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The number of cancer cases continues to increase worldwide, but progress is being
made in reducing the incidence of specific types of cancer. As our understanding of
the pathological mechanisms involved in tumorigenesis has increased, so has the availability
of newer and more potent chemotherapeutic agents. New drugs such as the taxoids and
camptothecins, new uses for old drugs such as thalidomide and minocycline, and the
advent of biological response modifiers such as the interferons, interleukins and
tumour necrosis factor, have enabled researchers to develop more sophisticated, multistep
protocols for cancer management, particularly in cases where the results of standard
treatments have been disappointing. Research towards the development of vaccines against
some cancers, such as melanoma and cervical cancer, is underway. Investigation of
the feasibility of using gene therapy to influence or suppress the growth of neoplasms
is another area of research. Another approach to improving patient survival involves
assessing the treatment centre location and the personnel on the cancer management
team. A number of recent studies have demonstrated that diagnosis and care by specialists
in team-centred units results in significantly less morbidity and significantly greater
long-term survival in many types of cancer. Cancer management will soon benefit from
the many newly available screening techniques for predicting susceptibility to various
types of tumours, decreasing environmental exposure to known carcinogens (especially
tobacco products), and rapid diagnosis of cancer in the earliest stages. Once the
cancer has been diagnosed, precise staging of the tumour to maximise the efficacy
of multidrug and adjuvant treatment regimens will be necessary, along with improved
surgical techniques to increase the chances of curative resection and improved radiological
techniques to minimise exposure of normal tissue. Aggressive methods to locate and
destroy residual tumour and/or distant metastases will be routinely employed to optimise
further long-term survival. Rapid dissemination of information regarding new treatments
and rigorous adherence to quality control and to protocols that have demonstrated
their effectiveness should improve a patient's chances of surviving a cancer diagnosis
in the next century.
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© 1997 Published by Elsevier Inc.
