This book is a comprehensive practical guide to the essential facts about most types of cancer-how to look for and diagnose cancer in the physician's office and what to do about it initially. It is not a definitive treatise or reference work on the subject of cancer and all its ramifications. A number of excellent volumes of this scope are available to those who wish to pursue the subject in depth. Furthermore, since the average practitioner does not have the facilities available for the definitive therapy of most types of cancer and since the all-important thing is to make an early diagnosis, treatment has not been included in this book.

This book consists of a total of eleven chapters and has been so arranged that if the physician will read Chapter 2, "The Cancer Detection Examination," the remaining chapters can be treated as separate entities. It is written for practicing physicians in all branches of medicine who have to deal with cancer, especially those in the fields of general medicine and surgery. It will also be useful to medical students, interns, and residents who want to become acquainted with the fundamentals of clinical cancer practice.

An attempt has been made to keep the material in semioutline, didactic form for easy reading and assimilation by the reader.

Why This Book?

This book stems from the following convictions:

1. Because of our aging population, cancer is becoming an increasingly frequent cause of disability and death.

2. The first physician to see the patient is unquestionably in the first line of defense against cancer. It is he who determines how long the hiatus will be between the beginning of the disease, the early symptoms and signs, the first suspicions, the diagnosis, and, finally, treatment. Until the latter part of this sequence, the consultant or cancer specialist may play little or no role. Thus, any realistic program of cancer control must start with the family physician. Furthermore, he is the one who must often counsel the patient and his family regarding extensions of diagnosis, choices of treatment, prognosis, and the like.

3. More and more people are coming to their doctors with few or no symptoms asking for a "checkup." Often cancer is the overt or unspoken reason for this. The term checkup may mean all things to all people, including doctors. It is the purpose of this book to define a cancer-oriented checkup which, with only a few modifications, can form the basis for a good general medical evaluation. Above all, this examination must strike a reasonable balance between effort and yield, a compromise between the minimum and the ideal.

4. It is hoped that this book will fill a vacuum. Although many valuable exhaustive treatises are available, there is, to our knowledge, no small, concise, authoritative book which brings together in one place the essential facts about most types of cancer.

5. It is our firm conviction that many lives presently lost could be saved through the application of the practical techniques of cancer detection, diagnosis, and prevention described in this book.

What Is In This Book?

1. Cancer which is common or accessible. To qualify for inclusion in this book, cancer of any site had to meet one of two criteria: frequency and accessibility.

(a) Frequency: Our attitude is that all doctors should be familiar with the fundamentals of the common cancers-regardless of how good or bad the techniques available for their detection or diagnosis are and without regard to their usual chances for cure following treatment. Thus it would be unrealistic to state that cancers of the lung or stomach are anything but discouraging. Nevertheless, their very frequency demands the physician's familiarity with them. Of course, for many other common cancers, quite the reverse situation with regard to prognosis holds.

(b) Accessibility: Included also are a number of cancers which, though relatively or actually uncommon, are readily accessible to inspection, palpation, and other simple techniques of detection and diagnosis and which may carry a high chance for cure when discovered in an early, localized stage. It would be equally unrealistic to omit cancer of the oral cavity, testicles, and vulva and run the risk of contributing to the missing of such accessible and potentially curable lesions.

Such a rule of thumb results in the inclusion in this book of about 85 per cent of all cancer as it occurs today.

There remains a hard core of lesions which, though fortunately of lesser incidence, have a dismally low score as far as accessibility and prognosis are concerned. These include cancer of the pancreas, cancer of the central nervous system, cancer of the liver, etc. For these, the reader must turn to other volumes.

Throughout this book we have endeavored to concentrate on those methods and procedures which are practical from the standpoint of time, expense, and patient convenience and which are reliable.

2. Background and details in selected areas. These have been included wherever it is thought that they may be of help to the doctor in his understanding of the problem or the management of the patient and his family. For example, epidemiologic data are included for cancer of some sites because this information may assist the physician in selecting his patients for intensive survey, in advising them about cancer hazards, and occasionally in making a differential diagnosis. Also, some details of gross pathology are included whenever it seemed likely that they might help the doctor in deciding, for example, on the cancer potential of a lesion discovered on x-ray examination or in estimating prognosis.

3. Numerous drawings and other visual aids. We feel that these are far superior to unrelieved paragraphs of prose or even photographs.