Improving cancer survival in the next century

Abstract

The number of cancer cases continues to increase worldwide, but progress is being made in reducing the incidence of specific types of cancer. As our understanding of the pathological mechanisms involved in tumorigenesis has increased, so has the availability of newer and more potent chemotherapeutic agents. New drugs such as the taxoids and camptothecins, new uses for old drugs such as thalidomide and minocycline, and the advent of biological response modifiers such as the interferons, interleukins and tumour necrosis factor, have enabled researchers to develop more sophisticated, multistep protocols for cancer management, particularly in cases where the results of standard treatments have been disappointing. Research towards the development of vaccines against some cancers, such as melanoma and cervical cancer, is underway. Investigation of the feasibility of using gene therapy to influence or suppress the growth of neoplasms is another area of research. Another approach to improving patient survival involves assessing the treatment centre location and the personnel on the cancer management team. A number of recent studies have demonstrated that diagnosis and care by specialists in team-centred units results in significantly less morbidity and significantly greater long-term survival in many types of cancer. Cancer management will soon benefit from the many newly available screening techniques for predicting susceptibility to various types of tumours, decreasing environmental exposure to known carcinogens (especially tobacco products), and rapid diagnosis of cancer in the earliest stages. Once the cancer has been diagnosed, precise staging of the tumour to maximise the efficacy of multidrug and adjuvant treatment regimens will be necessary, along with improved surgical techniques to increase the chances of curative resection and improved radiological techniques to minimise exposure of normal tissue. Aggressive methods to locate and destroy residual tumour and/or distant metastases will be routinely employed to optimise further long-term survival. Rapid dissemination of information regarding new treatments and rigorous adherence to quality control and to protocols that have demonstrated their effectiveness should improve a patient's chances of surviving a cancer diagnosis in the next century.