Harrison's Internal Medicine Chapter 77. Approach to the Patient with Cancer Approach to the Patient with Cancer: Introduction The application of current treatment techniques (surgery, radiation therapy, chemotherapy, and biological therapy) results in the cure of nearly two of three patients diagnosed with cancer. Nevertheless, patients experience the diagnosis of cancer as one of the most traumatic and revolutionary events that has ever happened to them. Independent of prognosis, the diagnosis brings with it a change in a person's self-image and in his or her role in the home and workplace. The prognosis of a person who has just. | Chapter 077. Approach to the Patient with Cancer Part 1 Harrison s Internal Medicine Chapter 77. Approach to the Patient with Cancer Approach to the Patient with Cancer Introduction The application of current treatment techniques surgery radiation therapy chemotherapy and biological therapy results in the cure of nearly two of three patients diagnosed with cancer. Nevertheless patients experience the diagnosis of cancer as one of the most traumatic and revolutionary events that has ever happened to them. Independent of prognosis the diagnosis brings with it a change in a person s self-image and in his or her role in the home and workplace. The prognosis of a person who has just been found to have pancreatic cancer is the same as the prognosis of the person with aortic stenosis who develops the first symptoms of congestive heart failure median survival 8 months . However the patient with heart disease may remain functional and maintain a self-image as a fully intact person with just a malfunctioning part a diseased organ a bum ticker . By contrast the patient with pancreatic cancer has a completely altered self-image and is viewed differently by family and anyone who knows the diagnosis. He or she is being attacked and invaded by a disease that could be anywhere in the body. Every ache or pain takes on desperate significance. Cancer is an exception to the coordinated interaction among cells and organs. In general the cells of a multicellular organism are programmed for collaboration. Many diseases occur because the specialized cells fail to perform their assigned task. Cancer takes this malfunction one step further. Not only is there a failure of the cancer cell to maintain its specialized function but it also strikes out on its own the cancer cell competes to survive using natural mutability and natural selection to seek advantage over normal cells in a recapitulation of evolution. One consequence of the traitorous behavior of cancer cells is that the patient feels
