Category Archives: Medical oncology

Palliative medicine and symptom control

Palliative medicine may be defined as the active, total care of patients whose disease is no longer responsive to curative treatment. The goal of this care is to achieve the best quality of life for patients and their families by controlling physical symptoms and psychological, social and spiritual problems. Many symptoms suffered by such patients have a complex aetiology in which the physical component may b

Solid tumours

The treatment of solid tumours involves the combined use of surgery, radiotherapy and chemotherapy. In the earlier stages surgery alone may be curative in many solid tumours, but may fail because of inadequate local excision with residual microscopic disease or because of disseminated micro metastases present at the time of diagnosis. Radiotherapy, similarly, is a local treatment which can often be used afte

Waldenstrom’s macroglobulinaemia

An illness most often seen in elderly men, the clinical features may be more like those oflymphoma, i.e. peripherallymph node enlargement and symptoms due to bone marrow infiltration, or symptoms of hyperviscosity may predominate. CLINICAL FEATURES • General malaise and weight loss • Lymph node enlargement • Symptoms of hyperviscosity (headaches, visual disturbance) • Symptoms of anaemia • A bleeding

The paraproteinaemias

Multiple myeloma Myeloma is part of a spectrum of diseases characterized by the presence of a paraprotein in the serum that can be demonstrated as a monoclonal, dark-staining band on protein electrophoresis. The paraprotein is produced by abnormal, proliferating plasma cells that produce, most often, IgG or IgA and rarely IgD. The paraproteinaemia may be associated with excretion of light chains in the urine

Myeloablative therapy with bone marrow transplantation

High doses of chemotherapy, such as cyclophosphamide, and radiation both kill cells indiscriminately; myelosuppression is therefore the main dose-limiting toxicity. Thus, without a ‘transplant’ the person would die of bone marrow failure. The indications for this type of treatment are shown A child with Burkitt, lymphoma Allogeneic BMT The donor is usually an HLA-identical brother or sister. The p

Non-Hodgkin’s lymphoma (NHL)

The term non-Hodgkin’s lymphoma encompasses many different histological subtypes. The basic subdivision into high and low grade (Kiel classification) reflects the rate at which the cells are dividing. Ironically, high-grade lymphomas (those in which the cells are dividing quickly) are potentially curable, whereas low-grade lymphomas are generally considered to be incurable with conventional therapy, al

The lymphomas

Lymphomas represent abnormal proliferations of different parts of the lymphoid system and are currently classified  on the basis of histological appearance into: • Hodgkin’s disease • Various subtypes of non-Hodgkin’s lymphoma Hodgkin’s disease (HD) With modern treatment (radiotherapy, chemotherapy or BOth), HD is now a potentially curable illness. The choice of treatment is determined la

TREATMENT AT RECURRENCE

Recurrence of ALL occurs most frequently in the bone marrow and is associated with a worse prognosis if it occurs during maintenance therapy. CNS recurrence, detected by the presence of leukaemic blast cells in the cerebrospinal fluid, is now less frequent since the regular use of CNS prophylaxis. Treatment comprises intrathecal drugs plus radiotherapy to the meninges surrounding the brain and spinal cord, f

TREATMENT AT RECURRENCE

Second remissions are more difficult to achieve and are virtually never durable. The decision to treat a person at the time of recurrence will therefore (even more than at presentation) depend on the patient’s overall situation and his/her wishes. In younger patients, provided a second remission can be achieved, cure is still a possibility for a proportion, with the use of myeloablative therapy with al

Haematological malignancy

Introduction Leukaemia, lymphoma and myeloma constitute only a small proportion of all malignant diseases. They share common origins in the myeloproliferative and lymphoproliferative systems but are a heterogeneous group, with a natural history resulting in survival ranging from a few months to several years. Their importance lies in their responsiveness to both chemotherapy and radiotherapy, so that many pa