
Contents
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Introduction Introduction
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Organization of cancer care Organization of cancer care
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The disease journey The disease journey
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At the time of original diagnosis At the time of original diagnosis
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Through the period of staging and/or surgery Through the period of staging and/or surgery
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Through the period of treatment Through the period of treatment
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The goals of oncology treatment The goals of oncology treatment
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Radical oncological treatment Radical oncological treatment
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Adjuvant oncological treatment Adjuvant oncological treatment
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Palliative oncological treatment Palliative oncological treatment
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Managing patients receiving oncology treatments Managing patients receiving oncology treatments
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Treatment planning Treatment planning
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Clinical trials Clinical trials
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Phase I Phase I
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Aims Aims
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Eligible patients Eligible patients
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Phase II Phase II
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Aim Aim
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Eligible patients Eligible patients
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Phase III Phase III
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Aim Aim
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Eligible patients Eligible patients
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Aims of clinical trials Aims of clinical trials
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Survivorship Survivorship
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Further reading Further reading
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Further reading Further reading
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Oncological surgery Oncological surgery
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Diagnosis and staging Diagnosis and staging
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Curative surgery Curative surgery
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Localized disease Localized disease
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Metastatic disease Metastatic disease
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Palliative surgery Palliative surgery
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Bowel obstruction Bowel obstruction
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Fistulae Fistulae
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Jaundice Jaundice
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Pain Pain
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Gastrointestinal bleeding Gastrointestinal bleeding
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Bone metastases Bone metastases
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Further reading Further reading
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Further reading Further reading
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Chemotherapy Chemotherapy
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Identification of agents Identification of agents
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Mechanism of action Mechanism of action
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Adverse effects of chemotherapy Adverse effects of chemotherapy
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Chemotherapy regimens Chemotherapy regimens
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Curative Curative
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Adjuvant Adjuvant
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Neoadjuvant Neoadjuvant
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Palliative Palliative
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Indications for palliative chemotherapy Indications for palliative chemotherapy
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When is chemotherapy offered in the palliative care setting? When is chemotherapy offered in the palliative care setting?
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How will chemotherapy affect the patient and family? How will chemotherapy affect the patient and family?
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Anticancer agents Anticancer agents
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Hormone therapy Hormone therapy
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Immunotherapy Immunotherapy
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Monoclonal antibodies Monoclonal antibodies
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Small-molecule inhibitors of tyrosine kinases Small-molecule inhibitors of tyrosine kinases
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Further reading Further reading
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Further reading Further reading
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Radiotherapy Radiotherapy
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Mechanism of action Mechanism of action
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Response of normal tissues to radiation Response of normal tissues to radiation
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Acute effects of radiation Acute effects of radiation
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Late effects of radiation Late effects of radiation
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Normal tissue tolerance Normal tissue tolerance
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Tolerance doses for specific tissues Tolerance doses for specific tissues
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Re-treatment Re-treatment
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Types of radiation therapy Types of radiation therapy
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External beam radiotherapy External beam radiotherapy
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Superficial X-rays Superficial X-rays
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Orthovoltage energy X-rays Orthovoltage energy X-rays
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Megavoltage X-ray Megavoltage X-ray
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Electron therapy Electron therapy
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Particle beam therapy and protons Particle beam therapy and protons
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Treatment planning for external beam radiation Treatment planning for external beam radiation
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Radiotherapy dose prescription Radiotherapy dose prescription
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Total dose/number of fractions Total dose/number of fractions
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Overall treatment time Overall treatment time
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Brachytherapy—sealed and unsealed source therapy Brachytherapy—sealed and unsealed source therapy
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Radiation therapy Radiation therapy
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Radical radiotherapy Radical radiotherapy
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Adjuvant radiotherapy Adjuvant radiotherapy
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Palliative radiotherapy Palliative radiotherapy
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Pain Pain
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Haemorrhage Haemorrhage
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Obstruction Obstruction
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Neurological symptoms Neurological symptoms
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Fungating tumours Fungating tumours
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Managing the side effects of radiotherapy Managing the side effects of radiotherapy
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Skin Skin
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General advice General advice
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Mild reactions Mild reactions
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Moderate reactions Moderate reactions
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Severe reactions Severe reactions
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Mouth and throat care Mouth and throat care
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General advice General advice
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Treatment of mucositis Treatment of mucositis
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Dysphagia Dysphagia
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Nausea and vomiting Nausea and vomiting
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Diarrhoea Diarrhoea
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Pneumonitis Pneumonitis
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Cerebral oedema Cerebral oedema
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Somnolence syndrome Somnolence syndrome
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Further reading Further reading
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Further reading Further reading
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New developments New developments
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Defining tumour volume Defining tumour volume
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Imaging Imaging
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Conformal therapy Conformal therapy
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Fractionation/combined modality treatment Fractionation/combined modality treatment
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Individualization of therapy Individualization of therapy
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Government funded screening (UK) Government funded screening (UK)
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Further reading Further reading
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Further reading Further reading
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Common cancers Common cancers
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Incidence Incidence
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Patients with lung cancer Patients with lung cancer
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Background Background
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Symptoms at presentation Symptoms at presentation
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Diagnosis and staging Diagnosis and staging
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Small-cell lung carcinoma Small-cell lung carcinoma
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Staging Staging
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Management Management
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Prognosis Prognosis
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Non-small-cell lung carcinoma Non-small-cell lung carcinoma
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Management Management
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Surgery Surgery
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NSCLC radiation therapyRadical radiotherapy NSCLC radiation therapyRadical radiotherapy
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Palliative radiotherapy Palliative radiotherapy
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NSCLC-targeted treatments NSCLC-targeted treatments
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NSCLC chemotherapy NSCLC chemotherapy
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NSCLC immunotherapy NSCLC immunotherapy
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General issues General issues
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Specific pain issues Specific pain issues
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Other complications Other complications
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Mesothelioma Mesothelioma
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General comments General comments
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Diagnosis Diagnosis
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Treatment Treatment
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Surgery Surgery
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Radiotherapy Radiotherapy
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Chemotherapy Chemotherapy
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Specific problems in the management of mesothelioma Specific problems in the management of mesothelioma
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Specific pain complexes Specific pain complexes
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Further reading Further reading
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Further reading Further reading
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Colorectal cancer Colorectal cancer
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Background Background
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Common presentations Common presentations
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Staging and diagnosis Staging and diagnosis
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Management Management
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Surgery for primary disease Surgery for primary disease
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Surgery for hepatic metastases Surgery for hepatic metastases
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Chemotherapy Chemotherapy
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Adjuvant chemotherapy of colorectal cancer Adjuvant chemotherapy of colorectal cancer
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Chemotherapy for advanced colorectal cancer Chemotherapy for advanced colorectal cancer
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Biological therapy Biological therapy
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Immunotherapy Immunotherapy
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General comments General comments
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Breast cancer Breast cancer
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Background Background
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Genetics of breast cancer Genetics of breast cancer
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Presentation Presentation
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Pathology Pathology
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Diagnosis and staging Diagnosis and staging
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Prognostic factors Prognostic factors
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Common problems Common problems
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Management Management
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Further reading Further reading
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Further reading Further reading
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Prostate cancer Prostate cancer
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Background Background
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Presentation Presentation
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Diagnosis and staging Diagnosis and staging
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Management Management
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Cancer confined to prostate gland Cancer confined to prostate gland
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If aged <70 and fit, consider radical localized therapy: If aged <70 and fit, consider radical localized therapy:
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Complications Complications
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If aged >70 years If aged >70 years
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Locally extensive disease (T3/T4) or Node N1 disease Locally extensive disease (T3/T4) or Node N1 disease
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Metastatic disease Metastatic disease
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Hormone refractory prostate cancer Hormone refractory prostate cancer
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Common palliation issues Common palliation issues
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Further reading Further reading
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Further reading Further reading
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Gynaecological cancer Gynaecological cancer
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Ovarian carcinoma Ovarian carcinoma
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Background Background
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Presentation Presentation
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Diagnosis and staging Diagnosis and staging
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Management Management
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First-line chemotherapy First-line chemotherapy
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Treatment at relapse Treatment at relapse
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Carcinoma of the cervix Carcinoma of the cervix
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Background Background
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Presentation Presentation
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Staging Staging
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Management Management
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Palliative issues in gynaecological cancers Palliative issues in gynaecological cancers
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Upper gastrointestinal tract cancer Upper gastrointestinal tract cancer
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Stomach cancer Stomach cancer
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Background Background
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Presentation Presentation
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Diagnosis and staging Diagnosis and staging
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Treatment Treatment
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Resectable disease Resectable disease
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Locally advanced/metastatic disease Locally advanced/metastatic disease
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Oesophageal carcinoma Oesophageal carcinoma
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Background Background
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Symptoms Symptoms
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Diagnosis and staging Diagnosis and staging
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Treatment Treatment
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Resectable disease Resectable disease
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Unresectable disease Unresectable disease
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Pancreatic carcinoma Pancreatic carcinoma
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Background Background
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Presentation Presentation
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Investigations Investigations
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Management Management
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Palliative issues for patients with upper gastrointestinal tract cancer Palliative issues for patients with upper gastrointestinal tract cancer
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Further reading Further reading
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Further reading Further reading
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Cancer of the bladder and ureter Cancer of the bladder and ureter
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Background Background
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Presentation Presentation
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Diagnosis and staging Diagnosis and staging
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Treatment Treatment
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‘Superficial’ tumours ‘Superficial’ tumours
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‘Invasive’ tumours ‘Invasive’ tumours
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Common problems Common problems
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Tumours of the central nervous system Tumours of the central nervous system
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Background Background
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Primary brain tumours include Primary brain tumours include
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Symptoms Symptoms
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Investigations Investigations
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Primary brain tumours Primary brain tumours
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Surgery Surgery
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Radiotherapy Radiotherapy
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Chemotherapy Chemotherapy
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Prognosis Prognosis
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Secondary brain tumours Secondary brain tumours
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Brain metastases Brain metastases
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Assessment—clinical history Assessment—clinical history
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Clinical features Clinical features
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Investigations Investigations
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Management Management
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Anti-epileptics Anti-epileptics
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Corticosteroids Corticosteroids
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Prognosis Prognosis
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Metastatic disease of the leptomeninges (meningeal carcinomatosis) Metastatic disease of the leptomeninges (meningeal carcinomatosis)
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Clinical features Clinical features
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Investigations Investigations
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Management Management
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Prognosis Prognosis
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Chronic leukaemia and myeloma Chronic leukaemia and myeloma
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Background Background
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General comments General comments
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Specific pain complexes Specific pain complexes
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Other complications Other complications
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Palliative care of patients with carcinomatosis of unknown primary Palliative care of patients with carcinomatosis of unknown primary
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Background Background
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Investigations Investigations
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Treatment Treatment
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Key points Key points
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Investigations Investigations
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Further reading Further reading
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Cite
Abstract
This chapter provides an overview of current oncology practice as it pertains to palliative care. It covers the care of patients undergoing oncological interventions including some of the newer biological treatments and includes the management of the common side effects associated with the management of solid tumours in adults. It includes a succinct summary of the current management of common cancers. Cancer is an important cause of morbidity and mortality, particularly in industrialized countries. Currently in the UK, one person in two will be diagnosed with some form of cancer during their lifetime and one in four will die of the disease. Cancer incidence increases exponentially with age; with increasing life expectancy, cancer will become an even more common problem in the future. Cancers may develop in all body tissues. The chapter reviews the various ways that the cells that form cancers can be differentiated from cells in normal tissues.
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