Cancer Treatment

What is cancer?

Cancer is any malignant growth or tumour caused by abnormal and uncontrolled cell division.

It is widely believed that damaged DNA and genes are the 'driving force' behind the development of cancer and they are therefore the focus of cancer research.

Unlike in healthy cells, damaged DNA is not capable of repair in cancerous cells.

People can inherit damaged DNA, which accounts for many cancers. A person's DNA may also become damaged by exposure to environmental factors, such as through smoke inhalation. Cancer cells travel around the body and begin to attack healthy tissue in a process called metastasis. This occurs when the cancer cells get into the bloodstream or lymph vessels of the body.

'Benign' tumours develop through the same process, but do not spread to other parts of the body (metastatize) and, with very rare exceptions, are not life-threatening.

There are over 200 different types of cancer that can occur anywhere in the body; the most frequently occurring are lung, breast and bowel cancer.

Background

The development in scientific understanding of DNA structures and improvements in research techniques has vastly improved understanding of cancer and the effectiveness of some cancer treatments.

However, in the early 20th century understanding was limited: surgery was the only method for effectively treating cancer and only worked on small and localised cancers that could be completely removed.

Radiation techniques were subsequently developed for use after surgery to control small tumour growths. Chemotherapy (drug treatment) was later developed to destroy small tumour growths that were not treatable by other methods. The drugs used in chemotherapy prevent tumour cells from dividing, so they stop growing or die in a variety of ways.

A major breakthrough in the treatment of cancer was the development of multiple chemotherapeutic agents (known as combination chemotherapy).

Improved understanding of the biology of cancer cells has led to the development of biological agents that mimic some of the natural signals that the body uses to regulate growth. This cancer treatment, known as biological response modifier therapy or immunotherapy, has been effective against several cancers in clinical trials.

As understanding of the causes of cancer has improved, so has the ability of doctors to pre-empt the development of cancerous diseases through the use of screening tests.

Cancer research scientists have also reported significant potential improvements in radiotherapy techniques by using microbeams, said to be the "future of cancer treatment" by Cancer Research UK. This technique involves firing particles of radiation one at a time at individual cancer cells. This then has a 'by-stander' effect, as treated cells send out 'suicidal' signals to their neighbours. This technique is thought to significantly reduce damage to healthy cells during radiotherapy.

Controversies

The Government's cancer policies are a key feature of the NHS reform programme and are therefore an important way of measuring its success.

This makes the ability of the Government to reach the targets set by the NHS Cancer Plan 2000 potentially highly controversial. The Plan says the ultimate goal should be to "offer patients a maximum one month wait from an urgent referral for suspected cancer to the beginning of treatment".

There were concerns that demand would outstrip the funds available to support the NHS supply of cancer services. For example, in 2003 the Christie Hospital in Manchester, one of the UK's leading cancer hospitals, said it might be forced to ration future treatment due to a lack of funds. This shortfall in cash means that patients may have to face delays in chemotherapy, which could put lives at risk. The NHS is also suffering from shortages of trained staff, as consultant oncologists take many years to train, as do radiographers and other experts.

However, a report from the King's Fund think tank found that by June 2006, 98.9 per cent of people suspected of having cancer were seeing a specialist within two weeks, and 99 per of those diagnosed began treatment within a month.

In 2007, Gordon Brown used his keynote speech at the Labour conference to announce several new measures to improve cancer treatment: Breast cancer screening extended for six months and every case treated as urgent; Colon screening extended into people's seventies; £15 billion investment for research in genetics, stem cell research and new cancer drugs.

The Cancer Reform Strategy, launched on 3 December 2007, sets out a clear direction for the development of cancer services in England over the next five years. More than 1000 stakeholders were involved in the development of the strategy, including representatives from cancer charities, cancer professionals, NHS managers, patients and social care professionals. The work was led by the National Cancer Director and chair of the National Cancer Research Institute Professor Mike Richards.

And in April 2008 the NCRI published its 'Strategic Plan 2008-2013' which aims by 2013 to have "further strengthened NCRI's reputation for connecting people, ideas and actions in cancer research, in the UK and internationally."

Statistics

There are around 289,000 new cases of cancer diagnosed each year in the UK. More than 1 in 3 people will develop some form of cancer during their lifetime.

Overall cancer incidence rates have increased by one quarter since 1975 but have remained fairly stable over the past decade.

Half of people diagnosed with cancer now survive for more than five years.The average ten-year cancer survival rate has doubled over the last 30 years.

More than seven out of ten children with cancer are now successfully treated.

Cancer causes one in four of all deaths in the UK. More than one in five of all cancer deaths are from lung cancer.

The overall cancer death rate has fallen by 10% over the last decade.

Source: Cancer Research UK - 2008

Quotes

"The actions we are taking are intended to ensure that every person has access to world class NHS services at every point of the cancer pathway. Our pledge to patients is that:

1. More will be done to help you to reduce your risk of developing cancer:
2. There will be increased chances of your cancer being detected earlier:
3. You will have access to high quality treatment at every stage of your cancer journey:
4. Whether you are living with or beyond your cancer, high quality information and support, tailored to your personal needs will be available:
5. Irrespective of who you are or what your background is, the NHS will work to give you access to the best possible cancer experience and outcomes:
6. Your care will be delivered in the most clinically appropriate and convenient setting for you:
7. You will be able to access information about the performance of your cancer services, enabling you to make informed choices which reflect your priorities:
8. Your PCT will be supported in ensuring that the best possible cancer services are available for you:
9. Your NHS cancer services will continue to be properly funded:
10. We will keep striving to improve the quality of cancer services available."

Department of Health - 'What the Cancer Reform Strategy means for patients' - 2008

"Our vision for NCRI is a research community in which people from different backgrounds and disciplines work ever more closely together to deliver benefits to cancer patients and to society generally."

NCRI chair Professor Mike Richards - 2008