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.

Statistics

153,397 people died of cancer in the UK in 2004 – 22 per cent from lung cancer, 11 per cent from bowel cancer, eight per cent from breast cancer and seven per cent from prostate cancer

Mortality rates for cancer fell by 15 per cent between 1975 to 2004, down from 215 per 100,000 of the population to 183

Among prostate cancer sufferers, the average survival rates increased by 12 per cent every five years between 1986 and 1999, to 65 per cent. Colon cancer survival rates have increased by four per cent every five years over the same period, and breast cancer rates by six per cent every five years, to 77 per cent in 2006

Two thirds of cancer deaths are thought to be avoidable through changes in behaviour and lifestyle

England, Scotland and Wales came 11th, 12th and 13th respectively in a 22-country Europe-wide study of survival rates for 42 different cancers

Statistics 1 to 4: (Sources: Cancer Research UK); Statistic 5: (Source: Eurocare, 2003)

Quotes

"We cannot prevent all deaths from cancer. But as this Plan is implemented, improved cancer prevention, earlier detection, and the guarantee of effective treatment and care will mean a lower death rate, improved prospects for survival and improved quality of life for those affected by cancer."

Department of Health, NHS Cancer Plan, 2000

"Most people rightly no longer view cancer as a death sentence."

Professor Robert Sourami, Research UK's director of clinical and external affairs, 2004