The management of cancer has
never been simple or satisfactory. In
the not too distant past, a relatively
limited evaluation could ascertain
whether the patient was beyond
curative primary therapy. If this
proved to be the case, the clinician
felt his therapeutic responsibility was
terminated; he concentrated his efforts on keeping the patient as comfortable as possible until the "end."
This philosophy has not changed, but
where formerly it meant morphine
and empathy, now in addition to
these pillars of medical practice, we
have many therapies: alone and in
combination, tested and experimental, helpful and harmful.
To add to the confusion of the
clinician, even the definition of what
"is beyond curative primary therapy"
is becoming more difficult to determine. Examples are numerous:
lymphangiography revolutionized the
significance of staging in Hodgkin's
Disease; this helped to change the
approach to therapy. Radiation therapy undertakes to reduce surgically
inoperable lesions to operable