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Many cancers are driven by hormones in the body. For instance, breast, prostate and uterine cancers. Over the years we have developed effective blockers of hormones that drive these cancers. These blockers have found a way into common usage, particularly in breast and prostate cancers.

Biological therapies are treatments that are gaining importance as we progress globally with the management of cancer. Understanding the biology of cancer has enabled us to understand the targets that go wrong in those cancers. We have successfully used many biological treatments that hit directly those targets in order to inhibit or switch-off the cancers. These biological therapies may be useful on their own or more commonly, combined with standard cancer treatment such as chemotherapy, surgery and radiotherapy. 

Chemotherapy is a scary word. It is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells and is a general term for many different kinds of treatment and drugs. There are more than 50 different chemotherapy drugs. In principle, it means not treating by surgery and radiotherapy, but by giving drugs that affect the entire body equally. The drugs go into the bloodstream and travel throughout the body to treat the cancer cells wherever they are. It can be given either as a tablet, or as an injection or infusion directly into a vein. Chemotherapy can cause side effects. The side effects will depend on which drug (or combination of drugs) is used. There are now very good ways of preventing or reducing the side effects of chemotherapy. 

Organ transplant is almost never associated with cancer. The reason for this is that, in the main, you cannot be sure that a cancer is completely cured until many years after diagnosis. In addition, organ transplantation carries many hazards including deliberate immonosuppression of the patient, which is associated with cancer risk.

Deliberately induced immunosuppression is generally done to prevent the body from rejecting and organ transplant.

Usually cancers which are diagnosed early have excellent survival rates. Patients are often cured when an early cancer is diagnosed and a multimodality therapy is given. However, there are types of cancer, which have exquisite response rates and where cure is the rule. These include diseases such as testicular cancer, lymphoma, choriocarcinoma, early cancer of the bowel and gut and even early ovarian cancer. Often patients are cured of these diseases.

Testicular Cancer Men who have a type of testicular cancer called seminoma have a very good chance of being cured. Since the introduction of combination chemotherapy in the 1970s, survival crates for testicular cancer have risen every year to cure rates of over 95 percent. The percentage of men who recover from early-stage testicular cancer is getting close to 100 percent.

Non Hodgkin's Lymphoma (NHL) Fifty one out of every 100 people (51percent) diagnosed in England and Wales with all types of NHL will live for at least 10 years. However, outcome of non Hodgkin’s lymphoma depends partly on how advanced it is when it is diagnosed.

Bowel Cancer If diagnosed early, over 90 percent of bowel cancer cases can be treated successfully.

Cancer is the general name for a group of diseases in which cells in a part of the body begin to grow out of control. All cancers start because abnormal cells grow out of control. If the immune system does not destroy these cells, they will continue to grow and invade adjacent tissues. Cancer usually kills because abnormal cells impair the function of the organ or tissue they are growing on.

Cancer can cause death by spreading from the primary site to other parts of the body. Usually, this is well tolerated and people can live well for many years without problems. Many treatments can control cancer for a long time even if they can not cure it. Bear in mind that some cancers have survival rates of more than 90 percent and overall, more than 50 percent of people diagnosed with cancer live for more than five years. However, if a cancer continues to grow it can overwhelm the body’s essential functions such as the lungs, liver and digestive system. If this happens the treatment may no longer control the cancer and this might make it difficult to survive such an experience. 

For most people having cancer is a single experience and hopefully one that is overcome. The main reason for a cancer relapse is because an incomplete clearance of the cancer cells. Cancer cells that grow without limitation, so even if one cell survives then it can multiply and cause the cancer to recur. Relapse is either local or distant. The former occurs when cells appear in the same location; for example breast cancer reoccurring in the breast. The latter occurs when a relapse is a metastases; for example breast cancer appearing in the lung or liver. Cancer may reoccur in people who have continued exposure to adverse environmental risks such as smoking or people who may have a genetic predisposition to cancer. In both these settings where there is a continued underlying risk, then a cancer may reoccur or other cancers may develop.

There are many different kinds of cancers. In fact, there are as many different cancers as there are tissue types in the body. The diversity of human tissue is incredible and it is possible for cancers to arise from almost any site and many cell types. However, there are probably 20 or so dominant types of cancer.  Although there are many kinds of cancer, they all start because abnormal cells grow out of control. From another point of view, there are as many different types of cancer as there are different types of human cell- just over 200. However, cancers can be broadly grouped into four types, depending on which tissues they come from.

• Carcinomas: arise from the cells that cover external and internal body surfaces. For example, lung, breast, and colon.
• Sarcomas: arise from cells found in the supporting tissues of the body such as bone, cartilage, fat, connective tissue and muscle.
• Lymphomas: arise in the lymph nodes and tissues of the body's immune system.
• Leukaemias: arise from immature blood cells that grow in the bone marrow and tend to accumulate in large numbers in the bloodstream.

Race and ethnicity is a complex issue for cancer. Partly there is an impact, which is truly about ethnic origins. The first breast cancer gene to be discovered is called BRCA1 and inherited mutations in BRCA1 increase the risk of various cancers including: breast, ovarian, uterus, cervix, pancreatic, and maybe prostate cancer. About 1.5 percent of the Ashkenazi (European origin) Jewish population carries an inherited mutation in the BRCA1 gene. While this increased risk could be due to a variety of factors such as diet and cigarette smoking, a growing body of evidence suggests that a significant portion of the increased risk of cancer in individuals of Ashkenazi Jewish descent has a genetic basis. In developed societies ethnicity tends to be a surrogate for economic activity and access the treatments. So, when the issue of ethnicity is raised in North America it is very different to when it is raised in, say, Israel. Breast cancer for Afro-Americans is tends to be more associated with socio-economic issues than it does ethnicity. 

Some of the most intensive and active research has been in the field of angiogenesis, which attempts to conquer a disease by controlling the blood vessels that feeds it. A large amount of research has resulted in the development of active agents that blocks blood vessels and starves tumors of oxygen. We are now beginning to see signals of the benefits of this approach in patients.  However, it is still early days, further research is required, which will take time.