This second edition of Cancer Explained updates the original version written ten years ago. It explains the present understanding, features, investigations, treatments and likely outcomes in cancer treatment today and describes significant advances both in current practice and practices under study. For anything but the most simple and uncomplicated cancers, cancer doctors now need to work in multidisciplinary teams often specialising in only one or two tumour types. This allows them to develop and maintain the sophisticated skills needed for today’s therapies as well as future roles in cancer care.
The authors wish to acknowledge the inspiration given to them by the dedicated work of many colleagues and friends in the medical and nursing professions as well as the research, secretarial and administrative fields, both in Australia and overseas. Many of these people have been the unsung contributors to current success stories in the care of people with cancer. Such exciting advances include the change in outlook for patients with melanoma: in our student days it was a disease with about a 50% mortality rate. Now this is less than 10% in Australian clinics.
Similarly the outlooks for acute leukaemia in children, acute myeloid leukaemia in adults, advanced testicular cancer in young men, chorionic carcinoma in women of child-bearing age, Hodgkin (also known as Hodgkin’s) and other lymphomas in young adults have all changed. From being considered virtually incurable, these have become almost always curable cancers.
Most once-standard mutilating surgical procedures, such as amputation of a limb, total removal of a breast or radical surgery to the head and neck, can now be avoided by multi-modality management in combined specialist clinics, with at least equally satisfactory curative results. This reflects the integration of minimalist surgery with radiotherapy and chemotherapy.
Anti-smoking campaigns and other public-health measures have resulted in reduced numbers of people dying from smoking-and asbestos-related cancers.
Early detection measures have resulted in reduced numbers dying from advanced breast cancer, cervical cancer, bowel cancer, prostate cancer and stomach cancer.
Preventive measures are now well established for many cancers, and this information is readily available to individuals, families and their communities. Cancer of the cervix in women will shortly be a largely preventable disease, thanks to the work of 2005 Australian of the Year Professor Ian Frazer in developing preventive vaccines.
Integrated treatment centres, more effective anti-cancer drugs, targeted biologics, more effective radiotherapeutic procedures and remarkable improvements in plastic and reconstructive surgery have all improved the outlook for most individuals and the community at large.
Finally, for those not as yet able to be cured, improvements in palliative care are now more readily available to make their lives more worthwhile and more comfortable.