Fundamental principles of oncological search
The success of combating any neoplasms is based on several cornerstone principles. The most important of them is early diagnosis. Timely identification of the pathological process, before it manages to cause widespread consequences for the organism, serves as the determining factor for the success of all subsequent therapeutic measures.
Inextricably linked with this is the concept of oncological vigilance. It is a misconception to think that tumor detection is exclusively the task of specialized oncologists. On the contrary, this vigilance is vitally important for physicians of all specialties without exception. Medical practice shows that a patient's initial contact with the healthcare system most often occurs not in a specialized oncology dispensary, but during a routine appointment at a regular outpatient clinic. A huge responsibility in this regard falls on the shoulders of primary care physicians, primarily general practitioners and gynecologists, who must be the first to suspect something is amiss.
The ultimate goal of any diagnostic examination when a tumor is suspected is precise staging. Specialists need to find out the exact extent of the tumor process. Only by having a complete picture of how far the disease has progressed can a medical board choose the most appropriate and effective treatment strategy.
Visualization and instrumental examination methods
To make a diagnosis as accurately as possible and determine the borders of the lesion, an extensive arsenal of additional techniques is used in modern surgery. A key role is played by various methods of visualizing anatomical structures:
- X-ray methods. This group includes classical fluoroscopy and radiography, as well as traditional tomography. Specialized contrast studies — angiography and lymphography — are used to assess the involvement of the vascular bed and lymphatic apparatus.
- Ultrasound diagnostics. Echography (ultrasound) allows for a rapid assessment of the internal organ structure and the detection of space-occupying lesions.
- Computed tomography (CT). This method provides highly accurate cross-sectional visualization of body structures.
- Radionuclide diagnostics. This includes scanning and scintigraphy, which help identify foci of specific radiopharmaceutical accumulation in tissues.
- Endoscopic examination. Allows the physician to visually assess the condition of the internal surfaces of hollow organs and mucous membranes with their own eyes.
Cellular, tissue, and laboratory diagnostics
Seeing a space-occupying lesion using equipment is not enough — it is critically important to confirm its true nature at the microscopic level and to assess the systemic reaction of the body. The following approaches are used for this:
- Cytological diagnostics. Involves the evaluation of individual isolated cells. The material for study is most often smear imprints from the surface of suspicious areas or the study of punctate material.
- Morphological diagnostics. This is the histological study of a whole tissue fragment. The main method here is biopsy.
- Laboratory tests. The development of a neoplasm is inevitably reflected in laboratory analyses. Physicians evaluate the morphological composition of the blood, study the activity of specific enzymes, and perform various special tests.
Briefly: answers to topical questions
What specific laboratory tests and specific tests (tumor markers) are performed when a neoplasm is suspected?
During the examination, the morphological composition of the blood, enzymes, and special tests may be evaluated. The cited sources indicate:
- b-hCG and AFP — specific markers of germ cell tumors;
- LDH — a marker determined in the study of germ cell tumors;
- AFP — an indicator of active cell proliferation or malignant transformation;
- CEA and CYFRA 21-1 — tumor markers in pericardial fluid;
- CDX-2, TTF-1, and PDX-1 — transcription factors used to determine the direction of differentiation and search for the primary site in metastases of unknown origin.
What specifically does the concept of a physician's «oncological vigilance» include (what rules and principles)?
Oncological vigilance is a combination of patient complaints and physician knowledge necessary for early diagnosis. It includes:
- knowledge of the symptoms of malignant tumors in early stages;
- knowledge of precancerous diseases and methods for their treatment;
- prompt referral of a patient with a detected or suspected tumor to a specialized oncological institution;
- thorough examination of every patient who visits a physician of any specialty to rule out oncopathology;
- the habit of taking into account the possibility of atypical or complicated presentation of a malignant tumor in difficult diagnostic cases.
What types of biopsy are used for the morphological diagnosis of tumors?
Various types of biopsy are used for the morphological diagnosis of tumors, allowing tissue to be obtained for study. The following techniques are used in clinical practice:
- Fine-needle aspiration biopsy (Fine needle aspiration) — a fast, minimally invasive procedure;
- Core needle biopsy (Core needle biopsy) — a thick-needle technique that increases diagnostic accuracy by extracting a cylindrical core of tissue;
- Incisional biopsy — partial excision of the neoplasm;
- Excisional biopsy — complete excision of the tumor with a margin;
- Endoscopic biopsy — tissue sampling using endoscopes;
- Surgical biopsy — tissue acquisition during open interventions.
What endoscopic methods are used to visualize tumors of various localizations?
Methods using flexible fiberoptic endoscopes are used to visualize tumors of various localizations. Depending on the organ being examined, the following types of endoscopy are used:
- Gastroscopy — for examining the stomach;
- Colonoscopy — for visualizing the intestine;
- Bronchoscopy — for examining the bronchi;
- Cystoscopy — for examining the urinary bladder;
- Pyeloscopy — for visualizing the renal pelvis and calyces using a flexible ureteroscope;
- Thoracoscopy — for examining the pleural cavity;
- Laparoscopy — for visualizing the abdominal cavity;
- Mediastinoscopy — for examining the mediastinum.
The «O.R.S.» rule for general principles: Oncological vigilance (checked by physicians of all specialties), Rearlier diagnosis (determines success), Staging (necessary for selecting tactics).
Class and exam questions
Who should primarily demonstrate oncological alertness?
Physicians of all specialties without exception. This applies particularly to outpatient specialists (general practitioners and gynecologists), as patients first contact them.
What is the difference between cytologic and morphologic diagnosis?
Cytology studies individual cells (for example, in smear imprints or punctates), whereas morphological diagnostics (biopsy) evaluates the full structure of the tissue fragment itself.
Why is assessment of disease spread (staging) performed?
Assessment of the extent of the neoplasm is necessary for physicians to correctly choose the patient's treatment tactics.
What else to study on this topic
- The technique for taking smear imprints and obtaining punctate material for cytology.
- Types of biopsy in the morphological diagnosis of tumors.
- Features of angiography and lymphography in oncology.
- Principles of radionuclide scanning and scintigraphy.
- The role of enzymes and special tests in blood laboratory studies.
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Other topics in "CHAPTER 14. TUMORS"
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