7.03.1 Disease State

Cancer broadly describes diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread through the bloodstream and lymphatic system to other parts of the body. The US National Institutes of Health (NIH) defines four general types of cancer.1 Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the bloodstream. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. The antimetabolite chemotherapeutics described in this review have generally been used to treat leukemias, lymphomas, and carcinomas.

Cancer of all types is the second leading cause of death in the USA, with 22.9% of deaths attributed to cancer in 2001, and it is estimated that almost 1.4 million new cases will be diagnosed in 2005 in the USA.2 Cancer is a more significant health issue in the developed countries than in less developed nations, with incidence for all cancers almost twofold higher in the former. The annual incidence per 100000 is 271 cases in developed nations such as the USA, Canada, and the countries of the European Union in comparison to 144 cases in less developed nations.3 The US Annual Report to the Nation on the Status of Cancer, 1975-20014 shows overall cancer incidence rates increased at a rate of 1.5% per year over the

Table 1 Cancer incidence,

mortality, and 5-year relative survival rates in the USA

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