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A Emergency and Supportive Measures
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Observe patients for at least 6 hours, and admit all patients with evidence of anticholinergic effects (eg, delirium,
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Specific information regarding emesis and chlorinated insecticides appears in CMDT Online at http://www accessmedicinecom
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The clinical aspects of cancer prevention, diagnosis, primary treatment, management of complications, and paraneoplastic syndromes are the main focus of this chapter Further information may be obtained by calling the National Cancer Institute (NCI) Cancer Information Service at 1-8004CANCER or accessing NCI s comprehensive cancer information database Physician Data Query (PDQ) via the Internet at wwwcancergov/cancerinformation PDQ is also available on CD-ROM The CANCERLIT feature of Medline (PubMed) is a familiar resource for articles about cancer that can be accessed by author or by subject words A series of oncology practice guidelines compiled by a panel of United States experts and encompassing diagnosis and treatment of a wide variety of cancers as well as pain management is available free of charge at the National Comprehensive Cancer Network Web site (wwwnccnorg) and is updated yearly The American Society of Clinical Oncology has an information Web site for patients and their families (www PeopleLivingWithCancerorg) as well as patient guides on subjects such as follow-up care for breast and colorectal cancers, understanding tumor markers, treatment of nausea and vomiting, and advanced lung cancer Two Web sites provide updated data as well as review articles on advances in oncology; these sites allow the user to search for specific areas of interest as well: PeerView Press (info@peerviewpresscom) and Medscape Hematology-Oncology (http:// wwwmedscapecom/hematology-oncologyhome)
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Cancer is the second most common cause of death in the United States The American Cancer Society estimates that almost 14 million new cases of invasive cancer will be diagnosed in the year 2007, with over 559,000 deaths Some type of invasive cancer will develop in slightly less than one of every two men and slightly more than one of every three women in the United States during their lifetime Based on the SEER 2005 database, the lifetime probability of developing cancer is about 46% for men and 38% for women and varies by race, and age Table 39 1 summarizes current US incidence and mortality figures for the ten leading types of cancer Women
have an approximately 1:8 lifetime chance of developing breast cancer, and men have an approximately 1:6 chance of developing prostate cancer Cancers of the lung, prostate, and breast and of the colon and rectum account for about 55% of all new cancer diagnoses and for over 50% of cancer deaths in the United States Lung cancer is the leading cause of cancer death in the United States, accounting for almost one-third of deaths in men and women Table 39 2 summarizes the lifetime risk of being diagnosed with or dying from the leading causes of cancer as well as from all types of cancer Rates are age adjusted to the year 2000 standard million population based on the 2000 census data The single most important risk factor for developing cancer is age About 76% of cancers are diagnosed in persons aged 75 years or older As the United States population increases in numbers and grows older, it is estimated that the number of cancer cases will double, by the year 2050, from 13 million cases per year to 26 million cases per year In the United States, the incidence of cancer stayed relatively stable and cancer-related mortality decreased an average of 1% per year from 1995 to 2002, although this progress has not been shared equally across all racial and ethnic populations This now sustained decline is attributed to changes in lifestyle as well as improved prevention, early detection, and treatment that clearly needs to be generalized to include all populations Interestingly, among men, the rate of cancers of the prostate and kidney, and melanoma increased; the same was true for lymphoma and melanoma in women The incidence of breast cancer in women markedly decreased in the year 2003 in women aged 50 and older; this decrease has been attributed to the rapid decline in the use of hormone replacement therapy following the initial publication of the Women s Health Initiative (WHI) trial Colorectal cancers decreased in both sexes Lung cancer incidence in women has stabilized since 1998, after increasing for the prior three decades Cancer incidence and mortality vary significantly among racial and ethnic groups, with blacks having the highest rates of mortality even in diseases for which the incidence of the specific cancer is lower than that seen in the white population Stage for stage, 5-year survival rates are lower, even when the fact that cancers are less likely to be diagnosed in localized sites is taken into account Recent data suggest that this difference is due in part to marked variations in the biology of the cancer
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