Hochhauser Daniel - Cancer and its Management

This edition first published 2015 2015 by John Wiley & Sons, Ltd.

2005, 2003, 1998, 1995, 1987, 1986 by R. Souhami and J. Tobias,

2010 J. Tobias and D. Hochhauser

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Fluorescence microscopy of human endothelium highlighting cadherin (green) between cells. Image courtesy of Wikimedia Commons under the GNU Free Documentation License.

To Susan and Jo, with love and thanks

In the 4 years that have elapsed since the previous edition of this book was published, we have been astonished by the number of changes made necessary by the introduction of newer treatments for cancer. Once again we can say without fear of contradiction that both our understanding of the biology, causation and natural history of many malignant tumours has continued to move forward. Equally and perhaps even more important, the outlook at least for some types of cancer has improved, in a number of cases, quite dramatically. Patients now have access to a far more integrated and seamless service, with multidisciplinary teams meeting regularly to discuss all aspects of patient management, resulting in a more balanced and expert approach to decision-making. They are increasingly managed by well-informed specialists with particular experience and expertise in their field of practice, and communication between general practitioners, hospital specialist and community services have continued to improve. Palliative care teams, which only 10 years ago were unevenly distributed even in economically developed parts of the world, have now become more fully accepted and much more widely available.

New chemotherapeutic agents and targeted therapies have appeared at a remarkably rapid rate, and in many cases have become fully established as part of standard treatment regimens breast, lymphoma, colorectal cancer and melanoma are good examples. We noted this development in the Preface to this book when it last appeared in 2010, and these innovations have progressed still further since then. It seems hard to believe that targeted therapies, so widely used today, have been available for less than 20 years, the first of these, the monoclonal antibody rituximab, appearing and achieving licence for use as recently as 1997. As we have previously remarked, it remains an exciting time to be in cancer medicine, though it is profoundly important to remember that the human, pastoral and technical lessons of the past do not change. We have tried to stress this in the specific site-related chapters, particularly since increasing levels of specialization carry the real danger that tomorrow's specialists will so to speak know more and more about less and less. Broadly speaking, we accept as so many others do that the benefits of site specialization clearly outweigh the disadvantages, but nonetheless it is as well to remember that most patients look to their specialist oncologist for far more than simply his or her technical expertise.

As we pointed out in the Preface to previous editions, a textbook limited to this size and designed to be widely comprehensible demands that only essential information can be presented. We have had to synthesize and abbreviate a variety of expert opinions and summarize interesting or unresolved controversies, which, in a larger text, would have been the subject of more detailed discussion. Nonetheless, we hope the result is an accessible text that avoids being too didactic in tone or synoptic in style. The aim of the book has not altered: it is to provide an introductory text for medical staff, nurses and other allied professionals, students and scientists interested in and challenged by the problems of cancer care.

Initially, we wrote this book because we were aware that many busy physicians, surgeons and gynaecologists, who are not themselves cancer specialists, may find it difficult to keep abreast in areas that are nonetheless of crucial importance in their professional lives. General surgeons, for example, spend a substantial portion of their time dealing with gastrointestinal and abdominal tumours, yet have little working knowledge of the non-surgical treatment of these conditions. Similarly, gynaecological surgeons need to know in a fair degree of detail about what the radiotherapist and medical oncologist can offer.