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By Neal, Anthony J

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Again, this had not been appreciated in an earlier CT survey. (a) 20 PRINCIPLES OF CANCER DIAGNOSIS AND STAGING cancer. It is accepted and contributed to by the most eminent cancer research groups such as the World Health Organization, International Union Against Cancer, and International Society of Paediatric Oncology. A formalized, universally applied staging scheme has several advantages. First, it aids the clinician in his or her appreciation of the extent of the cancer and gives a meaningful guide to likely prognosis.

1 Treatment options. Treatment options TREATMENT OPTIONS To treat or not to treat Not every patient in whom a diagnosis of cancer is made will benefit from active treatment of their disease. There is, for example, good evidence to show that active local treatment in the form of radiotherapy for inoperable carcinoma of the bronchus in poor performance status patients will have no impact whatsoever on the survival of a patient. It follows therefore, that in asymptomatic patients diagnosed with this condition, treatment will only be meddlesome and indeed may detract from that patient’s quality of life by invoking side-effects for no positive outcome.

Meaningful discussions with a patient who has advanced incurable cancer can, however, only progress once the notion of dying has been accepted, if only to subsequently agree not to mention it further. Patients and their relatives will often hide behind euphemisms such as ‘the end’ or ‘when it’s all over’, whilst healthcare professionals may use terms such as ‘very serious’ or ‘incurable’ to introduce the idea that an illness is fatal. Realistic expectations are important for practical issues to be faced such as where and by whom the patient wishes to be cared for in his or her last days, clarification of their wishes in the form of a will and, where dependent children are involved, arrangements for their future care.

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