Christopher C. McConkey

Introduction and Methods

Of the many varieties of cancer which affect man, cancer of the larynx has an importance which is quite disproportionate to its frequency. In Great Britain it is not common, and indeed by world standards the incidence is relatively low. In men it amounts to approximately 1% of all cancers, but it is significantly less common in women, a feature which summons up thoughts of possible occupation based aetiology. It is not a homogeneous cancer, by which is meant it does not affect the larynx uniformly. The larynx is a complex organ, and its various discrete parts are affected with unequal frequency (again, by international comparisons, in a manner differing from some other parts of the world). Cancers of the subsections of the larynx — supraglottis, glottis and subglottis, show variations in behaviour and in their tendency to metastasise. Some remarkable differences in metastasising capacity are portrayed.

Cancer of the large bowel

Epidemiology histology presentation and investigation treatment and survival stages appendix and anal canal lymphoma and sarcoma. Appendices: standardized rates census populations.

A regional audit of iatrogenic perforation of tumours of the oesophagus and cardia

Introduction : With the rising incidence of oesophageal cancer, palliative treatment has an increasingly important role. With median survival unlikely to exceed 6 months, in advanced disease the palliative therapy chosen must not hasten patients demise.

Late Toxicity after Short Course Preoperative Radiotherapy and Total Mesorectal Excision for Resectable Rectal Cancer

AIMS The late toxicity of short-course preoperative radiotherapy (SCPRT) after total mesorectal excision (TME) in resectable rectal cancer has not been adequately documented. The acute toxicity in a series of 176 consecutive patients has been previously reported. In this study, the late toxicity in the same cohort is presented. MATERIALS AND METHODS Side-effects occurring more than 3 months after the start of SCPRT were graded using the EORTC/RTOG late radiation toxicity system. We performed multivariate analysis to identify associated factors. RESULTS Of 176 patients, 15 died within 3 months of SCPRT and five patients were lost to follow-up. One hundred and fifty-six patients were assessable at a median follow-up interval of 41 months: severe (grade 3-4) toxicity was seen in 20 patients (13%), of which 13 were gastrointestinal (8%); three urological (2%); three thromboembolic (2%), and one musculoskeletal (1%). On multivariate analysis, abdomino-perineal (AP) resection (P < 0.02) was associated with a lower risk of grade 3-4 toxicity. CONCLUSIONS In this retrospective study, the rate of late grade 3-4 toxicity after SCPRT and TME was 13%. Although AP resection seems to be associated with a lower incidence of late toxicity, this could be counterbalanced by the impact of a stoma on quality of life. These factors should be considered when determining the optimal management of resectable rectal cancers.

Staging carcinoma : its value in cancer of the larynx

Three thousand four hundred and forty-five cases of cancer of the larynx were examined and 3,235 assigned to their TNM group. While good correlation with prognosis could be seen, the value of the detailed subsite (as opposed to the main laryngeal regions) was limited to defining T1a and T1b and aiding that of T2. T status gives some indication of prognosis, but the N status is of almost overriding importance.

Cancer of the Larynx

Introduction and methods epidemiology - demographic aspects multiple primaries, social class and occupation histology incidence by sub-site stage - supraglottis, glottis, subglottis survival - larynx, treatment survival related to treatment second treatments. Appendices: Birmingham and West Midlands Regional Cancer Registry standarized rates census and inter-censal populations TNM classification of malignant tumours - larynx.

Toxicity, recurrence and survival after adjuvant radiotherapy treatment for FIGO stage I cancer of the endometrium.

We conducted a retrospective observational study to determine the rate of toxicity, pattern of tumour recurrence and survival associated with radiotherapy treatment for FIGO stage I cancer of the endometrium. All patients had undergone definitive surgery and had been referred to the oncology department of the University Hospital Birmingham, U.K. Two hundred and forty-five women were included in the study; 228 patients were treated with radiotherapy; 160 had external beam radiation alone; 32 had vaginal vault brachytherapy alone; 36 patients had both modalities; and 17 patients were not given radiotherapy. There were nine cases of Grade 3 and 4 radiation reactions, of which four were acute, four were late and one was acute and late toxicity. The severity of both acute and late radiation effects was significantly associated with the delivery of vault brachytherapy (external beam radiotherapy alone compared with brachytherapy alone (1/158 vs 3/32; P = 0.02). Thirty-four patients were diagnosed with tumour recurrence (11 distant, 14 local, 4 patients had both distant and local disease and 5 patients had recurrence diagnosed at the time of death). Patients who received no radiotherapy were at greater risk of local pelvic tumour recurrence (P < 0.0001; hazard ratio [HR] 9.6, 95% confidence interval (CI) 3.5-26.3). Vaginal vault brachytherapy had no discernible effect on the pattern of tumour recurrence. Forty-six patients died during the follow-up period, 28 of these were attributable to carcinoma of the endometrium. There was no difference in survival between the four treatment groups (P = 0.68). The overall 5-year survival rate in our study group was 89.6% (85.4-93.8%). In a proportional hazards model, tumour grade (HR 2.0 per level [1.25, 3.17]; P = 0.004]) and age (HR 1.74 per 10 years [1.12, 2.69]; P = 0.01) were the only factors found to have an independent influence on survival. This study suggests that, although pelvic radiation may not alter overall survival, it does reduce the risk of local disease recurrence. In this study population, vaginal vault brachytherapy using a vaginal stock/dobbie showed no additional benefits compared with external beam radiotherapy; it was, however, associated with a higher rate of both acute and late radiation effects.

Primary treatment of cancer of the larynx

Analysis of 3,445 cases of cancer of the larynx with a follow-up of 99.8 per cent shows that over a period in which the survival has improved neither the modality of the treatment nor the severity of the cancer has changed. Improved survival may be due to socioeconomic factors or an improvement in the quality of treatment.

Extent of Disease

Unfortunately Dukes staging was only available for the period 1977–81, so the results for the entire 25 years could only be analysed on a broad grouping of node negative cases (equivalent to Dukes AB) or node positive cases (equivalent to Dukes C).

Learning about Cancer

In this article, we discuss the findings of a study about how patients who have been diagnosed with cancer learn about their disease. This is a form of learning that is not often thought of as learning, within the practices in which it takes place. It involves learners who neither possess specific forms of knowledge, nor are sure about what knowledge there is to possess. In medical practice, this form of learning is often referred to in terms such as “information seeking,” and the implemented practices of providing information do not always seem to take account of current understandings of teaching and learning amongst educational and psychological researchers. Here we report the findings of a U.K. Department of Health project concerned with the acceptability and usefulness of the Internet as a cancer information source. Post-Vygotskian theory is deployed in the interpretation of the data and the development of a model of the learning.