Showing papers in "CA: A Cancer Journal for Clinicians in 1986"

Cancer incidence and survival in patients 65 years of age and older

Abstract: The impact of cancer on persons 65 years of age and older has been assessed by examining incidence rates and survival rates. For all cancers combined, the incidence rate shown in Table 4 for males 65 and older (2,468.2 per 100,000) is four times the age-adjusted rate for males 45 to 64 years of age (586.7). For elderly females, the incidence rate is twice that for females aged 45 to 64 (1,401.1 versus 609.7). Ratios of incidence rates for older versus younger males are about four to five for cancers of the stomach, colon, rectum, pancreas, and urinary bladder, and for leukemia; about three for cancers of the lung and kidney, and for non-Hodgkin's lymphomas; and 10 for cancer of the prostate. For females, the corresponding ratios are similar to those for males, although a little lower for cancers of the colon, rectum, and urinary bladder, and for leukemia, and a little higher for cancers of the stomach and pancreas. The ratios for breast, uterine cervix, uterine corpus, ovary, and lung are less than two. The relative survival rates for patients 65 and older are for many cancer sites only a few percentage points lower than rates for those 45 to 64 years of age (Table 5), suggesting that patients in this age group fare only a little worse than younger patients in escaping the effects of cancer once it has been diagnosed. Exceptions are cancer of the urinary bladder and non-Hodgkin's lymphomas for both men and women and cancers of the uterine cervix, uterine corpus, ovary, and kidney for women. For these sites, the survival rates for older patients are considerably lower than for their younger counterparts. For female breast cancer patients, there was no difference in the five-year relative survival rate for those 65 and older compared with those 45 to 64.

The treatment of pain in the patient with cancer

Abstract: Pain is one of the most feared consequences of cancer. Control of pain from cancer should be possible with the approaches discussed above. Changing attitudes toward the effective use of narcotic analgesics, the development of novel routes and methods of administration, and a clinical approach based on scientific principles and humane care offer the promise of improved management of pain in patients with cancer.

Role of progesterone receptors in breast cancer.

Abstract: It has been demonstrated that progesterone receptors (PRs) are at least as valuable as estrogen receptors (ERs) for predicting outcome in breast cancer patients. Retrospective analysis indicates that the presence of PRs may be the second most critical factor, after the number of positive nodes, in predicting disease-free survival, with a correlation between length of survival and number of tumor PRs. The presence of PRs has been shown to be of value for predicting response in both early and advanced breast cancer patients. In studies of assay consistency, major discordance rates were minimal in simultaneous assays, but extremely high in sequential assays of tumors that were PR-positive in initial assay. The responsible factor was interim endocrine therapy, and it was subsequently determined that the prognosis was worse for those patients whose tumors lost PR between assays.

Dermatologic manifestations of internal cancer.

Abstract: The cutaneous manifestations of internal cancer can develop either before or after the presence of an underlying tumor has been established. These signs may result either from the physical presence of tumor cells in the skin or from presumed metabolic effects of tumor cells located at visceral sites. Occasionally, skin involvement in cancer patients is biologically unrelated to the tumor but is instead part of a well-defined inherited syndrome featuring an increased incidence of internal cancer. Whatever the association, inspection of the skin remains an essential part of the complete physical examination.

Prostate cancer: An update

Abstract: As noted at the beginning, a discussion of prostate cancer yields as many questions as answers. Yet, as this review has suggested, major advances in our understanding of the nature and treatment of prostate cancer have been made in recent years. As more unified and rational approaches to treatment emerge, some of the marked diversity in attitudes toward prostate cancer may lessen, and the controversies about management that characterize our present state of knowledge may abate. Carefully designed studies involving larger numbers of accurately staged and stratified patients are necessary to determine preferred treatment approaches for a disease that has such a tremendous impact on the health and well-being of so many.

How much should the cancer patient know and decide

Abstract: How much should the cancer patient know and decide? That question is a matter of great moral complexity, involving con flicts among moral principles and rules on two levels. First, there are substantive “? first level―problems, such as how much in formation professionals should disclose to patients. Second, there are procedural “? second-level― problems, such as who the primary decision-maker should be—pa tient, family, or professional. This paper will present a case that raises both types of problems and then sketch a moral framework for analyzing the prob lems. The guiding principle throughout this discussion is respect for persons, which means that competent patients have the right to know and to decide. This principle and the associated rights are subject to certain internal and external limits. We will argue, however, that family wishes, in general, do not set an acceptable external limit on what the competent patient may know and decide. We will use this framework to illustrate several problems related to disclosing diagnostic and prognostic

Referral of patients with cancer for participation in randomized clinical trials: ethical considerations.

Abstract: Physicians with patients with cancer may be faced with two conflicting ethical obligations One is to contribute to the advancement of scientific knowledge Among the ways available to respond to this duty is to refer patients for participation in RCTs The second obligation is to serve the health interests of the individual patient When these two duties conflict, the latter obligation to the individual takes priority In the words of the Declaration of Helsinki, "Concern for the interests of the subject (patient) must always prevail over the interests of science and society" Quite often there is no conflict The patient can pursue his or her health interests most effectively by enrollment in an RCT In such cases, the referring physician can contribute to the success of the patient's participation in the RCT by explaining what the patient can expect to experience as a patient-subject It is usually important to explain that referral does not necessarily entail severing the original doctor-patient relationship

Limited surgery and radiotherapy for early breast cancer

Abstract: Over the past five years, there has been increasing support for the use of conservative surgery combined with radiotherapy as primary treatment for women with early breast cancer. This support is based on published reports from both retrospective studies,1 2 3 4 5 which have demonstrated that this approach can provide high levels of local tumor control and good cosmetic results, and prospective randomized clinical trials,6 , 7 which have indicated that the outcome of this approach is comparable to that obtained with mastectomy. Although there is general agreement regarding the conceptual aspects of this approach, there has been little consensus regarding the technical details of . . .

The "atypical" Papanicolaou smear.

Abstract: Optimal management of the patient with the atypical smear requires a narrative description of the findings as well as frequent personal communication with the cytopathologist. When the cytologic abnormality suggests the possibility of an underlying early or poorly formed neoplastic lesion, colposcopy is recommended. A definitive histopathologic diagnosis can be obtained with a colposcopically directed biopsy, and any preinvasive lesions can usually be treated with excellent results on an outpatient basis with cryotherapy or laser therapy.

Choices of curative and palliative care for cancer patients

Abstract: Decision-making in cancer treatment is a complex art that requires specific attention by the physician who is principally responsible for the patient. Whenever possible, the aim should be to advance the patient's interests as the patient defines them. To achieve this, the patient must understand the situation and the likely outcomes of treatment options that might be of benefit, must be free of coercion and manipulation and capable of self-determination, and must be capable of reasoning. When a patient cannot collaborate in the decision-making, the physician needs to recognize this and a surrogate should be chosen to speak on the patient's behalf. The range of treatment options must not be unduly narrowed by lack of consideration, incorrect understanding of the governing moral and legal prohibitions, or unreflective use of imprecise categories.

Current concepts in the control of carcinoma of the endometrium.

Abstract: With respect to the most efficient approach to the diagnosis and treatment of carcinoma of the endometrium, the recognition of women at high risk can reduce this disease to a minimum and possibly eradicate much of the resulting mortality. Such an approach depends on the following factors: Recognition of the menopause as a time of life when high-risk patients may be identified. Recognition of adenomatous hyperplasia as a precursor of invasive endometrial cancer. Further research into the technology of obtaining suitable samples in menopausal women on an ambulatory basis without anesthesia is indicated as a search for efficient screening. Until such research yields new methods, however, recognition of the high-risk menopausal women through histologic sampling at menopause, with or without dysfunctional bleeding, can serve well. The modern FIGO staging formula shows the order of clinical virulence of any endometrial cancer and allows individualization of treatment in a manner that prevents overtreatment of those with less aggressive tumors and undertreatment of those with highly virulent tumors. Overtreatment causes an excess of complications, and undertreatment leads to a lower rate of cure than might be obtained by more radical treatment. Such individualization of treatment allows recognition of the appropriate place for surgical and/or radiotherapeutic treatment and the combinations that are most appropriate for the particular patient. Individualization also encourages the development of new chemotherapeutic agents and more efficient use of those now existing. Hormonal treatment is indicated for several categories of perimenopausal or postmenopausal patients.(ABSTRACT TRUNCATED AT 250 WORDS)