Transcript Generalities

Generalities in oncology
Dr. Fekete Zsolt
Direct signs of cancer
Direct signs are attributed to tumor growth either at the level of
the primary tumor or at the level of lymph nodes and
metastases.
1. The primary tumor- visible or palpable in
a) superficial tumors (skin, breast cancer, testicle, soft tissues)
b) advanced deep lying tumors
2. Adenopathy=larger than normal lymph node
-can be benign or malignant
-present in tumors extending through the lymphatics: lung
cancer, breast cancer, head and neck cancer, lymphomas
3. Metastasis-visible or palpable only when superficial
! Usually, at early stages, the presence of the primary tumor or
adenopathy does not produce pain.
Indirect signs/symptoms of cancer
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More frequent than direct signs
Abnormal discharge (vagina, rectum, nasal fossae, nipple)
hemorrhagic
serous
Compression syndromes
mediastinal-compression of the superior vena cava or
compression of the esophagus
- intracranial: intracranial hypertension
- abdominal: intestinal occlusion/incomplete occlusion,
decreased urinary stream, pollakiuria, mechanical jaundice
Indirect signs/symptoms of cancercont
3. Neurologic signs:
paralysis
neuralgia
sphincterial incontinence
nerve root compression at the level of spinal cord
cranial nerve (III-XII) paralysis
4. Paraneoplastic syndromes (see Lecture Book for details)
5. General signs and symptoms:
anorexia and weight loss
small grade fever
perspirationspruritus
6. Changes in blood test values:
increased ESR (erythrocyte sedimentation rate)
Anemia
thrombocytopenia
Diagnosis of cancer
• history
• physical examination
• Non-invasive diagnostic tools: imagery and
laboratory tests
• Invasive diagnostic tools: biopsy and
pathological evaluation of tumor tissue;
imaging through an incision- thoracoscopy,
mediastinoscopy
A medical procedure is defined as non-invasive when no
break in the skin is created (there is no contact with the
an internal body cavity beyond a natural or artificial body
orifice).
Evaluation of loco-regional and distant extension
• Evaluation of local extension-tumor size and
the rapports with healthy structures
• Evaluation of extension to regional lymphaticnodes
• Evaluation of metastases
Evaluation of the biological status of the patient
• The simplest way to evaluate the detrimental
effect of the cancer on the organism as a
whole, the performance index is used:
- Zubrod index
- Karnofsky index
Evaluation of the biological status of the patientthe Zubrod scale
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0 (Karnofsky 90-100) - Fully active, able to carry on all pre-disease activities
without restriction, no weight loss.
1 (Karnofsky 70-80) – Presents symptoms or weight loss, but less than 5% of initial
weight or restricted in physically strenuous activity but ambulatory and able to
carry out work of a light or sedentary nature. For example, light housework, office
work.
2 (Karnofsky 50-60) - Ambulatory and capable of all self-care but unable to carry
out any work activities. Up more than 50% of waking hours. OR: weight loss
between 5-10% of initial weight.
3 (Karnofsky 30-40) - Capable of only limited self-care; confined to bed or chair
50% or more of waking hours. OR: weight loss more than 10% of initial weight.
4 (Karnofsky 10-20) - Completely disabled. Cannot carry on self-care. Totally
confined to bed.
5 – Dead
Cancer staging
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Staging refers to the establishment of the extent of the disease and rendering
patients similar in disease features, prognostic and treatment in common groups.
Staging thus simplifies treatment decisions, offers prognostic data in the face of an
individual patient, helps evaluate treatment results and eases communication
between different cancer centers.
It can be clinical or surgical, pretherapeutic and after primary treatment (y).
Clinical staging (c) is based on clinical evaluation, imaging tests, endoscopy and
laboratory data.
Surgical (pathologic) staging (p) is obtained during surgical and pathological
evaluation of a tumor.
There are 4 stages for every cancer (I-II-III-IV)
These 4 stages are made up from a varying number of different TNM combinations
Cancer staging
The TNM staging is based on evaluation of three variables: the primary tumor (T),
regional no
• T0-there is no evidence of a primary tumor
• Tis-"in situ" cancer
• T1->T4 describes the tumor size and status of spreading
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N0-there is no evidence of cancer in the regional lymph nodes
N1->N3 describe the status of the spreading into the lymph nodes (for instance,
the location, size and number of lymph nodes affected).
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M0-there is no evidence of distant spreading
M1-distant spreading has been found.
Cancer epidemiology
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Western Europe, North AmericaRomaniaAsiaSouth America-
Questions
1. What are the direct signs of cancer?
2. Enumerate some indirect signs of cancer.
3. Which are the non-invasive and invasive diagnostic
procedures of a cancer?
4. What is the Zubrod performance index of a patient who is
confined to bed or chair 50% or more of waking hours?
5. What is the Zubrod performance index of a patient who lost
20 kg and his initial weight was 100 kg?
6. What is the Zubrod performance index of a patient who is
bedridden?