Primary tumor characteristics
During palpation, the physician must obtain comprehensive data on the physical parameters of the tumor. These criteria form the basis of differential diagnosis between benign and malignant processes.
- Shape and surface. Benign formations and cysts typically present with a rounded shape and a smooth surface. Malignant tumors, conversely, often have a nodular, uneven surface. Note: metastatic nodules on the surface of organs may also be smooth.
- Dimensions. All measurements must be taken by the physician exclusively in the metric system (in millimeters or centimeters).
- Consistency. Tissue density directly depends on the histological structure of the tumor:
- Soft: characteristic of benign processes (lipomas, mucosal polyps), but occasionally encountered in undifferentiated malignant tumors (e.g., sarcoma).
- Firm-elastic: typical of encapsulated formations containing fluid. In such cases, the fluctuation sign is often absent.
- Hard: caused by connective tissue proliferation (typical of fibromas).
- Woody: a classic sign of a cancerous tumor, usually combined with the absence of clear boundaries.
Assessing mobility
The mobility of a neoplasm is evaluated relative to the skin and underlying muscles.
Two types of displacement are distinguished:
- Independent (active): the tumor moves together with the organ from which it originates. This can be observed when the patient changes body position, during swallowing (e.g., goiter), or upon muscle contraction.
- Induced (passive): elicited directly by the physician when attempting to displace the node manually.
Important: if the tumor cannot be displaced, it is firmly fused with the surrounding tissues. This indicates infiltrative growth, which is a clear clinical sign of malignancy.
Palpation techniques and special maneuvers
Palpation should be performed gently, without excessive pressure on the tissues. First, the physician palpates the healthy areas around the suspicious region, and only then proceeds to the tumor itself.
For the examination of lymph nodes and the breast, bimanual palpation (examination with both hands) is used. There are also specialized techniques:
- Digital examination: necessary when the process is localized in the rectum, oral cavity, or nasopharynx. The size, shape, mobility, and consistency of the lesion are evaluated.
- Gynecological examination: bimanual examination is absolutely mandatory for all women with the slightest suspicion of oncological pathology.
Additionally, percussion and auscultation are used as part of a standard examination.
Lymph node examination
The state of regional and distant lymph nodes is critically important for staging. The physician is obligated to thoroughly palpate all accessible groups.
Unchanged (healthy) lymph node: small in size, oval in shape, and soft in consistency. It is mobile, completely painless, and feels no different from neighboring nodes.
Metastatic lymph node:
- Enlarged in size, acquiring a rounded shape.
- Becomes firm, sometimes nodular.
- Fuses with surrounding tissues and adjacent nodes, forming fixed conglomerates.
- Painless. This is a crucial differential diagnostic criterion that helps distinguish a metastasis from an inflammatory process (where the node is painful). Even small metastatic nodes that retain mobility cause no pain.
Searching for distant metastases
The detection of distant metastases unambiguously indicates Stage IV oncological disease.
Specific target areas include:
- Metastasis to the umbilicus.
- Virchow's metastasis (to the supraclavicular lymph node).
- Krukenberg tumor (metastasis to the ovaries).
Special attention is paid to the liver, as it is a frequent target for metastasis. Abdominal palpation reveals hepatomegaly (enlargement of the liver), its edge becomes firm and nodular, and a "nodular liver" may be palpated. At the same time, palpation remains painless. An additional sign of abdominal organ involvement is the presence of ascites.
It is also necessary to carefully examine the skeleton. Bone metastases are particularly common in lung, breast, and prostate cancer.
Briefly: answers to topical questions
Which clinical signs indicate infiltrative growth of a malignant tumor?
Infiltrative growth of a malignant tumor is indicated by its immobility and the lack of clear boundaries.
- Inability to displace — the tumor is fused with surrounding tissues, which is revealed when the physician attempts passive displacement.
- Difficulty in visual diagnosis of boundaries — caused by diffuse infiltrative growth without the formation of a distinct node.
- Destruction of structures — infiltrative growth leads to the destruction of normal tissues (e.g., glandular structures).
What visual symptoms are determined upon inspection of a malignant breast tumor?
Inspection of a malignant breast tumor reveals organ deformations and specific skin manifestations.
- Breast deformation — reduction or increase in size, upward retraction.
- Skin symptoms — noticeable skin deformation, coarse retractions, pronounced umbilication sign, tumor invasion into the skin, or ulceration.
- Peau d'orange sign — lymphedema over the tumor or beyond its borders.
- Changes in the nipple-areola complex — deformation, retraction and fixation of the nipple, pathological discharge, as well as Krause's sign (pronounced thickening of the nipple and areolar folds).
- Inflammatory signs — pronounced edema and hyperemia.
Which groups of lymph nodes are considered regional in gastric cancer?
Regional lymph nodes in gastric cancer are those located along the greater and lesser curvature of the organ. These include the following groups:
- Paracardial — right and left.
- Nodes of the lesser curvature — located along the corresponding curvature.
- Nodes of the short gastric vessels — regional for specific localizations.
- Gastro-omental — right and left.
- Suprapyloric — located above the pyloric part.
- Subpyloric — located below the pyloric part.
What do the abbreviations in the international TNM staging classification stand for?
In the international TNM classification, the abbreviation describes the anatomical extent of the tumor:
- T (Tumor) — tumor.
- N (Node) — lymph node.
- M (Metastasis) — metastases.
To distinguish a lymph node metastasis from inflammation, remember: cancer is a "silent killer". A metastatic node is firm and fixed, but always remains painless, whereas inflammation causes acute pain.
Class and exam questions
What does a "woody" consistency of a neoplasm indicate?
Such an extremely high density is typical of a cancerous tumor. It is usually combined with the absence of clear borders due to infiltrative growth into adjacent tissues.
How to properly begin tumor palpation?
Palpation should be performed gently and without excessive pressure. Start by palpating the surrounding healthy tissues, gradually moving closer to the neoplasm itself.
In which types of cancer is a particularly thorough bone examination necessary?
Special attention should be paid to the skeletal system when lung cancer, prostate cancer, and breast cancer are suspected, as they most frequently metastasize to the bones.
What else to study on this topic
- Virchow's metastasis: anatomy of supraclavicular lymph nodes
- Krukenberg tumor: pathways of metastasis to the ovaries
- Technique of bimanual breast palpation
- Infiltrative growth: histological basis of restricted mobility
- Differential diagnosis of benign cysts and soft tissue sarcomas
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