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Cancer medicine: principles of treating malignant disease: Part two: medical treatment

BMJ 2001; 323 doi: (Published 01 October 2001) Cite this as: BMJ 2001;323:0110371
  1. Carlo Palmieri, CRC clinical research fellow1,
  2. Anjana Singh, surgical research fellow1
  1. 1department of cancer medicine, Imperial College School of Medicine, London

Carlo Palmieri and Anjana Singh discuss the available options

This second article deals with the non-surgical or medical treatments and aims to provide an overview of this area of medicine. Current medical treatments or modalities include chemotherapy, radiotherapy, endocrine therapy, immunotherapy, and monoclonal antibodies.


There are six basic facts you should know:

  1. Chemotherapy or cytotoxic agents are drugs which interfere with cell division by preventing DNA synthesis or interacting with DNA leading to breaks in the structure.

  2. They are non-selective and will affect any cell which is rapidly dividing, whether it is malignant or non-malignant.

  3. Cytotoxics are usually given in combination, with drugs which interfere with replication at different phases of the cell cycle being used. This improves their effectiveness and reduces the likelihood of the development of drug resistance by the tumour.

  4. Chemotherapy is given every 21 to 28 days to allow recovery of the bone marrow.

  5. Each treatment is called a cycle and usually a course of chemotherapy involves a number of cycles.

  6. Expected toxicities of each agent given in combination should not overlap.

Cautionary notes

Vinca alkaloids--for example, vincristine and vinblastine--are highly neurotoxic and are given only intravenously. They kill if given intrathecally.

Methotrexate accumulates in ascites and pleural effusions and can later leak back into the circulation causing toxicity. Hence these should be drained before treatment or a lower dose of drug should be used.

Taxanes--that is, docetaxel and paclitaxel--can cause hypersensitivity reactions, hence premedication with steroids and antihistamines is given.

Cytotoxics such as vinca alkaloids, anthracyclines, and mitomycin C are vesicants and if they extravasate--that is, leak into surrounding tissue--they can cause severe tissue damage.


There are five basic facts you should know:

  1. Radiotherapy involves the use of high energy ionising radiation to cause DNA damage and ultimately cell death.

  2. Dose of radiotherapy is measured in Grays …

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