Showing papers in "CA: A Cancer Journal for Clinicians in 1988"

The role of interferon in cancer therapy: a current perspective.

Abstract: Recombinant interferon alpha has now been established as having a distinct if narrow role when used as a single agent in cancer therapy. The responses to single-agent therapy can be grouped as shown in Table 7. Interferon is likely to be the treatment of choice for hairy cell leukemia and possibly also for symptomatic nodular lymphoma. Interferon is very useful in treating papillomas and condylomas, and its role as a local agent will probably expand. The list of responding cancers for alpha interferon or other subtypes as a single agent is unlikely to expand greatly over the next few years. Nevertheless, in both melanoma and renal carcinoma, meaningful responses do occur. It is important to be aware of the possibility of both delayed and increasing extent of response with duration of treatment; adequate trials of interferon may therefore require longer periods of treatment than does conventional chemotherapy. Furthermore, because prior failure to respond to chemotherapy does not predict response to interferon, its use as a second-line agent should also be considered. The future of such biological agents, however, clearly lies in combination with other agents as the "fourth arm" of cancer therapy. The challenge is to define what the role of that fourth arm will be. There seems to be a clear choice with the interferons. They can be used at pharmacological doses, in which case their antiproliferative effect is likely to be due to induction of certain enzymes that result in a cytostatic effect in susceptible cancers, of which there are a limited but therapeutically important number. Alternatively, the interferons can be used at physiological doses, which are more likely to cause immunological and cell membrane effects such as NK-cell stimulation, as well as Fc-receptor and tumor-antigen expression. Thus, combination with cytotoxic agents may well require high doses, whereas combination with other biological agents, such as monoclonal antibodies or LAK cells, may be most effective at much lower doses. Over the next few years it will be important to establish the optimal biological doses of the interferons, so that we can maximize their usefulness in therapy and avoid the trap of thinking of them as purely cytotoxic agents.

Nicotine and smokeless tobacco

Abstract: The following may be concluded about nicotine and smokeless tobacco use: Systemic absorption and levels of nicotine are similar in users of smokeless tobacco and cigarette smokers. Data from the few studies performed to date suggest that smokeless tobacco users develop a dependency similar to that for cigarette smokers. Effective treatment strategies to help smokeless tobacco users quit need to be developed. Smokeless tobacco use in young people also poses a concern for later development of dependence on cigarettes. The health hazards known to be caused by cigarette smoking and suspected to be related to chronic nicotine exposure are expected to be a hazard of habitual use of smokeless tobacco. A major concern in young males is accelerated coronary artery disease. Information about the potential health hazards of nicotine, as well as oral pathology, may be incorporated into educational programs to help discourage the use of smokeless tobacco, with a resultant decrease in the associated cancer risk.

Tumor markers in cancer diagnosis and prognosis.

Abstract: A tumor marker is a biochemical indicator for the presence of a tumor. In clinical usage, the term usually refers to a molecule that can be detected in plasma or other body fluids. Table I summarizes the major concep tual developments in the history of tumor markers. Bence Jones proteins in urine and the serum levels of acid phosphatase have been employed for many years as indica tors for multiple myeloma and prostatic adenocarcinoma, respectively. Although efforts were made in the early decades of this century to identify tumor-specific anti gens, the number of markers in clinical use remained limited, and almost none were available for the more common cancers. The discovery of alpha-feto@@t@Th' (AFP) as a marker for hepatomas, and car cinoembryonic antigen2 (CEA) as a marker for colon carcinoma, provided a fresh im petus for the search for specific tumor

Practical aspects of pain control in the patient with cancer.

Abstract: Cancer-related pain can be well controlled in most patients. With prolonged survival and cure now possible with many tumors, pain management becomes a compelling issue for the quality of the patient's remaining life. In advanced stages of disease, analgesia is an imperative for both the patient and family; it provides the patient the opportunity for a dignified and comfortable death and lifts from the family the added burden of anger and despair that is so often associated with uncontrolled pain in a loved one. Astute assessment, a systematic approach to pharmacologic treatment, and ongoing monitoring of therapy are the fundamental elements of successful management of pain in most patients.

The sexual and intimate consequences of breast cancer treatment

Abstract: Confronting the loss of sexual desire, feelings of sexual attractiveness, range of sexual activities, and ability to reproduce is often a seriously neglected area in oncology and a great source of distress for the breast cancer patient. Addressing the problem early in the doctor-patient relationship and simply giving the woman permission to discuss these critical concerns with the person managing her care will do much to reduce some of the anguish that accompanies breast cancer and its treatments.

Smokeless tobacco and cancer: the epidemiologic evidence.

Abstract: In summary, evidence from human populations has shown that smokeless tobacco users have risks of cancer several times higher than that of nonsmokers. Smokeless tobacco is very strongly related to cancers of the cheek and gums, locations typically in direct contact with the tobacco. The association is evident in studies in the US and Scandinavia and also in Asia, where the chewing of quids containing tobacco and other ingredients is strongly related to the region's high rates of oral cancer. Reports on health effects date back to the 18th century and the evidence is consistent, with most investigators reporting positive findings. Dose-response relationships--increasing risk with increasing use--are also evident in several studies. Finally, preliminary work on cancers in other anatomic sites suggests that smokeless tobacco may also be related to other upper digestive tract cancers. With the exception of one group of medical scientists who described the relationship as only an "association," expert consensus conferences and committees in both the US and France have agreed that the evidence from clinical, epidemiologic, and carcinogenesis studies supports a causal relationship between the use of smokeless tobacco and oral cancer in humans. These expert groups include the International Agency for Research on Cancer (1984), the National Institutes of Health Consensus Conference on the Health Implications of Smokeless Tobacco Use (1986), and the Surgeon General's Advisory Committee on the Health Consequences of Using Smokeless Tobacco (1986).(ABSTRACT TRUNCATED AT 250 WORDS)

The role of self-help groups in helping patients and families cope with cancer.

Abstract: Self-help processes of change are different and distinct from those of professional service and evolve empirically out of the patients' own experience. There is increasing evidence that self-help groups are beneficial, and their use should be encouraged. It is not a question of which system of change-self help or professional-is better. Both methods appear to have a meaningful role in helping individuals with psychosocial problems, including patients with cancer.

Oral mucosal lesions in smokeless tobacco users.

Abstract: ticed throughout the world include tobacco chewing and snuff dipping. Tobacco chew ing is the practice of placing a portion of leaf, plug, cake, or thread twines of to bacco between the cheek and gingiva after it has been chewed. Snuff dipping involves placing a pinch of powdered or carefully cut tobacco between the cheek or lip and gingiva or beneath the tongue.' Both chew ing and dipping give rise to clinical changes of the oral mucosa; periodontal lesions have also been described. In Scandinavian countries, smokeless tobacco is enjoyed mostly in the form of snuff; the use of chewing tobacco is rare. Snuff-induced oral mucosal changes are characterized by a white, folded, wrin kled surface, often with a pattern of deli cate white striae. †? @ The lesions are some times slightly elevated and diffusely demarcated from the surrounding normal mucosa (Fig. I). They are usually whitish,

Update on pancreatic cancer.

Abstract: T he commonest form of pancreatic cancer is pancreatic ductal adenocarcinoma (PDAC). The latest f igures from the Cancer Research Campaign show that PDAC was responsible for 6770 new cases in 1996 and 6560 deaths in 1998 (Coleman et al, 1999). PDAC has a median survival of 3–6 months without treatment, which increases to around 20 months with resectional surgery and adjuvant treatment (Neoptolemos et al, 2001a,b). Unfortunately, the late presentation and aggressive tumour biology of this disease mean that only a minority of patients have local disease that can be treated with ‘potentially curative’ surgery.

The effects of irradiation on breast cancer and the breast.

Abstract: The pathologic changes in tissues from 100 women who had received radiation therapy for breast cancer were studied. It is concluded that carcinoma of the breast cannot be considered a radiosensitive tumor, that irradiation should not be considered conservative treatment, and that radiotherapy is not innocuous. More studies of post-irradiation breasts are needed, from biopsy, surgical, and autopsy specimens. These studies should evaluate the tissues for the presence or absence of tumor, for radiation changes in the breast and the tumor, for evidence of tumor regression, for multicentricity, and for histologic types and patterns. Until this is done, the final results of radiation therapy for carcinoma of the breast will remain unknown.

The "most-significant-other" in the care of the breast cancer patient.

Abstract: Most-significant-others can play a major role in helping breast cancer patients live stable, productive, and esteemed lives. Physicians are urged to respect and exercise their clinical judgment on the emotional makeup of the patient, the most-significant-other, and their relationship, and to instruct them according to their needs and capacities. Supportive roles include mobilizing social support; monitoring the patient's return to daily living; being with her during treatments, both physically and emotionally; and understanding her instinctive requests for assistance through double-bind and other difficult communication. Most-significant-others can be an extension of the physician's common sense and clinical care to the degree that they are able and willing to perform this important role.

Psychiatric treatment of the patient during cancer therapy

Abstract: In summary, the physician should view abnormal behavior in the cancer patient as an early and important diagnostic sign that an underlying medical problem (such as hypercalcemia) may be present. Depression and insomnia yield to intervention with antidepressants and hypnotics in cancer patients as readily as in noncancer patients. Finally, attentive listening is in and of itself anxiety-relieving and can go a long way toward reducing the emotional distress of people with cancer.

The use of neutron beam therapy in the management of locally advanced nonresectable radioresistant tumors

Abstract: Locally advanced nonresectable radioresistant tumors can often be ablated by external irradiation using high-energy fast neutrons. Long-term remission, with local control rates of 50 to 70 percent, have been reported in a number of very large osteogenic sarcomas, soft tissue sarcomas, melanomas, and adenocarcinomas of the alimentary tract. Malignant salivary gland tumors and prostate carcinomas respond well to neutron therapy, with high remission rates and significantly increased survival, even in locally advanced stages of the disease. Neutron beam therapy is a valuable adjunct in the management of nonresectable cancers that are resistant to conventional therapy.