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INTRODUCTION

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The major features of this chapter are the clinical aspects of cancer, including etiology and prevention; staging; diagnosis and treatment of common cancers; and recognition and management of complications from cancer.

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Etiology

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Cancer is the second most common cause of death in the United States. In 2015, an estimated 1,658,370 cases of cancer were diagnosed, and 589,430 persons died as a result of cancer. Based on current statistics, one in three Americans will be diagnosed with cancer in their lifetime. Table 39–1 lists the 10 leading cancer types in men and women by site.

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Table 39–1.Estimated 10 most common cancer cases in the United States in males and females (all races).
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However, the death rates from cancer are decreasing. Compared to the 1991 cancer death rate of 215.1 per 100,000 population, the 2009 rate of 173.1 per 100,000 represents a 20% reduction in its death rate. Importantly, death rates have declined in the four most common cancer types (lung, colon-rectum, breast, and prostate). The largest declines in death rates have been seen in chronic myeloid leukemia, stomach and colorectal cancer, and non-Hodgkin lymphoma.

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Reductions in cancer mortality reflect a successful implementation of a broad strategy of prevention, detection, and treatment. Due to these improvements, the number of cancer survivors is increasing. In 2015, an estimated 14.5 million people were alive in whom cancer had been diagnosed at some point previously; that number is projected to grow to 18.9 million in 2024.

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Modifiable Risk Factors

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Tobacco is the most common preventable cause of cancer death; it is estimated that at least 30% of all cancer deaths in the United States are directly linked to tobacco. In 2013, a total of 174,100 cancer deaths in the United States could be directly attributed to tobacco abuse. Clear evidence links at least 15 cancers to tobacco use. The most dramatic link is with lung cancer; 80% of lung cancer cases occur in smokers. Remarkably, among individuals who are long-term survivors of a tobacco-related cancer, almost 10% continue to use tobacco products, increasing ...

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