
Contents
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2.1 Cancer prevention 2.1 Cancer prevention
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Introduction Introduction
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Risk and protective factors of cancer Risk and protective factors of cancer
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Smoking and cancer Smoking and cancer
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Infectious diseases Infectious diseases
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Radiation exposure Radiation exposure
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Environmental hazards Environmental hazards
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Immunosuppression Immunosuppression
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Obesity, diet, and alcohol Obesity, diet, and alcohol
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Physical activity Physical activity
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Diabetes Diabetes
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Hormone replacement therapy (HRT) Hormone replacement therapy (HRT)
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Cellular phone Cellular phone
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Prevention of cancer Prevention of cancer
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Chemoprevention Chemoprevention
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Chemoprevention in breast cancer Chemoprevention in breast cancer
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Chemoprevention in colorectal cancer Chemoprevention in colorectal cancer
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Chemoprevention in prostate cancer Chemoprevention in prostate cancer
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Vaccination Vaccination
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Vitamins and dietary supplements Vitamins and dietary supplements
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Surgical prevention Surgical prevention
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Internet resources Internet resources
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2.2 Cancer screening 2.2 Cancer screening
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Introduction Introduction
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Cervical cancer screening Cervical cancer screening
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Breast cancer screening Breast cancer screening
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Bowel cancer screening Bowel cancer screening
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Prostate cancer screening Prostate cancer screening
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Lung cancer screening Lung cancer screening
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Ovarian cancer screening Ovarian cancer screening
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Screening women at higher risk Screening women at higher risk
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Internet resources Internet resources
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2.3 Cancer genetics 2.3 Cancer genetics
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Introduction Introduction
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Mechanisms of inherited cancer Mechanisms of inherited cancer
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Diagnosis Diagnosis
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Inherited breast cancer Inherited breast cancer
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Hereditary breast/ovarian cancer syndromes (HBOS) Hereditary breast/ovarian cancer syndromes (HBOS)
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Clinical features Clinical features
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Incidence Incidence
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Inheritance pattern Inheritance pattern
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Genetics and pathology Genetics and pathology
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Diagnosis Diagnosis
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Clinical management Clinical management
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Primary prevention Primary prevention
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Secondary prevention Secondary prevention
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Treatment of BRCA-associated breast cancer Treatment of BRCA-associated breast cancer
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Hereditary colorectal cancer Hereditary colorectal cancer
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Lynch syndrome Lynch syndrome
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Clinical features Clinical features
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Incidence Incidence
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Genetics and pathology Genetics and pathology
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Diagnosis Diagnosis
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Primary prevention Primary prevention
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Secondary prevention Secondary prevention
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Management of colonic carcinoma Management of colonic carcinoma
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Familial adenomatous polyposis Familial adenomatous polyposis
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Clinical features Clinical features
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Incidence Incidence
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Genetics and pathology Genetics and pathology
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Diagnosis Diagnosis
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Primary prevention Primary prevention
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Secondary prevention Secondary prevention
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Management of colonic carcinoma Management of colonic carcinoma
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Li–Fraumeni syndrome (LFS) Li–Fraumeni syndrome (LFS)
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Clinical features Clinical features
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Inheritance pattern Inheritance pattern
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Genetics and pathology Genetics and pathology
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Incidence Incidence
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Diagnosis Diagnosis
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Clinical management Clinical management
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Von Hippel–Lindau (VHL) syndrome Von Hippel–Lindau (VHL) syndrome
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Clinical features Clinical features
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Inheritance pattern Inheritance pattern
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Genetics and pathology Genetics and pathology
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Incidence Incidence
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Clinical management Clinical management
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Multiple neuroendocrine neoplasia (MEN) syndromes Multiple neuroendocrine neoplasia (MEN) syndromes
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MEN1 MEN1
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Clinical features Clinical features
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Inheritance Inheritance
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Genetics and pathology Genetics and pathology
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Incidence Incidence
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Diagnosis Diagnosis
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Clinical management Clinical management
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MEN2 MEN2
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Clinical features Clinical features
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Familial medullary thyroid cancer (FMTC) Familial medullary thyroid cancer (FMTC)
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Inheritance Inheritance
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Genetics and pathology Genetics and pathology
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Incidence Incidence
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Diagnosis Diagnosis
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Clinical management Clinical management
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Further reading Further reading
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Internet resources Internet resources
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2.4 Genetic counselling 2.4 Genetic counselling
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Introduction Introduction
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Who should be referred for genetic counselling? Who should be referred for genetic counselling?
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The genetic counselling process The genetic counselling process
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Taking a family history: key points Taking a family history: key points
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Oncogenetic model and treatment-focused genetic testing Oncogenetic model and treatment-focused genetic testing
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Pattern of inheritance Pattern of inheritance
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Autosomal dominant Autosomal dominant
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Penetrance Penetrance
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Autosomal recessive Autosomal recessive
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New mutation New mutation
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Type of malignancies Type of malignancies
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Risk assessment models Risk assessment models
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Who should be tested? Who should be tested?
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Genetic testing Genetic testing
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Full mutation screen Full mutation screen
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Predictive testing Predictive testing
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Explaining genetic test results Explaining genetic test results
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Mutation screening Mutation screening
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Advantages and disadvantages of mutation screening Advantages and disadvantages of mutation screening
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Predictive testing Predictive testing
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Advantages and disadvantages of predictive testing Advantages and disadvantages of predictive testing
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Advantages Advantages
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Disadvantages Disadvantages
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Confidentiality Confidentiality
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Further reading Further reading
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Internet resources Internet resources
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2.5 Principles of cancer diagnosis and management 2.5 Principles of cancer diagnosis and management
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Introduction Introduction
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Investigations for a suspected cancer Investigations for a suspected cancer
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Diagnostic and staging investigations Diagnostic and staging investigations
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Blood tests Blood tests
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Serum tumour markers Serum tumour markers
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Imaging Imaging
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Endoscopy Endoscopy
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Histology Histology
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Pretreatment assessment Pretreatment assessment
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Staging Staging
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Prognostic factors Prognostic factors
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Multidisciplinary management Multidisciplinary management
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Initial consultation and breaking the news Initial consultation and breaking the news
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Decision about the most appropriate treatment Decision about the most appropriate treatment
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Intent of treatment Intent of treatment
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Palliation Palliation
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Internet and information overload Internet and information overload
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Implementing planned treatment Implementing planned treatment
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Follow-up during treatment Follow-up during treatment
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Second opinions Second opinions
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Support during treatment Support during treatment
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Follow-up after treatment and management of recurrence Follow-up after treatment and management of recurrence
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Beyond cure and survivorship Beyond cure and survivorship
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Internet resources Internet resources
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2.6 Principles of surgical oncology 2.6 Principles of surgical oncology
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Introduction Introduction
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Role of surgery in diagnosis and staging Role of surgery in diagnosis and staging
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Role of surgery in treatment Role of surgery in treatment
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Curative surgery Curative surgery
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Surgery of the primary tumour Surgery of the primary tumour
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Surgery of regional lymph nodes Surgery of regional lymph nodes
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Metastatectomy Metastatectomy
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Debulking surgery Debulking surgery
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Salvage surgery Salvage surgery
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Palliative and emergency surgery Palliative and emergency surgery
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Reconstructive (oncoplastic) surgery Reconstructive (oncoplastic) surgery
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Risk reduction surgery Risk reduction surgery
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Minimal access and robotic surgery Minimal access and robotic surgery
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Image-guided surgery Image-guided surgery
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Further reading Further reading
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2.7 Radiotherapy 2.7 Radiotherapy
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Role in the treatment of cancer Role in the treatment of cancer
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Mode of action Mode of action
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Types of radiotherapy treatment Types of radiotherapy treatment
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Superficial X-rays (orthovoltage) Superficial X-rays (orthovoltage)
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Brachytherapy Brachytherapy
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Radio isotopes Radio isotopes
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Megavoltage radiotherapy Megavoltage radiotherapy
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Particle beam therapy Particle beam therapy
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Radiotherapy techniques Radiotherapy techniques
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Stereotactic radiotherapy Stereotactic radiotherapy
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The radiotherapy process The radiotherapy process
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Collection of relevant data Collection of relevant data
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Devising an optimal treatment plan/calculation of dose distributions Devising an optimal treatment plan/calculation of dose distributions
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Delivery of treatment and verification of accuracy Delivery of treatment and verification of accuracy
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Monitoring treatment effects Monitoring treatment effects
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Further reading Further reading
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2.8 Systemic therapy 2.8 Systemic therapy
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Introduction Introduction
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Aims of systemic treatment Aims of systemic treatment
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Chemotherapy Chemotherapy
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Cellular kinetics Cellular kinetics
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Tumour kinetics Tumour kinetics
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Alkylating agents Alkylating agents
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Heavy metals Heavy metals
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Antimetabolites Antimetabolites
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Natural products Natural products
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Antitumour antibiotics Antitumour antibiotics
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Mitotic inhibitors Mitotic inhibitors
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Topoisomerase inhibitors Topoisomerase inhibitors
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Enzyme Enzyme
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Adverse effects of chemotherapy Adverse effects of chemotherapy
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Overcoming chemotherapy resistance Overcoming chemotherapy resistance
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Novel formulations of chemotherapy Novel formulations of chemotherapy
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Prescribing chemotherapy Prescribing chemotherapy
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Hormone therapy Hormone therapy
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Molecularly targeted therapy Molecularly targeted therapy
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Categories of targeted anticancer therapies Categories of targeted anticancer therapies
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Small molecule inhibitors Small molecule inhibitors
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Monoclonal antibodies Monoclonal antibodies
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Adverse effects of molecularly targeted agents Adverse effects of molecularly targeted agents
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The future of molecularly targeted agents The future of molecularly targeted agents
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Immunotherapy Immunotherapy
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Principles of immunotherapy Principles of immunotherapy
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Immune checkpoint inhibitors Immune checkpoint inhibitors
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Cancer vaccines Cancer vaccines
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Adoptive T cell therapy Adoptive T cell therapy
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Cytokines Cytokines
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Toxicity of immunotherapy Toxicity of immunotherapy
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Combining immunotherapy with conventional cancer treatments Combining immunotherapy with conventional cancer treatments
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2.9 Clinical trials 2.9 Clinical trials
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Introduction Introduction
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Phase 1 trials Phase 1 trials
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Phase 2 trials Phase 2 trials
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Phase 3 trials Phase 3 trials
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Phase 4 trials Phase 4 trials
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Novel concepts in trial design Novel concepts in trial design
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Trial endpoints Trial endpoints
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Further reading Further reading
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Internet resources Internet resources
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Cite
Abstract
Carcinogenesis is a multistep process consisting of progressive molecular and cellular changes leading to early invasive cancer and finally to distant metastasis and death. The initiation and progression of cancer usually takes years. Attempts are being made to reverse the molecular and cellular changes at an early stage of cancer initiation or progression. The World Health Organization (WHO) estimates that at least one-third of all cancers are preventable. This chapter outlines the biological and environmental risk factors associated with cancer, and preventative measures including cancer screening and genetic counselling. It also covers the principles of cancer diagnosis and management, principles of surgical oncology, radiotherapy, systemic therapy, and clinical trials.
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