesophageal Cancer Treatment......Page 443
References......Page 444
Abstract......Page 450
1. Bowel Perforation......Page 451
2. Bowel Obstruction......Page 454
3. Neutropenia and Abdominal Pain......Page 455
4. Cholecystitis and Biliary Obstruction......Page 458
5. Gastrointestinal Bleeding......Page 460
6. Appendicitis......Page 461
References......Page 462
Abstract......Page 468
2. Fast-Track Surgery Challenging Traditional Peri-operative Care......Page 469
2.1 Use of oral pre-operative carbohydrate fluids......Page 470
2.3 Early return to normal nutrition......Page 471
3. Management of Patients with More Advanced Symptoms......Page 472
3.1 Anorexia and metabolic disturbances......Page 473
3.2 Malnutrition......Page 474
4. Pre-Operative Assessment of Nutritional Status......Page 475
4.1 Subjective global assessment (SGA)......Page 476
4.2 Malnutrition related complication score (MRCS)......Page 477
4.4 Fasting for tests......Page 478
5. The Concept of Peri-Operative Nutritional Support......Page 479
6. Enteral Nutrition......Page 480
7.2 Post-operative parenteral nutrition......Page 482
7.3 Nutritional therapy reduces the risk of complications after surgery......Page 484
7.4 Choosing the mode of post-operative nutritional support......Page 485
7.5 Long term outcome in malnourished patients......Page 486
References......Page 488
Abstract......Page 494
2.1 Pre-operative radiation and chemotherapy......Page 495
2.2 Surgery......Page 496
2.4 Post-operative chemotherapy......Page 497
3.1 Bowel function......Page 498
3.1.2 Management of incontinence......Page 499
3.2.1 Defunctioning loop ileostomy......Page 500
3.3 Radiotherapy effects......Page 501
3.4 Sexual function......Page 502
3.5 Fertility......Page 503
3.6 Urinary function......Page 504
4.1 Diagnosis......Page 505
4.2 Treatment......Page 506
References......Page 507
20. Management of Nutritional Issues After Major Pancreatic Resections Nam Q. Nguyen, Neil D. Merrett and Andrew V. Biankin......Page 516
1. Introduction......Page 517
2.1 Exocrine insufficiency......Page 518
2.2 Endocrine insufficiency......Page 520
3.1 Upper gastrointestinal dysfunction......Page 521
3.2 Biliary dysfunction......Page 523
4. Management of Other Nutritional-Related Issues After Pancreatectomy......Page 524
5. Summary and Conclusions......Page 526
References......Page 527
Abstract......Page 536
2.1.1 Epidemiology......Page 537
2.1.2 Diagnosis of hepatocellular carcinoma......Page 538
2.1.4 Ablative and ‘non-invasive’ therapies......Page 539
2.1.5 Surgical resection......Page 543
2.1.6 Portal vein embolisation......Page 544
2.1.8 Liver transplantation......Page 545
3.1 Hepatocellular carcinoma......Page 547
3.2 Cholangiocarcinoma......Page 548
4.1.1 Epidemiology......Page 549
4.1.3 Imaging......Page 550
4.1.4 Chemotherapy......Page 551
4.1.5 Patient selection for surgery......Page 552
4.1.6 Adjuvant chemotherapy......Page 553
4.1.9 Other strategies to increase resectability......Page 554
4.1.10 Local ablation......Page 555
4.1.11 Approach to synchronous liver metastases......Page 556
4.2.1 Neuroendocrine liver metastases......Page 557
References......Page 558
Abstract......Page 576
1. The Origins of Gynaecological Oncology......Page 577
2. Cervical Cancer......Page 579
3. Vulvar Cancer......Page 583
4. Ovarian Cancer......Page 588
References......Page 592
Abstract......Page 598
1. Fractures......Page 599
1.1 Impending fractures......Page 603
1.2 Pathologic fractures......Page 608
2. Spinal Cord Compression......Page 614
3.1 Septic arthritis......Page 618
3.2 Necrotizing fasciitis......Page 620
3.3. Extremity abscesses......Page 621
4. Acute Compartment Syndrome (ACS)......Page 622
5. Role of Amputation......Page 624
References......Page 625
Abstract......Page 632
1. Introduction......Page 633
2.1 Failure of the lymphatic system......Page 634
2.4 Secondary lymphoedema......Page 635
3. Other Reasons for a Swollen Limb......Page 636
4. Incidence and Prevalence of Lymphoedema......Page 637
5. Risk Factors for Lymphoedema......Page 638
6. Signs of Impending Lymphoedema and Recognising the Group at Risk......Page 639
6.2 A holistic picture......Page 640
7.2 Bio-impedance spectroscopy (BIS)......Page 641
7.3 Tonometry......Page 642
8.1.2 Increasing lymph transport......Page 643
8.2.4 Benzopyrones......Page 644
8.2.6 Compression garments......Page 645
8.2.10 Elevation......Page 646
8.2.13 Laser treatments......Page 647
8.2.15 Massage pads and massage devices......Page 648
8.2.17 T’ai Chi and Qi Gong......Page 649
10. Summary......Page 650
References......Page 651
Abstract......Page 656
1.1 Prognostication and estimation of the risk of recurrence following radical prostatectomy......Page 657
1.3.1 Definition of biochemical recurrence......Page 659
1.3.2 Local versus systemic disease......Page 660
1.3.3 Natural history of biochemical recurrence......Page 662
1.4.1 Expectant management......Page 663
1.4.2 Salvage radiotherapy......Page 664
1.4.3 Androgen deprivation therapy......Page 665
2.1 General complications......Page 666
2.2.2 Obturator nerve injury......Page 667
2.3.2 Incontinence......Page 668
2.3.3 Erectile dysfunction......Page 669
References......Page 671
1. Principles of Reconstructive Surgery......Page 676
1.2 Healing by secondary intention......Page 677
1.3 Skin grafting......Page 678
1.4 Tissue expansion......Page 679
1.5.1 Local flaps......Page 680
1.5.2 Regional flaps......Page 681
1.5.3 Free flaps......Page 684
2.1 Introduction......Page 685
2.2.1 Intraoral......Page 688
2.2.2 Mandible......Page 689
2.2.3 Midface......Page 690
2.3 Summary......Page 691
3.2 Pre-operative assessment......Page 692
3.4.1 Implant......Page 693
3.4.3 Autologous......Page 694
References......Page 697
Abstract......Page 702
2. Aetiology......Page 703
3. Pathology......Page 704
4.2 Physical examination......Page 706
5. Management......Page 708
5.1 Histological diagnosis......Page 710
5.2 Imaging......Page 711
5.4 Staging......Page 712
5.5 Treatment......Page 713
6.2 Mucosal squamous cell carcinoma......Page 714
6.2.1 Oral cavity carcinoma......Page 715
6.2.2 Oropharyngeal carcinoma......Page 716
6.2.3 Laryngeal carcinoma......Page 717
6.2.5 Nasopharyngeal carcinoma......Page 718
6.2.6 Squamous cell carcinoma of unknown primary site......Page 719
6.4 Thyroid carcinoma......Page 720
6.5 Carcinoma of the salivary glands......Page 721
7.1 History of head and neck surgery......Page 722
7.2 ENT surgeon as the primary care physician......Page 724
7.3.1 The role of the ENT surgeons in MDT......Page 725
7.4 ENT surgeon as innovator, educator and researcher......Page 726
References......Page 727
IIc: Cancer and the Physician......Page 9
Abstract......Page 732
1. Prognosis of Differentiated Thyroid Cancer......Page 735
2.1 Surgery......Page 736
2.2.1 Preparation for RAI......Page 737
2.2.2 Side effects of radioactive iodine......Page 738
2.3 Thyroid hormone suppressive therapy (THST)......Page 740
3.1.1 Thyroglobulin (Tg)......Page 741
3.1.2 Neck ultrasonography......Page 742
3.1.3 Radioactive iodine whole body scans......Page 743
3.2 Protocols for follow-up......Page 744
4. Treatment of Recurrent or Persistent Disease......Page 746
5.1 Low detectable thyroglobulin......Page 747
5.2 Thyroglobulin positive, whole body scan negative patients......Page 748
References......Page 749
Abstract......Page 758
1. Background — Significance and Recognition of Infertility after Cancer......Page 759
2.1 Effect of cytotoxic therapies on the ovary......Page 760
2.2 Radiotherapy and the ovary......Page 762
2.3 Effect of cytotoxic therapies on the testis......Page 763
3. Sex Hormone Production, Cancer and Gonadotoxic Therapy......Page 765
4.1.1 Ovarian transposition before radiation......Page 766
4.1.2 Use of gonadotrophin releasing hormone (GnRH) analogues and oral contraceptives to protect the ovary during chemotherapy......Page 767
4.2.1 Collection and cryopreservation of fertilised oocytes or embryos......Page 768
4.2.2 Mature oocyte and ovarian cortical tissue cryopreservation......Page 770
4.2.3 Cryopreservation options for men......Page 771
5. Stem Cell Therapy for Germ Line Replacement......Page 772
6.3 Ovarian cancer......Page 773
8. Summary......Page 774
References......Page 775
Abstract......Page 782
1. Introduction......Page 783
2. VTE as a Precursor of Cancer Diagnosis......Page 785
2.1 Risk assessment (Table 1)......Page 786
2.2.1 Hospitalised and/or immobilised patients......Page 788
2.2.2 Ambulatory patients......Page 789
2.2.5 Mechanical prophylaxis......Page 790
2.3 Diagnosis of VTE in cancer patients......Page 791
2.3.2 Pulmonary Embolism......Page 792
2.4 Treatment of VTE and PE (Table 3)......Page 793
2.4.2 Inferior vena cava (IVC) filters......Page 794
2.5 Emerging anticoagulants......Page 795
2.5.3 Direct thrombin inhibitors132,133......Page 796
3. Links Between Tumour Biology and Haemostasis......Page 797
References......Page 798
Abstract......Page 812
2.1 Incidence......Page 813
2.3 Aetiology......Page 814
2.4 Specific treatments for anaemia......Page 815
2.4.2 Treatments for autoimmune haemolytic anaemia......Page 816
2.4.3 Red cell transfusions......Page 817
2.5 Erythropoietin......Page 819
3. Neutropenia......Page 821
3.1 G-CSF and GM-CSF......Page 823
3.1.2 Secondary prophylaxis......Page 824
3.1.4 Increasing dose intensity......Page 825
4.1 Platelet transfusion......Page 826
4.2 Megakaryocyte stimulating agents......Page 827
5.1 Diffuse intravascular coagulation (DIC)......Page 828
5.2 Thrombotic thrombocytopenic purpura (TTP)......Page 829
References......Page 830
Abstract......Page 842
1. Epidemiology of Hepatitis-B Reactivation......Page 843
2. Hepatitis B Serology......Page 844
2.2 Anti-HBc positive patients......Page 847
3. Clinical Manifestations of Hepatitis B Reactivation......Page 848
4. Management of Hepatitis B Reactivation......Page 849
5. Prevention of Hepatitis B Reactivation......Page 850
7. Timing and Duration of Lamivudine Prophylaxis......Page 851
8. Other Antiviral Agents......Page 852
9.3 Monitoring and prophylaxis of occult CHB......Page 853
9.5 Hepatitis B and delta co-infection......Page 854
11. Summary......Page 855
References......Page 856
1. Introduction......Page 862
1.1 General approach to the patient with gastrointestinal obstruction......Page 863
2.2 Endoscopic management......Page 864
2.3 Oesophageal stenting......Page 866
3.1 Presentation......Page 867
3.2 Endoscopic management......Page 868
4.1 Presentation......Page 871
4.2 Endoscopic management......Page 872
5.1 Presentation and assessment of malignant biliary obstruction......Page 874
5.3 Biliary stents......Page 876
5.4 Plastic versus metal stents......Page 878
5.5 Other methods of biliary drainage......Page 879
5.6 EUS-guided coeliac plexus blockade......Page 880
References......Page 881
1.1 History......Page 888
1.3 Benign and malignant cardiac tumours......Page 889
1.3.1 Malignant cardiac tumours: Cardiac lymphomas......Page 890
1.3.2 Malignant cardiac tumours: Angiosarcomas......Page 891
1.3.3 Benign tumours: Cardiac myxomas......Page 892
1.3.4 Other benign cardiac tumours......Page 893
1.3.5 Papillary fibroelastoma......Page 894
2.2 Examination and investigations......Page 896
2.3 Management......Page 898
2.4.1 Tumours metastasising to the heart......Page 899
3.1 History......Page 900
3.2.1 Anthracycline toxicity......Page 901
3.2.3 5-Fluorouracil cardiotoxicity......Page 902
3.2.5 Monitoring cardiotoxicity......Page 903
3.2.6 Role of antifailure therapy......Page 904
4.2 Management......Page 905
4.3 Discussion......Page 907
4.3.1 Cardiac effects of radiation......Page 908
References......Page 909
Abstract......Page 914
1. Introduction......Page 915
2. Definitions......Page 916
3.1 Physical development......Page 917
3.3 Psychological development......Page 919
3.5 Existential changes......Page 920
4.1 Public health impact of cancer in adolescents and young adults......Page 921
4.2 Types of cancer affecting AYA patients......Page 922
4.3 Mortality and survival......Page 926
4.4 Gender effects......Page 928
5.1 Clinical trials......Page 929
5.2 Medico-legal implications for AYA cancer patients......Page 930
6. Summary......Page 931
References......Page 932
Abstract......Page 936
1. Introduction......Page 937
3. Older Patients in Departments of Cancer Care......Page 938
3.1 Specific management issues......Page 941
4. Consent in Relation to Cognitive Impairment......Page 942
6. Conclusion......Page 943
References......Page 944
Abstract......Page 946
1. Cancer and Primary Care: Opportunities and Challenges......Page 947
2. The Role of Primary Care in Cancer Diagnosis......Page 949
2.1 The role of primary care during cancer treatment......Page 951
2.2 The role of primary care in cancer survivorship and support......Page 952
3. Conclusions......Page 955
References......Page 956
IIIa: Survivorship Issues......Page 10
Abstract......Page 960
1. Cancer is a Genetic Disease......Page 961
3. The Role of the Familial Cancer Service......Page 962
4. Genetic Testing for Cancer Susceptibility......Page 964
5. Conclusion......Page 966
References......Page 967
Abstract......Page 970
1. Who is at High Risk for Breast/Ovarian Cancer?......Page 971
3. Risk-Reducing Surgery......Page 973
3.1 Bilateral risk-reducing mastectomy......Page 975
3.2 Risk-reducing bilateral salpingo-oophorectomy......Page 976
4.1 Breast cancer chemoprevention......Page 977
4.2 Ovarian cancer chemoprevention......Page 978
5.1.1 Mammography......Page 979
5.1.3 Breast clinical and self-examination......Page 980
6.1 Parity......Page 981
6.3 Oral contraceptive use......Page 982
7. What about Risk Management in High-Risk Women with Cancer?......Page 983
8. Conclusion......Page 984
References......Page 985
Abstract......Page 998
1. Introduction......Page 999
2. Familial Adenomatous Polyposis (FAP)......Page 1000
3.1 Hereditary nonpolyposis colorectal cancer (HNPCC)/Lynch syndrome......Page 1001
5. Peutz–Jeghers Syndrome......Page 1005
6. Hyperplastic Polyposis......Page 1006
References......Page 1007
Abstract......Page 1010
1. Tumour Evolution as an Indicator of a Germline Cancer Susceptibility Mutation......Page 1011
2. Identification of Individuals with Germline Cancer Predisposition Mutations......Page 1013
3.1 MIN colorectal cancer high risk features......Page 1014
3.1.2 Somatic versus germline loss of mismatch repair gene expression......Page 1015
3.2 Novel cancer predisposition due to germline epimutations......Page 1016
3.3 Prognostic indicator......Page 1017
4.1 BRCA and high risk breast cancer features......Page 1018
4.1.1 Triple negative breast tumours......Page 1019
4.2 BRCA and high risk ovarian cancer features......Page 1020
4.4 Treatment response and tailored therapy for BRCA-related breast and ovarian cancer......Page 1021
5. PTEN Associated Hamartomatous Syndromes and the PI3K/Akt/mTor Pathway......Page 1022
5.1 Akt/PI3K/mTOR inhibitors......Page 1023
6. VHL and VEGF Targeted Therapy......Page 1024
References......Page 1025
Abstract......Page 1034
2. The Process of Adjustment......Page 1035
2.3 Residual symptoms and disability......Page 1036
3.2 Common concerns......Page 1037
3.3.1 Exploration of psychosocial issues......Page 1039
3.3.3 Fear of recurrence......Page 1040
3.3.5 Assessment of distress......Page 1041
4. Promoting Adjustment......Page 1042
4.3 Lifestyle changes......Page 1043
4.4 Psychosocial interventions......Page 1044
5. Rehabilitation......Page 1045
6. Identification and Treatment of Psychiatric Disorder......Page 1046
References......Page 1047
Abstract......Page 1052
2.1 Healthy but not quite healthy?......Page 1053
2.2 Capturing the identity of survivors......Page 1054
2.3 How survivors see themselves over time......Page 1057
2.4 How survivors work on their identity......Page 1060
3. Cancer Survivors and Intimate Relationships......Page 1061
3.1 The roles of the sexual partner and care-giver......Page 1063
3.2 Studies of survivors and their partners......Page 1064
3.3 Predictors of outcomes in sexual relations......Page 1067
4. Practice Implications......Page 1068
References......Page 1071
1. Introduction......Page 1076
2.2 Second malignant neoplasms......Page 1079
2.3.1 Congestive heart failure......Page 1083
2.4 Thyroid......Page 1084
2.5.2 Radiotherapy......Page 1085
2.6 Growth and body composition......Page 1086
2.7 Bone health......Page 1087
2.8 Neurocognitive and psychosocial late effects......Page 1088
3. Challenges for Future Research and Care......Page 1089
References......Page 1090
Abstract......Page 1106
1. Background......Page 1107
2. Lifestyle Habits of Cancer Survivors......Page 1108
3. Body Weight Issues and Outcomes in Cancer Survivors......Page 1109
4.1 Effect of physical activity on psychosocial outcomes and cardiovascular fitness......Page 1110
4.2 Effect of physical activity on cancer specific survival and overall survival......Page 1111
5. Dietary Factors......Page 1113
5.1 Role of dietary supplements......Page 1114
5.3 Advice for cancer survivors......Page 1116
5.4 Soy and phytoestrogens......Page 1119
5.4.2 Recommendations......Page 1120
6. Recommendations......Page 1121
References......Page 1122
IIIb: Cancer, Palliative Care and End of Life Issues......Page 11
Abstract......Page 1128
1. Introduction......Page 1129
1.1 Goals of care......Page 1131
1.2 What are the demonstrated benefits of appropriate involvement of specialist palliative care?......Page 1132
1.3 Who gets care for what and where?......Page 1134
1.4 Access to services......Page 1136
2. Developing a Competent Workforce: Training for Palliative Care Service Delivery......Page 1138
3. Populations that Illustrate Specific Issues in Supportive and Palliative Care......Page 1140
4. The Elderly in Nursing Homes — Terminal Care, Rather than Palliative Care......Page 1141
6. How are Supportive and Palliative Care Services Actually Delivered in Australia?......Page 1142
References......Page 1143
Abstract......Page 1150
1. Palliative Care as a Paradigm of Excellence for the Generalist......Page 1151
1.1 Best practice care......Page 1152
1.2 Teamwork......Page 1153
2.1 Maturity and suffering......Page 1155
2.3 Time management......Page 1156
2.4 Self-awareness......Page 1157
3. Palliative Care and the Challenge of Self-Care......Page 1158
3.1 What do we know about self-care in the palliative context?......Page 1159
3.2 The experience of dying......Page 1160
3.3 The aftermath of death......Page 1161
References......Page 1162
Abstract......Page 1168
1. Introduction......Page 1169
2. Existential, Spiritual, Religious......Page 1170
3. Evidence for Spiritual Need and the Effects of Spiritual Care......Page 1173
3.1 Evidence for spiritual need......Page 1174
3.2 Religion, spirituality and pain......Page 1175
3.3 Religion, spirituality and decision-making......Page 1176
3.5 Religion, spirituality and the clinical relationship......Page 1178
4. Key Issues in Providing Spiritual Care......Page 1179
4.1.1 Assessment......Page 1180
4.2 Strategies for spiritual care......Page 1181
5. Conclusion......Page 1183
References......Page 1184
Index......Page 1190