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Cancer occurs when structurally abnormal cells begin to divide rapidly and form a tumour. They fail to carry out their normal function and can spread rapidly via the blood and lymphatic system. Malignant tumours produce substances that break down other tissues, so preventing them from being separated surgically from the tissues they infiltrate. A primary tumour will continue to grow because of rapid cell division, but then break into other organs of the body by breaching the walls of blood vessels, lymphatic vessels and other organs. These breaches can cause secondary cancers in the parts of the body they spread to. For example, bowel cancer with a tumour in the large intestine can readily spread to the liver – a process called metastasis. This is because the blood vessels of the bowel travel from there to the liver for processing and digestion.
Cancer, in its many forms, is on the increase. It can affect both the old and the young; women, men and children. There has been considerable progress in the use of drugs, which has prolonged patients’ lives. But there is now a realisation that extending life must be balanced against the quality of that extended life.
When a patient is diagnosed with cancer they are usually offered a combination of surgery, chemotherapy and radiotherapy. Chemotherapy is the most common, and the one we shall focus on here. Chemotherapy itself can take two forms. First, treatment that is general and influences both the cancerous cells as well as the ‘good’ cells. This is a cytotoxic treatment. Second, there are drugs that can target just the cancerous cells, but this is not possible in all forms of cancer. So the main chemotherapy treatment is a cytotoxic one. Again, here we shall focus purely on cytotoxic chemotherapy.