Current Issues in Cancer

In the narrowest sense radiotherapy is a treatment almost exclusively used in managing cancer and based on the use of ionising radiation. In practice, however, the scope of the subject is broad (box 1) as management decisions relating to cancer must be made in the context of a thorough appraisal of the tumour and patient. Tumours are characterised by histogenesis and morphology, and, increasingly, molecular and genetic analyses are improving the precision and prognostic power of histopathology.' 3 Assessment of patients must incorporate not only a thorough general medical examination but investigation with both established and developing radiological techniques, which can provide sensitive assessments of extent of disease and may soon be able to give information such as tumour blood flow,4 cell membrane turnover,5 proliferative capacity, or degree of oxygenation.6 Radiotherapy is used for about half of the 200 000 patients who develop cancer in the United Kingdom each year.7 It has a curative role in two thirds of patients and a palliative role in the remainder (box 2). Increasingly, management of cancer also involves surgery and chemotherapy.8 For many cancers the appropriate balance of treatments is still being evaluated, and audit and clinical trials are particularly important in view of the speed and frequency with which treatment advances are brought into clinical practice. Among the problems compounding the difficulties of treating cancer is the need for medical and psychological support for coincidental or treatment related problems and for the anxiety and stress experienced by patients and their relatives at the prospect of a life threatening illness.9 In the United Kingdom radiotherapists are often also responsible for chemotherapy, and the breadth of management responsibility has led to the renaming of the specialty as clinical oncology.