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- CANCER TREATMENT: INTRODUCTION -
It is important for people to realize that cancer is often cured. Between one third and one half of all cancer patients have successful treatments and subsequently live almost entirely normal lives. Some common cancers, such as those arising in the large bowel (colon and rectum), some breast cancers, kidney cancers and bladder cancers, are, when diagnosed early, localized to their primary site. Such cancers can be removed by an operation and these operations are curative. Thousands of people with these cancers are cured every year. Surgery has not produced a much greater proportion of cures In the last few years but surgeons are becoming more skilful at minimizing the damaging effects of their operations. This means that it is often possible to remove a cancer without leaving large scars or without removing a whole organ. Perhaps the greatest benefits have come from conservative breast cancer surgery, leaving the breast intact after surgery and perhaps following up with additional treatment like radiotherapy or chemotherapy to try to ensure cure. Surgery is a successful treatment for many people. Radiotherapy is capable of curing some localized cancers - notably those arising in the head and neck and some gynaecological cancers. Although less successful than surgery, it is still a very useful treatment for many people. Treatments with drugs - chemotherapy and biological therapy - are newer and, so tar, less consistently successful. Nevertheless, they have brought about real improvements. Admittedly, these are found mostly in the treatment of relatively uncommon cancers, but the individuals who are treated successfully for these cancers can then return to normal life. Chemotherapy is notably effective in treating cancers arising from lymph glands - Hodgkin's disease and non-Hodgkin lymphomas - leukaemias, many childhood cancers and cancers arising in the testes in men. Many of these are routinely and regularly cured by drug treatment. In other situations, drug treatment can increase the cure rate, although not by as much as we would like. The best example is that of breast cancer, where careful use of drug treatment can increase the cure rate significantly above that which can be obtained by surgery alone. The amount of the increase varies but is about 10 per cent. Although this is a very valuable effect, there is still room for great improvement.
Probably the best examples of progress by drug treatment are in the treatment of testicular cancers in young men and the treatment of cancer in children.
Cancer in the testis is not common, but it is the commonest form of cancer in men aged between twenty and thirty-four in the United Kingdom and there are about one thousand new cases every year. A man has only a I in 480 chance of developing a testicular cancer at some time in his life so the odds in his favour are pretty high.
Once testicular cancer has spread to the rest of the body (secondary spread or metastasis) it can only be treated effectively with drugs. Before 1970 there was no successful drug treatment and everybody who developed secondary spread from a testicular cancer died of the disease. In the early 19700, some drugs were used successfully for the first time and between 10 and 20 per cent of patients were cured. There were dramatic improvements in drug treatment during the 1970s
with the introduction, in particular, of a new group of drugs based on the metal platinum. The platinum drugs were so successful that, by the end of the 1970s, 80 per cent of young men with widespread testicular cancer were cured. Now the results have improved even further and over 90 per cent of patients are cured. This is a major advance.
Cancers in children are very rare but until effective drug treatments were introduced they were often fatal because the diseases tend to be widespread. However, many (sadly, not all) children's cancers have now yielded to effective drug treatment and over half are cured. This has transformed the outlook for children with cancer and in many cases the emphasis can now be 00 ensuring the best quality of life for the survivors as they grow up.