The lancet oncology
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Dyspnoea, defined as a sensation of an uncomfortable awareness of breathing, is one of the most frightening and distressing symptoms for patients with cancer. It is very common in cancer patients with and without direct lung involvement. The gold standard of diagnosis and assessment is the patient's self-report. ⋯ Opioids are the first line of therapy for such relief. Medical management can be directed at the underlying cause when the potential benefits outweigh the burdens of such treatment. In rare cases for which symptomatic treatment does not control dyspnoea to the patient's satisfaction, sedation is an effective, ethical option.
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The accuracy of the dinical diagnosis of cutaneous melanoma with the unaided eye is only about 60%. Dermoscopy, a non-invasive, in vivo technique for the microscopic examination of pigmented skin lesions, has the potential to improve the diagnostic accuracy. Our objectives were to review previous publications, to compare the accuracy of melanoma diagnosis with and without dermoscopy, and to assess the influence of study characteristics on the diagnostic accuracy. ⋯ A comparison of various diagnostic algorithms for dermoscopy showed no significant differences in their diagnostic performance. A thorough appraisal of the study characteristics showed that most of the studies were potentially influenced by verification bias. In conclusion, dermoscopy improves the diagnostic accuracy for melanoma in comparison with inspection by the unaided eye, but only for experienced examiners.
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The lancet oncology · Jul 2001
ReviewDermoscopy of pigmented skin lesions--a valuable tool for early diagnosis of melanoma.
The clinical use of dermoscopy has uncovered a new and fascinating morphological dimension of pigmented skin lesions. Dermoscopy is a non-invasive diagnostic technique that links clinical dermatology and dermatopathology by enabling the visualisation of morphological features not seen by the naked eye. ⋯ In the past, dermoscopy has been known by various names, including skin surface microscopy, epiluminescence microscopy, incident light microscopy, dermatoscopy, and videodermatoscopy. However, the term 'dermoscopy', first used by Friedman and colleagues in 1991, is the most widely used.
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The lancet oncology · May 2001
ReviewAngiogenesis: pathological, prognostic, and growth-factor pathways and their link to trial design and anticancer drugs.
Angiogenesis is essential for tumour growth, invasion, and metastasis. Tumour blood vessels show many differences from normal vessels and are not genetically unstable, so they form a potentially key area for therapy of all types of cancer including leukaemias. Here we review current knowledge on the multiple pathways controlling tumour angiogenesis and assess which are the most clinically relevant. ⋯ Also, the presence of vascular endothelial growth factor in high concentrations in primary cancers is associated with poor prognosis. Key targets for drug development, current clinical trials, and the problems of developing drugs that do not have direct cytotoxic effects are reviewed. Recommendations are made on organising and monitoring antiangiogenic trials.
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The lancet oncology · Apr 2001
ReviewUnconventional therapies for cancer and cancer-related symptoms.
A significant proportion of cancer patients try unconventional therapies and many use 'complementary' therapies, as adjuncts to mainstream care, for management of symptoms and to improve quality of life. A smaller proportion use 'alternative' therapies, which are typically invasive, biologically active, and commonly promoted as replacements for, rather than adjuncts to, mainstream therapy. Many alternative therapies, including high-dose vitamin C, the Di Bella regimen, and laetrile have been shown not to be effective. ⋯ Conversely, most complementary therapies are well studied and of proven benefit. There is evidence from randomised trials supporting the value of hypnosis for cancer pain and nausea; relaxation therapy, music therapy, and massage for anxiety; and acupuncture for nausea. Such complementary therapies are increasingly provided at mainstream cancer centres.