A complete history and physical examination can yield unexpected evidence of early tumors.
The diagnosis of a malignant tumor can be made on the basis of medical history and physical examination, histopathological examination of a biopsy of the tumor, however, must always confirm the diagnosis. Sometimes the first indication is an abnormal laboratory test result (z. B. anemia resulting from cancer). A complete history and physical examination can yield unexpected evidence of early tumors. History The medical history should especially predisposing factors and tumor diseases in the family and environmental factors (including smoking history) and former or currently existing diseases (eg class. Autoimmune diseases, previous immunosuppressive therapies, hepatitis B or hepatitis C, HIV infection, abnormal Papanicolaou test, infection with the human papilloma virus) are requested. Symptoms that may indicate an occult tumor are fatigue weight loss fever night sweats cough hemoptysis hematemesis hematochezia Change of stool behavior Persistent pain Physical examination Special attention should be skin, lymph nodes, lungs, breasts, testicles and abdomen. the examination of the prostate and rectal and vaginal examination also are important. Because of the findings, further tests are carried out, including Röntgenuntersichungen and biopsies. Tests The tests include imaging tests, serum tumor markers and biopsy; one of these tests or more may be indicated for patients for whom there are appropriate instructions in the medical history or physical or lab results. For imaging often include X-rays, sonography, CT, PET and MRI scans, which identify anomalies that determine the quality of a mass (solid or cystic) and can define the dimensions and relationship to surrounding structures. This can be important for surgical intervention or biopsies. Tumor markers in serum may occur in patients with findings that indicate a particular malignant tumor, an additional indication represent (immunodiagnostics in tumor diseases). Most are used except in patients not at high risk as a routine screening tests. Suitable examples are ?-fetoprotein (hepatocellular carcinoma, testicular carcinoma), carcinoembryonic antigen (colon carcinoma), ?-human chorionic gonadotropin (chorionic carcinoma, testicular carcinoma) serum immunoglobulins (multiple myeloma) DNA probes (z. B. BCR probe for detecting a chromosomal 9- 22 translocation in chronic myelogenous leukemia) CA 125 (ovarian cancer) CA 27-29 (breast cancer) prostate-specific antigen (prostate cancer) Some of these serum tumor markers can be most useful to treatment rather than in tumor detection in monitoring the response. If there is suspicion of a tumor, to confirm the diagnosis and identify the tissue of origin, a biopsy is almost always required. The choice of biopsy site is typically determined by the ease of access and the degree of invasiveness of the tumor. In the presence of lymphadenopathy, a fine needle or punch biopsy may be sufficient to determine the type of tumor. If this is not sufficient for diagnosis, an open biopsy is indicated. Other additions for a biopsy are the bronchoscopy in easily accessible mediastinal or central lung tumors, percutaneous liver biopsy in the presence of liver lesions and controlled by CT or ultrasound biopsies of lesions in the lungs or the soft tissue. Are these types of biopsy is not feasible, an open biopsy may be necessary. When grading the histological level is called for tumor aggressiveness; it provides important prognostic information. It is determined by the biopsy on the basis of morphological characteristics of the tumor cells. These include the appearance of the Tumorzelole, its nucleus, the cytoplasm and the nucleoli, the mitotic and extent of necrosis. For many tumor types, a corresponding grading was developed. Molecular tests such as chromosome analysis, fluorescence in situ hybridization (FISH), PCR, and cell surface antigens (eg. As in lymphomas, leukemias, lung, and gastrointestinal cancer) give indications of the Urspung a metastasis, particularly in cancer with unknown primary origin, and may be useful in the treatment choice. After staging a histological diagnosis was made, the staging helps (d. E. The determination of the disease spreading) in the treatment choice and affects the prognosis. Clinical staging is based on the clinical history, physical examination, imaging studies, laboratory tests and biopsies of bone marrow, lymph nodes or other suspicious areas. Mediastinoscopy is particularly valuable in the staging of non-small cell lung cancer. Imaging by imaging studies, v. a. CT, PET and MRI, can metastases in the brain, lungs or abdominal organs, including adrenal glands, retroperitoneal lymph nodes, liver and spleen, are detected. For the detection and measurement of primary brain tumors as well as brain metastases, MRI with gadolinium is the method of choice. Positron emission tomography (PET) is increasingly used to determine the metabolic activity of suspect lymph node masses or the integrated PET-CT can v. a. be useful in lung, head and neck and breast tumors as well as lymphomas. By ultrasound can be examined lesions in breast, orbit, thyroid, heart, pericardium, liver, pancreas, kidney, testes and retroperitoneal space. Percutaneous biopsy can be performed ultrasound guidance and serve to differentiate between a fluid-filled cyst and solid masses. With the help of nuclear medicine examinations different types can be identified by metastases. By abnormal bone growth a bone (d osteoblastic activity. H.) Can be detected before it becomes conspicuous in the radiograph. Useless this method is therefore in neoplasms that show exclusively osteolytic involvement (eg. As multiple myeloma). Here are the routine X-ray examinations of the skeleton (Editor’s note: also the bone-CT) the method of Wahl.Laboruntersuchungen The staging also can biochemical tests such as serum chemistry and enzyme activities, be useful. Elevated liver enzymes (alkaline phosphatase, LDH, ALT) and increased bilirubin indicate the presence of liver metastases. (Editor’s note: Recalling LDH has no significance here.) An elevated alkaline phosphatase, or elevated serum calcium levels may be the first indication of bone metastasis. Increased blood urea or creatinine levels may be indicative of an obstruction of the urinary tract due to a tumor mass in the pelvis. However, they also occur in an intra-renal obstruction due to tubular precipitation of proteins in multiple myeloma or a uric acid nephropathy as a result of lymphomas or other tumor types. Increased uric acid levels are frequently found in patients with rapidly proliferating tumors and those with myeloproliferative and lymphoproliferative Krankheiten.Invasive Test Methods mediastinoscopy (mediastinoscopy and mediastinotomy) is particularly valuable in the staging of non-small cell lung carcinomas. It shows a mediastinal lymph node involvement, the patient may benefit from an initial chemoradiotherapy followed by resection. (Editor’s note: This is where the PET is used in the meantime, which saves the patient mediastinoscopy.) The bone marrow aspiration aspiration and biopsy are particularly useful in the detection of metastases of malignant lymphoma and small cell lung cancer. The bone marrow biopsy is positive at diagnosis in 50-70% of patients with malignant lymphoma, in patients with small cell lung cancer, this rate is 15-18%. A bone marrow biopsy (anemia, thrombocytopenia, pancytopenia, d. H.) Should also in patients with unexplained haematological changes are performed. The biopsy of regional lymph nodes is part of the assessment of any tumors, such as breast, lung or colon cancer. The removal of the sentinel lymph node (defined by the inclusion of a coloring agent or radioactivity that is injected to the tumor site) can provide a limited but definite lymph node sample.