The term ‘malignant disease’ encompasses a wide range of illnesses, including common ones such as lung, breast and colorectal cancer (Table 9.1), as well as rare ones, like the acute leukaemias. Malignant disease is widely prevalent and, in the West, almost a third of the population will develop cancer at some time during their life. It is second only to cardiovascular disease as the cause of death. Although the mortality of cancer is high, many advances have been made, both in terms of treatment, and in understanding the biology of the disease at the molecular level.

Treatment is given with curative or palliative intent, depending upon the evidence from continuing clinical trials. For many people, the word ‘cancer’ implies certain death, although this is clearly not always the case. Physicians have an obligation to be honest with their patients, combining realism about the prognosis with compassion and understanding so that patients can take an informed part in treatment decisions.

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