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Volume 3, Issue 2 |
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| Diagnosis and management of multiple myeloma |
Alastair G Smith BSc MBChB FRCP (Glasgow & London) FRCPath Consultant Haematologist and Honorary Clinical Senior Lecturer, Southampton General Hospital, Southampton University Hospitals NHS Trust |
Myeloma is a complex disease to diagnose and manage. Although it is still ‘incurable’, an increasing range of supportive and antineoplastic treatments offer the potential for increased duration and quality of survival. Myeloma accounts for 1.5% of cancers in the UK; the median age of onset is around 70.1 With a complex clinical management algorithm, it is a challenging condition for clinicians and patients. |
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| Eccrine porocarcinoma |
Carolyn L Datta SMBChB MRCP Specialist Registrar in Palliative Medicine, The Ayrshire Hospice, Ayr; Barry J A Laird MBChB MRCGP Specialist Registrar in Palliative Medicine, Beatson Oncology Centre, Western Infirmary, Glasgow |
A 76-year-old man with a previous history of basal cell carcinoma of the forehead (which was excised) and slowly progressive chronic lymphocytic leukaemia (CLL) presented with a 3–4 cm lesion on his forehead. An invasive, poorly differentiated squamous cell carcinoma (SCC) of his right temple was subsequently diagnosed and treated with surgery, skin grafting and photodynamic therapy. |
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| NICE’s opinion not so nice for myeloma patients |
Graham H Jackson, Editor |
As I write, we have just seen the preliminary opinion from the National Institute for Health and Clinical Excellence (NICE) on bortezomib (Velcade®, Ortho Biotech, UK) suggesting that patients should only be treated with this drug in clinical trials and that it should not be generally available. This has caused huge consternation for haematologists and patients alike. |
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| Non-opioid pain relief |
Marcia Schofield MSc MA MB BChir Clinical Research Assistant; Rajesh Munglani FRCA Consultant in Pain Management, West Suffolk Hospital, Bury St Edmunds |
Fortunately, severe pain only affects 5–10% of individuals who have cancer. For many of those patients who do experience significant pain, the use of paracetamol, anti-inflammatory drugs and mild opioids (such as codeine-based preparations or tramadol) usually provide adequate analgesia. For the more resistant cases, more potent opioids can be used, such as oral morphine and oxycodone, and sustained-release topical fentanyl and buprenorphine. |
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| Recognising high-risk groups for oesophagogastric cancer |
Rebecca Fitzgerald MA(Cantab) MBBChir MD FRCP Programme Leader, Cancer Cell Unit, Hutchison Medical Research Council Research Centre; Honorary Consultant Gastroenterologist, Addenbrooke’s Hospital, Cambridge |
Oesophagogastric cancer generally presents at an advanced stage and the prognosis is poor, despite radical multimodal therapy. Advances in our understanding of the pathogenesis of this condition mean that high-risk individuals can be identified before the development of invasive cancer. This affords the opportunity for curative treatment. |
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| The use of molecularly targeted therapy in acute promyelocytic leukaemia |
David Grimwade PhD MRCP MRCPath Senior Lecturer (Honorary Consultant), Department of Medical and Molecular Genetics, King’s College London |
Acute promyelocytic leukaemia (APL) is one of the most common subtypes of acute myeloid leukaemia (AML), accounting for 10–15% of cases. It has been of particular interest as it is the first form of leukaemia for which molecularly targeted therapies, such as all-transretinoic acid (ATRA) and arsenic trioxide (ATO), have been successfully used in clinical practice.1 |
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