Diseases of the respiratory system. Neoplasms of the lung.

1331 radiotherapy. If need be, white count and platelets permitting, my dose can be built up to the maximum by the third course. Too often I have seen patients develop profound marrow depression and overwhelming superinfection with bacteria or fungi. Although they have survived, their morale has been harmed and they are that much more debilitated. No, I will hope to reach my maximum dose by degrees and, if need be, I will submit to an extra course or two. While I am having my nine months' course of chemotherapy I shall expect to carry on my work, something which most of my own patients manage to do. I will want to be given further MVPP if I deteriorate after a good response to earlier six-course chemotherapy. Some of my patients do well enough with the occasional single course in these circumstances, and do not seem to need a full rerun for another nine months. If I reach the position of failing to respond to MVPP I will submit to alternative drug regimens-but with little confidence or hope. Unless it is through over-vigorous treatment, dying of Hodgkin's disease is not sudden. Generally, death is from infection and exhaustion, and that never seems too distressing-at least from the observer's point of view. Knowing what is happening may make it worse, and it would be irritating to die from a disease when that outcome is becoming rarer. Survival is far more likely, and the experience of serious illness would probably be good for my future practice, though I would be happier to forego the experience and continue to treat patients with cancer without being a victim myself. Neoplasms of the lung cause 33 000 deaths a year in England and Wales and remain the commonest of all cancers. There are four common histological subtypes: epidermoid (squamous) carcinoma, anaplastic small cell (oat cell) carcinoma, adeno-carcinoma, and large cell anaplastic carcinoma. The first two appear to be induced bv smoking, but the last two may not be entirely related to the habit. While stopping smoking has no influence on the established case, giving up may halt or reduce the increasing risk of cancer from continued smoking. Attempts to cure the established condition fail in all but a fortunate 5-7 '"0. The presenting symptoms usually occur against a background of chronic bronchitis of variable degree. Invasion of the bronchial mucosa by the primary lesion results …