Biology of Disease

of the patient. During surgery, lymph nodes are sampled to aid more accurate

staging of disease. Radiotherapy is recommended for patients with stage I, II or

III disease. Patients with Stage III or IV may be offered chemotherapy although

NSCLC is only moderately sensitive to chemotherapy. Chemotherapy for

advanced NSCLC uses a combination of drugs such as paclitaxel or docetaxel,

together with a platinum drug such as cisplatin. Patients with SCLC are

treated with a platinum drug and multidrug regimens. The drug regimen may

be given in cycles to patients who respond to treatment. Patients with limited

stage SCLC are given radiotherapy concurrently with chemotherapy. Those

who have inoperable lung cancer should be given palliative treatments to

ease their symptoms. This may include radiotherapy to relieve breathlessness

and chest pain, opioids to ease the cough, and procedures to alleviate large

airway obstruction.

Breast Cancer

Breast cancer (Figure 17.32) is the commonest cancer in women in both the

UK and the USA, and the second leading cause of cancer deaths in women.

The incidence of new cases in the UK is about 41 000 per year and in the USA

it is just over 210 000, while the annual incidence worldwide is approximately

1.2 million. It is estimated that about one in nine women will develop breast

cancer during their lifetime. Breast cancer also occurs in men, though with

a much lower incidence. In the UK, around 250 men are diagnosed with the

disease each year and approximately 70 die annually of the disease.

Risk factors for the development of breast cancer include increased age,

childlessness, early menarche or late menopause, hormone replacement

therapy, being overweight or obese, use of the contraceptive pill and regular

consumption of alcohol over a long period of time. Breastfeeding reduces the

risk of contracting the disease. Familial breast cancer accounts for 5% of all

breast cancers and is related to the inheritance of mutated forms of genes

such as the BRCA1 andBRCA2 genes as described in Section 17.4.

Signs, symptoms, diagnosis and staging of breast cancer

Breast cancer develops either in the milk-producing glands or in the ducts that

deliver milk to the nipple. Symptoms of breast cancer include a new painless

lump occurring in a breast, changes in the size or shape of the breast or in

the position of the nipple, a discharge from the nipple, an eczematous rash

Figure 17.31The TNM classification of nonsmall

cell lung cancer. Summarized from NICE

guidelines http://www.nice.org.uk

X]VeiZg&,/ CANCER

*%% W^dad\nd[Y^hZVhZ

T1 T2 T3 T4

N0 1A 1B IIB IIIB

N1 IIA IIB IIIA IIIB

N2 IIIA IIIA IIIA IIIB

N3 IIIB IIIB IIIB IIIB

Patient offered surgery

if no medical

contraindications

Surgery may be suitable

for some patients, based

on clinical judgment

Not suitable for surgery