Practical Clinical Oncology

Practical Clinical Oncology

Practical Clinical Oncology has been designed as a hands-

on review of all aspects of current practice in clinical oncol-

ogy. The introductory section to the book provides back-

ground information on the four main treatment modalities

– radiotherapy, chemotherapy, hormone therapy and bio-

logical therapy – plus research, oncological emergencies

and palliative care. Subsequent chapters describe the diag-

nosis and treatment of malignancies, based on tumour site

or type. Each chapter follows a standard template, making

it easier for the readers to locate information quickly; mul-

tiple choice questions are also provided to enable readers

to test their knowledge.

With an emphasis on practical information that will be

useful in day-to-day decision making and treatment, Prac-

tical Clinical Oncology is an invaluable resource on clinical

care of the cancer patient for all trainees in clinical onco-

logy, medical oncology, surgical oncology and palliative

care, as well as for specialist nurses and radiographers.

Louise Hanna is a Consultant Clinical Oncologist at the

Velindre Cancer Centre, Velindre Hospital, Cardiff.

Tom Crosby is a Consultant Clinical Oncologist at the


Fergus Macbeth is a Consultant Clinical Oncologist at the


© Cambridge University Press www.cambridge.org

Cambridge University Press978-0-521-61816-8 - Practical Clinical OncologyEdited by Louise Hanna, Tom Crosby and Fergus MacbethFrontmatterMore information

http://www.cambridge.org/0521618169

http://www.cambridge.org


Practical Clinical Oncology

Edited by

Louise Hanna

Tom Crosby

Fergus Macbeth






CAMBRIDGE UNIVERSITY PRESS

Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, Sao Paulo

Cambridge University Press

The Edinburgh Building, Cambridge CB2 8RU, UK

Published in the United States of America by Cambridge University Press, New York

www.cambridge.org

Information on this title: www.cambridge.org/9780521618168

C© Cambridge University Press 2008

This publication is in copyright. Subject to statutory exception

and to the provisions of relevant collective licensing agreements,

no reproduction of any part may take place without

the written permission of Cambridge University Press.

First published 2008

Printed in the United Kingdom at the University Press, Cambridge

A catalog record for this publication is available from the British Library

Library of Congress Cataloging-in-Publication Data

Practical clinical oncology / edited by Louise Hanna, Tom Crosby, Fergus Macbeth.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-521-61816-8 (hardback)

1. Oncology. 2. Cancer. I. Hanna, Louise. II. Crosby, Tom.

III. Macbeth, Fergus.

[DNLM: 1. Neoplasms – therapy. 2. Neoplasms – diagnosis. QZ 266 P895 2007]

RC261.P693 2007

616.99′4–dc22

2007020223

978-0-521-61816-8 (hardback)

Every effort has been made to ensure that the information in this text, including drug and radiotherapy

doses, is correct. However, the reader is strongly advised to consult the published product information

and data sheets provided by manufacturers. The authors and publishers cannot accept any legal

responsibility or liability for any errors or omissions which occur in this book or for the misuse or

misapplication of the material therein.

Cambridge University Press has no responsibility for the persistence or accuracy of URLs for

external or third-party Internet Web sites referred to in this publication, and does not guarantee

that any content on such websites is, or will remain, accurate or appropriate.






CONTENTS

List of contributors page viiPreface ixAcknowledgements xAbbreviations xi

1 Practical issues in cytotoxic chemotherapyusage 1Sian Evans and Philip Savage

2 Biological treatments in cancer 13Rachel Jones and Robert Leonard

3 Hormones in cancer 23Jacinta Abraham and John Staffurth

4 Radiotherapy planning 39Andrew Tyler and Louise Hanna

5 Research in cancer 55Robert Hills

6 Oncological emergencies 70Paul Shaw

7 Palliative care 83Simon Noble

8 Head and neck 93Laura Moss and Chris Gaffney

9 Oesophagus 121Tom Crosby

10 Stomach 132Michael Button and Tom Crosby

11 Liver, gallbladder and biliary tract 141Somnath Mukherjee and Tom Crosby

12 Exocrine pancreas 151Somnath Mukherjee and Tom Crosby

13 Colon and rectum 159Richard Adams, Timothy Maughan andTom Crosby

14 Anus 174Richard Adams and Tom Crosby

15 Gastrointestinal stromal tumours 183Kate Parker and Tom Crosby

16 Breast 190Nayyer Iqbal and Peter Barrett-Lee

17 Kidney 214Jason Lester and John Wagstaff

18 Bladder 222Stephen Williams and Jim Barber

19 Prostate 231Jim Barber and John Staffurth

20 Testis 240Jim Barber and John Staffurth

21 Penis 252Jim Barber

22 Ovary 257Louise Hanna and Malcolm Adams

23 Body of the uterus 267Louise Hanna and Malcolm Adams

24 Cervix 278Louise Hanna and Malcolm Adams

25 Vagina 290Louise Hanna and Malcolm Adams

26 Vulva 296Louise Hanna and Malcolm Adams

27 Gestational trophoblast tumours 304Philip Savage

28 Lung 313Fergus Macbeth and Carys Morgan

29 Mesothelioma 328Louise Hanna and Fergus Macbeth

v






Contents

30 Soft tissue and bone tumours in adults 335Owen Tilsley

31 The lymphomas and myeloma 347Eve Gallop-Evans and Chris Poynton

32 Central nervous system 370Sean Elyan

33 Skin cancer other than melanoma 382Sankha Suvra Mitra

34 Melanoma 395Tom Crosby, Louise Hanna and Dafydd Roberts

35 Thyroid 406Laura Moss

36 Neuroendocrine tumours 418Atul Kalhan and Aled Rees

37 Cancer in children 426Sally Goodman

38 Cancer of unknown primary 442Paul Shaw and Tom Crosby

39 The use of radiotherapy in the treatmentof benign conditions 449Alison Brewster

Multiple choice questions 453Multiple choice answers 468Index 469

vi






CONTRIBUTORS

Jacinta AbrahamConsultant Clinical Oncologist, Velindre Cancer Centre,

Velindre Hospital, Whitchurch, Cardiff, UK.

Malcolm AdamsConsultant Clinical Oncologist, Velindre Cancer Centre,


Richard AdamsSenior Lecturer in Clinical Oncology, Velindre Cancer

Centre, Velindre Hospital, Whitchurch, Cardiff, UK.

Jim BarberConsultant Clinical Oncologist, Velindre Cancer Centre,


Peter Barrett-LeeConsultant Clinical Oncologist, Velindre Cancer Centre,


Alison BrewsterConsultant Clinical Oncologist, Velindre Cancer Centre,


Michael ButtonSpecialist Registrar in Clinical Oncology, Velindre Cancer


Tom CrosbyConsultant Clinical Oncologist, Velindre Cancer Centre,


Sean ElyanConsultant Clinical Oncologist, Cheltenham General

Hospital, Cheltenham, UK.

Sian EvansChief Pharmacist, Velindre Cancer Centre, Velindre

Hospital, Whitchurch, Cardiff, UK.

Chris GaffneyConsultant Clinical Oncologist, Velindre Cancer Centre,


Eve Gallop-EvansConsultant Clinical Oncologist, Velindre Cancer Centre,


Sally GoodmanConsultant Clinical Oncologist, The Bristol Haematology

and Oncology Centre, Bristol, UK.

Louise HannaConsultant Clinical Oncologist, Velindre Cancer Centre,


Robert HillsSenior Lecturer in Translational Statistics, Department of

Haematology, Cardiff University, Cardiff, UK.

Nayyer IqbalConsultant Clinical Oncologist, Velindre Cancer Centre,


Rachel JonesSpecialist Registrar in Medical Oncology, South West Wales

Cancer Institute, Singleton Hospital, Sketty, Swansea, UK.

Atul KalhanSpecialist Registrar, Centre for Endocrine and Diabetes

Sciences, University Hospital of Wales, Heath Park,

Cardiff, UK.

Robert LeonardProfessor of Medical Oncology, South West Wales Cancer

Institute, Singleton Hospital, Sketty, Swansea, UK.

Jason LesterConsultant Clinical Oncologist, Velindre Cancer Centre,


Fergus MacbethConsultant Clinical Oncologist, Velindre Cancer Centre,


vii






Contributors

Timothy MaughanProfessor of Cancer Studies, Consultant Clinical

Oncologist, Velindre Cancer Centre, Velindre Hospital,

Whitchurch, Cardiff, UK.

Sankha Suvra MitraConsultant Clinical Oncologist, The Sussex Cancer Centre,

Royal Sussex County Hospital, Brighton and Sussex

University Hospitals NHS Trust, Brighton,

East Sussex, UK.

Carys MorganSpecialist Registrar in Clinical Oncology, Velindre Cancer


Laura MossConsultant Clinical Oncologist, Velindre Cancer Centre,


Somnath MukherjeeConsultant Clinical Oncologist, Velindre Cancer Centre,


Simon NobleSenior Lecturer and Honorary Consultant in Palliative

Care, Royal Gwent Hospital, Newport, UK.

Kate ParkerSpecialist Registrar in Clinical Oncology, Velindre Cancer


Chris PoyntonSenior Lecturer and Honorary Consultant Haematologist,

University Hospital of Wales, Heath Park, Cardiff, UK.

Aled ReesSenior Lecturer, Centre for Endocrine and Diabetes

Sciences, School of Medicine, Cardiff University, Heath

Park, Cardiff, UK.

Dafydd RobertsConsultant Dermatologist, Singleton Hospital, Sketty,

Swansea, UK.

Philip SavageConsultant Medical Oncologist, Department of Health

Gestational Trophoblastic Tumour Unit, Charing Cross

Hospital, London, UK.

Paul ShawSpecialist Registrar in Clinical Oncology, Bobby Moore

Clinical Research Fellow, School of Bioscience, Cardiff

University, Park Place, Cardiff, UK.

John StaffurthClinical Senior Lecturer in Oncology, Consultant Clinical

Oncologist, Velindre Cancer Centre, Velindre Hospital,

Whitchurch, Cardiff, UK.

Owen TilsleyConsultant Clinical Oncologist, Velindre Cancer


Andrew TylerMedical Physicist, Velindre Cancer Centre, Velindre

Hospital, Whitchurch, Cardiff, UK.

John WagstaffConsultant Medical Oncologist, Singleton Hospital, Sketty,

Swansea, UK.

Stephen WilliamsSpecialist Registrar in Clinical Oncology, Velindre Cancer


viii






PREFACE

This book is intended primarily for trainees in clini-cal oncology, but members of other professions such asmedical oncology, surgery, palliative care, nursing andradiography will also find it useful. The book startedlife as a set of lecture notes from the Cardiff AnnualFRCR Part II course but has since grown to include moretopics than could possibly be covered during the threedays of that course. Our approach in producing this vol-ume has been to focus on practical suggestions appro-priate to day-to-day decision making during the treat-ment of oncology patients. We are very grateful to ourcolleagues from Velindre and elsewhere, who are listedon page xi, for reviewing specific chapters and ensuringthat the advice contained within is as widely applicableas possible.

The first seven chapters cover ‘generic’ topics thatprovide background information on cancer treatments.These are chemotherapy, biological and hormonal treat-ments, radiotherapy planning, research, emergenciesand palliative care. The chapters that follow each focuson a tumour site or tumour type. In this latter group,the chapter layout is fairly consistent to help thereader navigate through the book. Thus, each chapterbegins with background information on tumour types,anatomy, incidence, epidemiology, risk factors and

aetiology. Next, there are sections on pathology, routesof spread and, where appropriate, screening. These arefollowed by clinical sections on presentation, investiga-tions, treatment, and prognosis. Most of the chaptersalso discuss areas of current interest and clinical trials,reflecting the rapidly changing nature of clinical oncol-ogy where many areas of practice are open to debate.Where references are given, we have tried as much aspossible to include the key publications that have influ-enced clinical practice. Towards the end of the book,there is a series of ‘single best answer’ multiple choicequestions, which give the readers the opportunity to testtheir knowledge.

In a book of this length, it is not possible to provide asmuch of the subject as would be found, for example, inthe larger multivolume oncology textbooks. Neverthe-less, an attempt has been made to give an overview ofclinical oncology practice at the present time, which wehope will be of interest and benefit to trainees.

The idea for writing this book came about severalyears ago when two of the editors (TC and LH) werestudying for their FRCR part II examination. They havesince become consultants in Velindre Hospital with FMand all three now teach on the Cardiff Annual FRCR partII course.

ix






ACKNOWLEDGEMENTS

We are very grateful to those who have helped by review-ing specific chapters: Dr K. Benstead, Dr G. Bertelli,Dr P. Blake, Dr N. Burnet, Mr A. Carter, Dr M. Evans,Dr S. Falk, Prof A. Fiander, Dr C. Gaffney, Dr J. Glees,Dr P. Keeley, Dr V. Khoo, Dr U. Mallick, Dr M. Marples,Prof M. Mason, Dr C. Nutting, Ms T. Perrett, Dr N.O’Rourke, Dr D. Sebag-Montefiore, Dr N. Somaiah, ProfR. Taylor, Prof H. Thomas, Dr A. Wardley, Dr S. Williamsand Dr V. Wolstenholme.

Our thanks also go to those who have helped with thepreparation of this book: Jane Flewitt, Rhydian Maggs

and Lucy Wills of the Department of Medical Physics,Velindre Cancer Centre; Anne Cleves of the CancerResearch Wales Library; and the staff at Cambridge Uni-versity Press, particularly Pauline Graham, Betty Fulfordand Eleanor Umali who have always responded help-fully to our many queries.

And, finally, we acknowledge our respective familiesfor their enduring love and support during the prepara-tion of this book.

x






ABBREVIATIONS

General1D one-dimensional2D two-dimensional3D three-dimensional5AC MUC subtypes A and C5-FU 5-fluorouracil5-HIAA 5-hydroxy-indoleacetic acid5-HT3 5-hydroxy-tryptamine 35YDFS 5-year disease-free survival5YOS 5-year overall survival5YS 5-year survivalαFP alpha feto-proteinβhCG beta human chorionic gonadotrophinAAPM American Association of Physicists in

MedicineABCSG Austrian Breast and Colorectal Cancer

Study GroupABL Abelson protein tyrosine kinaseACE anticholinesteraseACh acetylcholineACOSOG American College of Surgeons

Oncology GroupACTH Adrenocorticotrophic hormoneACTION Adjuvant Chemotherapy in Ovarian

NeoplasmADH antidiuretic hormoneADT androgen deprivation therapyAF activating functionAGES age, grade, extent, sizeAHT adjuvant hormone therapyAI aromatase inhibitorAIDS aquired immune deficiency

syndromeAIM HIGH Adjuvant Interferon in Melanoma

HIGH riskAJCC American Joint Committee on

CancerAKT thymoma viral proto-oncogeneALL acute lymphoblastic leukaemiaALM acral lentinginous melanoma

ALMANAC Axillary Lymphatic Mapping AgainstNodal Axillary Clearance

ALND axillary lymph node dissectionAMES age, metastases, extent, sizeAML acute myelocytic leukaemiaANC axillary nodal clearanceAPBI accelerated partial breast irradiationAP abdominoperinealA–P anterior–posteriorAP-1 activator protein-1ApC antigen-presenting cellAPC adenomatosis polyposis coliAPR abdominoperineal resectionAPUD amine precursor uptake and

decarboxylationAR androgen receptorARE androgen response elementsARNO arimidex-nolvadexARSAC Administration of Radioactive

Substances Advisory CommitteeASCO American Society of Clinical OncologyASCT autologous stem cell transplantASH American Society of HematologyASTEC A STudy in Endometrial CancerASTRO American Society for Therapeutic

Radiology and OncologyATAC Arimidex, Tamoxifen, Alone or in

CombinationATD amino-terminal domainATLAS Adjuvant Tamoxifen Longer Against

ShorterATP adenosine triphosphateaTTom adjuvant Tamoxifen – Treatment offer

moreAUC area under curveb.d. twice a dayBC British ColumbiaBCG Bacille Calmette-GuerinBCL2 B-cell CLL/lymphoma 2BCR breakpoint cluster region

xi






Abbreviations

BCT breast conservation therapyBGND bilateral groin node dissectionBIG Breast International GroupBILCAP adjuvant capecitabine in biliary tract

cancer trialBIR British Institute of RadiologyBMD bone mineral densityBMI body mass indexBMT bone marrow transplantBNLI British National Lymphoma

InvestigationBOND Bowel Oncology with Cetuximab

AntibodyBP blood pressureBRAF v-raf murine sarcoma viral oncogene

homolog B1BRCA breast cancer geneBSA body surface areaBSC best supportive careBSO bilateral salpingo-oophorectomyBTOG British Thoracic Oncology GroupBTS British Thoracic SocietyCA cancer antigenCagA cytotoxicity-associated

immunodominant antigenCAIX carbonic anhydrase IXCALGB Cancer and Leukaemia

Group BCb carboplatinCCLG Children’s Cancer and Leukaemia

GroupCD cluster of differentiationCDH-1 cadherin 1CE conversion electronCEA carcino-embryonic antigenCgA chromogranin ACHART continuous hyperfractionated

accelerated radiotherapyCHF congestive heart failureCI confidence intervalCIN cervical intraepithelial neoplasiaCIS carcinoma in situCK cytokeratinCLA common leukocyte antigenCLCG Children’s Leukaemia Cooperative

GroupCLL chronic lymphocytic leukaemiaCML chronic myelocytic leukaemiacN clinical lymph node stageCNS central nervous system

COG Children’s Oncology Group of NorthAmerica

COMS Collaborative Ocular Melanoma StudyCONSORT Consolidated Standards of Reporting

TrialsCOPD chronic obstructive pulmonary

diseaseCR complete responseCRC colorectal cancerCrCl creatinine clearanceCreat serum creatinineCRM circumferential resection marginCRP c-reactive proteinCRT chemoradiotherapyCRUK Cancer Research UKCSF cerebrospinal fluidCSI craniospinal irradiationCT computed tomographyCTA clinical trials authorisationCTV clinical target volumeCTZ chemoreceptor trigger zoneCUP cancer of unknown primaryCVP central venous pressureCX characteristic X-ray photonCXR chest X-rayCYP1B1 cytochrome P450, family 1, subfamily

B, polypeptide 1D docetaxelD2 dopamine D2DAHANCA Danish Head and Neck CancerDCC deleted in colon cancerDCIS ductal carcinoma in situDDFS distant-disease-free survivalDDT dichloro-diphenyl-trichloroethaneDES diethylstilboestrolDFS disease-free survivalDHA dihydroxyandrostenedioneDHT 5α dihydrotestosteroneDLBCL diffuse large B-cell lymphomadmax depth of maximum doseDMC Data Monitoring CommitteeDMSA dimercapto succinic acidDMSO dimethyl sulfoxideDNA deoxyribonucleic acidDOPA dihydroxyphenylalanineDRE digital rectal examinationDRR digitally reconstructed radiographDTC differentiated thyroid cancerDTIC dacarbazineDVH dose volume histogram

xii






Abbreviations

EAU European Association of UrologyEBC early breast cancerEBCTCG Early Breast Cancer Trialists’

Collaborative GroupEBRT external beam radiotherapyEBV Epstein Barr virusECG electrocardiogramEcho echocardiogramECOG Eastern Cooperative Oncology GroupEDTA ethylenediaminetetraacetic acidEGF epidermal growth factorEGFR epidermal growth factor receptorEIC extensive intraductal componentELISA enzyme-linked immunosorbent assayELND elective lymph node dissectionEM electron microscopyEMA epithelial membrane antigenENET European Neuroendocrine Tumor

NetworkENT ear nose throatEORTC European Organisation for Research

and Treatment of CancerEPO erythropoietinEPP extrapleural pneumonectomyER oestrogen receptorERB B1 official symbol = EGFR; official

name = epidermal growth factorreceptor (erythroblastic leukemiaviral (v-erb-b) oncogene homolog,avian)

ERBB2 (alias = HER-2); official symbol =ERBB2; official name = v-erb-b2erythroblastic leukemia viraloncogene homolog 2,neuro/glioblastoma derivedoncogene homolog (avian)

ERCP endoscopic retrogradecholangiopancreatogram

ERE oestrogen response elementERG v-ets erythroblastosis virus E26

oncogene homolog (avian)ESPAC European Study Group for Pancreatic

CancerESR erythocyte sedimentation rateESTRO European Society for Therapeutic

Radiology and OncologyEU European UnionEUA examination under anaestheticEURAMOS European and American

Osteosarcoma Study Group

EUS endoscopic ultrasoundEWS EWSR1; official name = Ewing

sarcoma breakpoint region 1FA folinic acidFAP familial adenomatous polyposisFBC full blood countFDA Food and Drug AdministrationFDG fluorodeoxyglucoseFIGO Federation Internationale de

Gynecologie et d’ObstetriqueFinHer Finland Herceptin TrialFISH fluorescent in situ hybridisationFL follicular lymphomaFLI1 Friend leukemia virus integration 1FLIPI Follicular Lymphoma International

Prognostic IndexFLT3 fms-related tyrosine kinase 3fms peptide deformylaseFNA fine needle aspirationFNAC fine needle aspiration cytologyFOB faecal occult bloodFRCR Fellow of the Royal College of

RadiologistsFSD focus skin distanceFSH follicle-stimulating hormoneFT4 free T4FTC follicular thyroid carcinomaGANT gastrointestinal autonomic tumourGBq giga-BecquerelGC germinal centreG-CSF granulocyte-colony stimulating factorGCP good clinical practiceGCT germ cell tumourGELA Groupe d’ Etude des Lymphomes de l’

AdulteGFR glomerular filtration rateGHRH growth hormone-releasing hormoneGHSG German Hodgkin Study GroupGI gastrointestinalGIST gastrointestinal stromal tumourGLI glioma-associated oncogene homologGnRH gonadotropin-releasing hormoneGO gastro-oesophagealGOG Gynecologic Oncology GroupGORD gastro-oesophageal reflux diseaseGP General PractitionerGTT gestational trophoblast tumourGTV gross tumour volumeGy GrayH2 histamine H2

xiii






Abbreviations

HAART highly active antiretroviral therapyHAI hepatic arterial infusionHART hyperfractionated accelerated

radiotherapyHBF heterotopic bone formationHBL hepatoblastomaHBV hepatitis B virusHCC hepatocellular carcinomaHCG human chorionic gonadotropinHCV hepatitis C virusHDC/ASCT high-dose chemotherapy with

autologous stem cell transplantHDCT high-dose chemotherapyHDR high dose rateHDU high-dependency unitHER-2 human epidermal growth factor

receptor 2HERA Herceptin® AdjuvantHGG high-grade gliomaHH hedgehogHHV human herpesvirusHIFU high-intensity focussed ultrasoundHIV human immunodeficiency virusHL Hodgkin lymphomaHMB human melanoma blackHNPCC hereditary non-polyposis colorectal

cancerHPOA hypertrophic pulmonary

osteo-arthropathyHPV human papilloma virusHR hazard ratioHRT hormone replacement therapyHTLV-1 human T-cell lymphotropic virus -1IBCSG International Breast Cancer Study GroupICAM1 intercellular adhesion molecule 1ICC interstitial cells of CajalICG iodocyanine greenICON International Collaborative Ovarian

Neoplasm studyICRU International Commission on

Radiation Units and MeasurementsIDC invasive ductal carcinomaIDL indirect laryngoscopyIES International Exemestane StudyIFNα interferon alphaIFNAR interferon (alpha and beta) receptorIFNGR interferon gamma receptorIFRT involved-field radiotherapyIGCCC International Germ Cell Consensus

Classification

IGCCCG International Germ Cell CancerCollaborative Group

IGCN intratubular germ cell neoplasiaIGF-1 insulin-like growth factor-1IGRT image-guided radiation therapyIHC immunohistochemistryIHD ischaemic heart diseaseIJV internal jugular veinIL-2 interleukin-2ILC invasive lobular carcinomaILT intraluminal brachytherapyi.m. intramuscularIM internal marginIMIG International Mesothelioma Interest

GroupIMN internal mammary nodeIMP investigational medicinal productIMRT intensity-modulated radiation therapyINTACT Iressa NSCLC Trial Assessing

Combination TreatmentIPFS international prognostic factor scoreIPI international prognostic indexIRS Intergroup Rhabdomyosarcoma

StudiesISO International Organisation for

StandardisationISS international staging systemITA Italian Tamoxifen Arimidex trialITT intention to treatITU intensive therapy unitIU international unitsi.v. intravenousIVC inferior vena cavaIVU intravenous urogramJDG jugulo-digastricJVP jugulo-venous pressureKIT kitten (v-kit Hardy-Zuckerman 4

feline sarcoma viral oncogenehomolog)

KPS Karnofsky performance statusKRAS v-Ki-ras2 Kirsten rat sarcoma viral

oncogene homologLACE Lung Adjuvant Cisplatin EvaluationLAK lymphokine-activated killerLCIS lobular carcinoma in situLD latissimus dorsi; lymphocyte depletedLDH lactate dehydrogenaseLDL low-density lipoproteinLDR low dose rateLE local excision

xiv






Abbreviations

LEEP loop electro-excision procedureLFT liver function testLGG low-grade gliomaLH luteinising hormoneLHRH luteinising hormone releasing

hormoneLHRHa luteinising hormone releasing

hormone agonistLLETZ large loop excision of the

transformation zoneLM lentigo malignaLMM lentigo maligna melanomaLN lymph nodeLOH loss of heterozygosityLR local recurrenceLVI lymphovascular invasionMAB maximal androgen blockadeMACIS metastases, age, completeness of

surgery, invasion of extrathyroidaltissues, size

MAG 3 mercaptoacetyltriglycerineMAGE melanoma antigen expression familyMAGIC Medical Research Council Adjuvant

Gastric Infusional ChemotherapyMALT mucosa-associated lymphoid tissueMAP mitogen activated proteinMAPK mitogen-activated protein kinaseMART melanoma antigen recognised by

T-cellsMBC metastatic breast cancerMBq mega-BecquerelMC mixed cellularityMDM multidisciplinary meetingMDR medium dose rateMDT multidisciplinary teamMEN multiple endocrine neoplasiaMF mycosis fungoidesMFH malignant fibrous histiocytomaMGMT O6 methylguanine-DNA

methyltransferaseMGUS monoclonal gammopathy of

undetermined significanceMHRA Medicines and Healthcare Products

Regulatory AuthorityMIBG meta-iodobenzylguanidineMInT MabThera® International TrialMLC multileaf collimatorMM malignant melanomaMR magnetic resonanceMRC Medical Research Council

MRCP magnetic resonancecholangiopancreatogram

MRI magnetic resonance imagingmRNA messenger ribonucleic acidMS median survivalMSCC malignant spinal cord compressionMSH DNA mismatch repair geneMSI microsatellite instabilityMSU midstream urineMTC medullary thyroid carcinomaMTD maximally tolerated doseMTI malignant teratoma intermediatemTOR target of rapamycinMTT malignant teratoma trophoblasticMTU malignant teratoma undifferentiatedMUC-1 mucin 1MUGA

scanmultigated acquisition scan

MV megavoltageMW molecular weightMYC v-myc myelocytomatosis viral

oncogene homologNAC nipple areola complexNAHT neoadjuvant hormone therapyNCCN National Comprehensive Cancer

NetworkNCCTG National Central Cancer Treatment

GroupNCI National Cancer InstituteNCI-

CanadaNational Cancer Institute of Canada

NCRI National Cancer Research InstituteNCRN National Cancer Research NetworkNd-YAG neodynium-doped

yttrium-aluminium-garnetNEAT National Epirubicin Adjuvant TrialNET neuroendocrine tumourNF neurofibromatosisNHL non-Hodgkin lymphomaNHS National Health ServiceNICE National Institute for Health and

Clinical ExcellenceNIH National Institutes of Healthn-myc official symbol = NMI; official

name = N-myc (and STAT)interactor (NMI)

NNT number needed to treatNOS not otherwise specifiedNPVMD non-pulmonary visceral metastatic

disease

xv






Abbreviations

NS not significantNSAA non-steroidal antiandrogenNSABP National Surgical Adjuvant Breast and

Bowel ProjectNSAID non-steroidal anti-inflammatory drugN/saline normal salineNSCLC non-small-cell lung cancerNSGCT non-seminomatous germ cell tumourNST no specific typeNTRAC National Translational Cancer

Research NetworkOAR organs at riskOC oesophageal cancerOFS ovarian function suppressionOR odds ratioOS overall survivalp450 cytochrome p450PAI-1 plasminogen activator inhibitor type 1Pap PapanicolauPCI prophylactic cranial irradiationPCNSL primary central nervous system

lymphomapCR pathological complete responsePDA poorly differentiated

adenocarcinomaPDC poorly differentiated carcinomaPDD percentage depth dosePDGF platelet-derived growth factorPDGFR platelet-derived growth factor

receptorPDN poorly differentiated neoplasmPDR pulsed dose ratePDT photodynamic therapyPEI percutaneous ethanol injectionPERCHE Premenopausal Endocrine

Responsive Chemotherapy TrialPET positron emission tomographyPFS progression-free survivalPgR progesterone receptorPI3K phosphatidyl inositol 3 kinasePICC peripherally inserted central catheterPLD post-transplantation

lymphoproliferative diseasePLDH pegylated liposomal doxorubicin

hydrochloridepM pathological metastasis stagePMS PMS1 postmeiotic segregation

increased 1pN pathological lymph node stagePNET primitive neuroectodermal tumour

p.o. per oralPORT postoperative radiotherapyPPE palmar-plantar erythrodysaesthesiaPR partial responsePR-A progesterone receptor APR-B progesterone receptor BPRV planning risk volumePS WHO performance statusPSA prostate-specific antigenPSTT placental site trophoblast tumourpT pathological tumour stagePTC papillary thyroid carcinoma (in

thyroid cancer); percutaneoustranshepatic cholangiograph (inhepatobiliary cancer)

PTCH patched genePTEN phosphatase and tensin homolog

(mutated in multiple advancedcancers 1)

PTH parathyroid hormonePTH-RP parathyroid hormone-related

peptidePTV planning target volumePUVA psoralen plus ultraviolet APV per vaginaPVC poly(vinyl chloride)QA quality assuranceQART Quality Assurance in Radiation

TherapyQLQ quality of life questionnaireQOL quality of lifeR0 complete resectionRAGE renal antigen expression familyRAF v-raf-1 murine leukaemia viral

oncogene homologRAS rat sarcoma viral oncogene homologRb retinoblastomaRB1 retinoblastoma 1 (including

osteosarcoma)RBE radiobiologically equivalent doseRCC renal cell carcinomaRCR Royal College of RadiologistsRCT randomised controlled trialREAL revised European-American

lymphomaRECIST response evaluation criteria in solid

tumoursRFA radiofrequency ablationrhTSH recombinant human

thyroid-stimulating hormone

xvi






Abbreviations

RMI relative malignancy indexRMH Royal Marsden HospitalRMS rhabdomyosarcomaRPLND retroperitoneal lymph node dissectionRR response rateRT radiotherapyRTOG Radiation Therapy Oncology GroupS-100 S-100 calcium-binding proteinSAB same as beforeSABCS San Antonio Breast Cancer

SymposiumSAE serious adverse eventSCC squamous cell carcinomaSCF supraclavicular fossaSCLC small-cell lung cancerSCTBG Scottish Cancer Trials Breast GroupSEER Surveillance Epidemiology and End

ResultsSERM selective oestrogen receptor

modulatorSHH sonic hedgehogSI sacro-iliacS–I superior–inferiorSIADH syndrome of inappropriate

antidiuretic hormoneSIGN Scottish Intercollegiate Guidelines

NetworkSIOP Societe Internationale d’Oncologie

PediatriqueSLN sentinel lymph nodeSLND sentinel lymph node dissectionSM setup marginSMA smooth muscle actinSLNB sentinel lymph node biopsySOFT Suppression of Ovarian Function TrialSPECT single photon emission computed

tomographysrc v-src sarcoma (Schmidt-Ruppin A-2)

viral oncogene homologSRH stigmata of recent haemorrhageSSD source-skin distanceSSG Scandanavian Sarcoma GroupSSM superficial spreading melanomaSSP statutory sick paySSRS somatostatin receptor scintigraphySTNI subtotal nodal irradiationSUSAR suspected unexpected serious

adverse reactionSUV standardised uptake valueSV 40 simian virus 40

SVC superior vena cavaSVCO superior vena cava obstructionSWOG Southwest Oncology GroupSXR superficial X-rayT4 thyroxineTACE transarterial chemoembolisationTAH total abdominal hysterectomyTB tuberculosisTBI total-body irradiationTCC transitional cell carcinomaTD teratoma differentiatedt.d.s. three times a dayTEM transanal endoscopic microsurgeryTEXT Tamoxifen and EXemestane TrialTFT thyroid function testTg thyroglobulinTGF-β transforming growth factor betaTis carcinoma in situTKI tyrosine kinase inhibitorTLD thermoluminescence dosimetryTLS tumour lysis syndromeTME total mesorectal excisionTMR tissue maximum ratioTNFα tumour necrosis factor alfaTNM tumour nodes metastasesTP53 tumour protein p53TPR tissue phantom ratioTRAM transverse rectus abdominus

myocutaneousTRH thyrotropin-releasing hormoneTRUS transrectal ultrasoundTSC trial steering committeeTSE total skin electronsTSH thyroid-stimulating hormoneTTF-1 thyroid transcription factor 1TUR transurethral resectionTURBT transurethral resection of bladder

tumourTURP transurethral resection of the prostateTVS transvaginal ultrasoundUC ulcerative colititsU+E urea and electrolytesUICC International Union Against CancerUK United KingdomUKCCSG United Kingdom Children’s Cancer

Study GroupUKCTOCS UK Collaborative Trial of Ovarian

Cancer ScreeningUKNET United Kingdom Neuroendocrine

Society

xvii






Abbreviations

ULN upper limit of normaluPA urokinase-type plasminogen

activatorUS ultrasound scanUSA United States of AmericaUS Inter-

groupUnited States Intergroup

USPIO ultra-small-particle iron oxideUV ultravioletUVA ultraviolet AUVB ultraviolet BVAIN vaginal intraepithelial neoplasiaVATS video-assisted thoroscopic surgeryVC vomiting centreVEGF vascular endothelial growth factorVEGFR vascular endothelial growth factor

receptorVHL Von Hippel-LindauVIN vulval intraepithelial neoplasiaVIP vasoactive intestinal peptideVSIM virtual simulation softwareVQ ventilation perfusionWAGR Wilms’ tumour, aniridia, ambiguous

genitalia and mental retardationWBC white blood cellWBS whole-body scanWHO World Health OrganisationWLE wide local excisionXRT X-ray treatment

Chemotherapy regimens

ABVD doxorubicin, bleomycin, vinblastine,dacarbazine

ABVPP doxorubicin, bleomycin, vinblastine,procarbazine, prednisolone

AC doxorubicin, cyclophosphamideA→CMF doxorubicin, cyclophosphamide,

methotrexate, 5-FUAC→

pacli-taxel

doxorubicin, cyclophosphamide thenpaclitaxel

ACVBP doxorubicin, cyclophosphamide,vindesine, bleomycin, prednisolone

A-T-C doxorubicin, paclitaxel,cyclophosphamide

AVG doxorubicin, vinblastine, gemcitabineBEACOPP bleomycin, etoposide, doxorubicin,

cyclophosphamide, vincristine,procarbazine, prednisolone

BEAM carmustine, etoposide, cytarabine,melphalan

BEC bleomycin, etoposide, carboplatinBEP bleomycin, etoposide, cisplatinBOP bleomycin, vincristine, cisplatinBu/Cy busulphan, cyclophosphamideCAF cyclophosphamide, doxorubicin,

5-FUCarboPEC carboplatin, etoposide,

cyclophosphamideCAP cyclophosphamide, doxorubicin,

cisplatinCAV cyclophosphamide, doxorubicin,

vincristineC-BOP carboplatin, bleomycin, vincristine,

cisplatinCG cisplatin gemcitabineCHOEP cyclophosphamide, doxorubicin,

vincristine, etoposide,prednisolone

CHOP cyclophosphamide, doxorubicin,vincristine, prednisolone

CMF cyclophosphamide, methotrexate,5-FU

CMV cisplatin, methotrexate, vinblastineCOJEC cisplatin, vincristine, carboplatin,

etoposide, cyclophosphamideCOPP cyclophosphamide, vincristine,

procarbazine, prednisoloneCTD cyclophosphamide, thalidomide,

dexamethasoneCVAD cyclophosphamide, vincristine,

doxorubicin, dexamethasoneCVP cyclophosphamide, vincristine,

prednisoloneCYVADIC cyclophosphamide, vincristine,

doxorubicin, dacarbazineDAT daunorubicin, ara-C, thioguanineDHAP dexamethasone, cytarabine,

cisplatinEBVD epirubicin, bleomycin, vinblastine,

prednisoloneEC epirubicin, cyclophosphamideECF epirubicin, cisplatin, 5-FUE→CMF epirubicin, cyclophosphamide,

methotrexate, 5-FUECX epirubicin, cisplatin, capecitabineEMA-CO etoposide, methotrexate,

actinomycin-D – cyclophos-phamide, vincristine

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Abbreviations

EOF epirubicin, oxaliplatin, 5-FUEOX epirubicin, oxaliplatin,

capecitabineEP etoposide, cisplatinEP-EMA etoposide, cisplatin – etoposide,

methotrexate, actinomycin-DESHAP etoposide, methylprednisolone,

cytarabine, cisplatinFAC 5-FU, doxorubicin,

cyclophosphamideFAMTX 5-FU, doxorubicin, methotrexateFC fludarabine, cyclophosphamideFEC 5-FU, epirubicin,

cyclophosphamideFEC→

docetaxel5-FU, epirubicin,

cyclophosphamide thendocetaxel

FMD fludarabine, mitoxantrone,dexamethasone

FOLFIRI 5-FU, FA, irinotecanFOLFOX 5-FU, FA, oxaliplatinGemCarbo gemcitabine, carboplatinGem-cis gemcitabine, cisplatinGT gemcitabine, paclitaxelHD-MTX high-dose methotrexateHyper-CVAD fractionated cyclophosphamide,

vincristine, doxorubicin,dexamethasone

ICE ifosfamide, carboplatin, etoposideJEB carboplatin, etoposide, bleomycinMACOP-B methotrexate, doxorubicin,

cyclophosphamide, vincristine,prednisone, bleomycin

m-BACOD methotrexate, bleomycin,doxorubicin, cyclophosphamide,vincristine, dexamethasone

MAP methotrexate, doxorubicin,cisplatin

MIC mitomycin, ifosfamide, cisplatinMOPP mechlorethamine, vincristine,

procarbazine, prednisoloneMOPP-ABV mechlorethamine, vincristine,

procarbazine, prednisolone,doxorubicin, bleomycin,vinblastine

MVAC methotrexate, vinblastine,doxorubicin, cisplatin

MVP mitomycin, vinblastine, cisplatinNP vinorelbine, cisplatin

OEPA vincristine, etoposide,prednisolone, doxorubicin

PIAF cisplatin, interferon, doxorubicin,5-FU

PLADO cisplatin, doxorubicinProMACE-

cytaBOMprednisone, methotrexate,

doxorubicin, cyclophosphamide,etoposide, cytarabine, bleomycin,vincristine, and methotrexate

R-CHOP rituximab, cyclophosphamide,doxorubicin, vincristine,prednisolone

R-DHAP rituximab, dexamethasone,cytarabine, cisplatin

R-ICE rituximab, ifosfamide, carboplatin,etoposide

R-CODOX-M/IVAC

rituximab, cyclophosphamide,vincristine, doxorubicin,cytarabine, methotrexate,etoposide, ifosfamide

Stanford V doxorubicin, vinblastine,vincristine, bleomycin,mechlorethamine, etoposide,prednisone

SuperPLADO PLADO + carboplatinTAC docetaxel, doxorubicin,

cyclophosphamideTIP paclitaxel, ifosfamide, cisplatinVAD vincristine, doxorubicin,

dexamethasoneVIP etoposide, ifosfamide, cisplatinXELOX capecitabine, oxaliplatinZ-DEX idarubicin, dexamethasone

Radioisotopes60Co cobalt-60137Cs caesium-13718F fluorine-18123I iodine-123125I iodine-125131I iodine-131111In indium-111192Ir iridium-192103Pd palladium-103106Ru ruthenium-10699mTc technetium-99m90Y yttrium-90

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Practical Clinical Oncology