Targeted questioning of an oncological patient
Taking a medical history when a tumor process is suspected provides crucial orienting data. Questioning the patient cannot be formal; it must be strictly targeted in nature.
First of all, the physician is obligated to analyze:
- Living conditions and habits: presence of bad habits (such as smoking or tobacco chewing), which are proven carcinogenic factors.
- Cancer epidemiology: regional features strongly influence disease statistics. For example, residents of southern regions are more often diagnosed with skin cancer (due to insolation), whereas residents of industrial zones and areas with heavy air pollution are in the risk group for lung cancer.
Since specific complaints in the patient are often absent in the early stages of the disease, the physician needs to actively investigate the presence of the slightest changes. The physician should specifically question the patient about mild changes in well-being, causeless rapid fatigue, and the onset of aversion to a certain type of food. Special attention is required for changes in existing formations in the patient, for example, if birthmarks have changed their shape, size, consistency, or color.
Clinical presentation of early stages and subjective sensations
The insidiousness of malignant neoplasms lies in the fact that the initial diagnosis sometimes has to be built on just 1–2 mild symptoms. A key role here is played by the syndrome of small signs.
This syndrome includes:
- An unmotivated state of discomfort.
- Initial signs of internal organ dysfunction.
Important: although these changes do not always indicate oncology, they categorically require increased attention from the clinician.
The patient's subjective sensations in the early stages also have their own characteristics. Pain is practically never noted during this period. General symptoms come to the fore: increased fatigue, unmotivated drowsiness, decreased performance, as well as indifference and a noticeable decrease in interest in surroundings. Specific sensations that the physician must identify during questioning include a feeling of heaviness, a sensation of a foreign body in the body, or a lack of relief after physiological excretion.
Dynamics of the course and features of the anamnesis
Evaluation of the oncological anamnesis requires analysis of the disease dynamics. Malignant tumors are characterized by a continuous increase in symptoms without periods of true improvement in condition.
Most often, physicians encounter a short disease history. However, the anamnesis may also turn out to be long-term. This occurs in cases where cancer develops against the background of a long-standing chronic inflammation or is the consequence of malignant transformation of a pre-existing benign tumor. In this regard, all patients from risk groups must be under constant dispensary observation. Timely treatment of precancerous conditions (including surgical treatment) serves as the main measure for the prevention of malignant neoplasms.
Oncological alertness
The basis for successful early diagnosis is a competent combination of patient complaints (even the most insignificant ones) and the professional knowledge of the physician. This synthesis is called oncological alertness.
The main components of oncological alertness that every physician must possess:
- Knowledge of the clinical symptoms of malignant tumors specifically in the early stages.
- Firm knowledge of precancerous diseases and modern methods of their treatment.
- Prompt referral of the patient to a specialized oncological institution upon detection or even suspicion of a tumor.
- Thorough examination of every presenting patient (regardless of the physician's specialty) in order to completely rule out oncopathology.
- The professional habit in complex and confusing diagnostic cases of never missing the opportunity of an atypical or complicated course of a malignant tumor.
Briefly: answers to topical questions
What does the syndrome of small signs include (according to A.I. Savitsky)?
The syndrome of small signs includes:
- a state of discomfort;
- signs of internal organ dysfunction.
What risk factors and carcinogens must be identified when taking an oncological history?
When taking an oncological history, it is necessary to identify modifiable risk factors, occupational hazards, and hereditary predisposition. The main factors include:
- Chemical carcinogens — polycyclic aromatic hydrocarbons (benzpyrene), nitroso compounds, aminoazo compounds, aromatic amines, aflatoxins.
- Physical factors — ionizing radiation.
- Biological factors — oncogenic viruses.
- Lifestyle — smoking, tobacco chewing, poor nutrition, alcoholism, sedentary lifestyle.
- Epidemiological factors — living in southern regions or industrial zones.
What changes in a nevus (birthmark) are clinical signs of its malignancy?
Alarming changes in a nevus include its evolution and changes in shape, size, consistency, or color. For nodular melanoma, growth of a node, possible pain or burning, as well as ulceration, bleeding, and crust formation have also been described.
What obligate and facultative precancerous diseases should a surgeon know?
Obligate precancerous diseases include adenomatous polyps and gastric polyposis, chronic callous gastric ulcer, rigid antral gastritis, and obligate precancer of the lip.
Facultative precancerous diseases of the stomach include chronic atrophic gastritis, operated stomach disease, pernicious anemia, and Ménétrier's disease.
5 rules of oncological alertness: Know early symptoms — Know precancers — Thoroughly examine everyone — Promptly refer to an oncologist — Suspect an atypical course.
Class and exam questions
Is pain syndrome characteristic of the early stages of tumor development?
No, pain is almost never observed in the early stages. Mild general symptoms and discomfort come to the forefront.
What does the "syndrome of small signs" include?
It includes an unmotivated state of discomfort and initial signs of internal organ dysfunction. These changes require a detailed examination of the patient.
What pattern of symptom progression is typical for an oncological anamnesis?
Malignant tumors are typically characterized by a continuous increase in clinical symptoms without periods of improvement.
Can a cancer history span many years?
Yes, if a malignant tumor develops against the background of a prolonged chronic inflammatory process or from a benign tumor.
What else to study on this topic
- Classification and clinical presentation of precancerous diseases
- Surgical treatment as a method of preventing malignant tumors
- Differential diagnosis of the syndrome of small signs
- Organization of dispensary observation for cancer patients
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