Neoplastic disease In most cases, the cause of cancer is multifactorial. About 75% of cancers are due to environmental factors, some of which are within the control of the individual, . tobacco smoking, exposure to sunlight. Growing understanding of cancer genetics and inherited disease suggests that fewer than 10% of cancers are different systemic modalities used to treat cancer patients are discussed. Immunosuppressive drugs are described here as they share many characteristics with cytotoxics. . | SECTION 6 Neoplastic disease and immunosuppression SYNOPSIS Neoplastic disease In most cases the cause of cancer is multifactorial. About 75 of cancers are due to environmental factors some of which are within the control of the individual . tobacco smoking exposure to sunlight. Growing understanding of cancer genetics and inherited disease suggests that fewer than 10 of cancers are different systemic modalities used to treat cancer patients are discussed. Immunosuppressive drugs are described here as they share many characteristics with cytotoxics. Cancer treatments and outcomes Rationale for cytotoxic chemotherapy1 Classes of cytotoxic chemotherapy drugs Chemotherapy in clinical practice Endocrine therapy Immunotherapy and biological therapies Emerging anticancer treatments Immunosuppression and immunosuppressive drugs 1 Although not in strict accord with the definition of Chapter 11 the word chemotherapy is in general use in this connection and it would be pedantic to avoid it. It arose because some malignant cells can be cultured and the disease transmitted by inoculation as with bacteria. The more precise term cytotoxic chemotherapy is adopted here. Neoplastic disease Cancer treatments and outcomes Cancers share some common characteristics Growth that is not subject to normal restrictions for that tissue and fails to respond to apoptotic signals see later or in which a high proportion of cells are dividing . there is a high growth fraction Local invasiveness Tendency to spread to other parts of the body metastasise Less differentiated cell morphology Tendency to retain some characteristics of the tissue of origin. Cancer treatment employs six established principal modalities 1. surgery 2. radiotherapy 3. chemotherapy 4. endocrine therapy 5. immunotherapy 6. biological therapy. Details of the exploitation of all of these techniques whether alone sequentially or concurrently is beyond the scope of a book on clinical phar- 603 SECTION 6 7Q .
