Staging of the tumor
Staging of the tumor
Staging of cancer
Upon receipt of a histological diagnosis, staging of the tumor is performed (i.e., determining the prevalence and extent of the lesion), which helps in determining the tactics of treatment and prognosis. In case of clinical staging, data of anamnesis, examination of the patient and non-invasive examination methods are used. Histological staging requires tissue samples (for staging specific tumors, see the details in the chapters on the relevant organs).
Mediastinoscopy is a particularly valuable method in the staging of non-small cell lung cancer. In the presence of a lesion of the mediastinal lymph nodes, the patient, as a rule, is shown not tora-cotomy with resection of the lungs, but chemotherapy and radiotherapy followed by resection of the tumor.
Aspiration and biopsy of the bone marrow are particularly valuable in determining metastases in malignant lymphoma and small cell lung cancer, as well as in breast and prostate cancer.With a bone marrow biopsy, 50–70% of patients with malignant lymphoma (low and intermediate grade) and 15–18% of patients with small cell lung cancer are affected. A bone marrow biopsy is necessary in patients with hematological disorders (for example, anemia, thrombotic cytopenia, pancytopenia) that cannot be explained by other mechanisms, or in patients with known hematological pathology.
Lymph node biopsy is usually a necessary stage in the diagnosis of lymphoma. Often, a regional lymph node biopsy is performed during the treatment of prostate and breast cancer.
Biochemical analysis of blood with the determination of serum enzymes can help in determining the stage of the disease. Increased liver enzymes (alkaline phosphatase, LDH, ALT) suggests the presence of metastases in the liver. Increased alkaline phosphatase activity and serum calcium levels may be the first signs of bone metastasis. Acid phosphatase elevation suggests extracapsular proliferation of prostate cancer.Rapidly developing hypoglycemia indicates insulin, hepatocellular carcinoma or retroperitoneal carcinoma. Increasing the level of urea or creatinine is possible with obstruction of the urinary tract tumor mass, intrarenal pathology with deposition in the tubules of myeloma protein or nephropathy caused by uric acid in lymphoma or other tumors. Elevated uric acid levels are often found in myelo-lympho-proliferative diseases.
Methods of imaging, especially CT and MRI, can detect the presence of metastases in the brain, lungs, spinal cord, abdominal organs, including the adrenal glands, the peritoneal lymph nodes, the liver, and the spleen. MRI (Contrasting with H-Valley) is the procedure of choice for identifying both primary and metastatic brain tumors. PET is used to determine metabolic activity in case of suspected presence of a tumor mass and provides important information for determining the stage of the disease, treatment and prognosis. A combined CT / PET study can be informative, especially for cancer of the lung, head and neck, breast and lymphoma. The use of other imaging research methods is being studied.
Ultrasound can be used to study lesions in the area of the orbit, thyroid, heart, pericardium, liver, pancreas, retroperitoneal region. Ultrasound is also used to visually monitor biopsy and differentiation of renal cell carcinoma from benign renal cyst.
Nuclear scanning helps identify some types of metastases, revealing an abnormal bone growth (for example, with osteoblastic activity), earlier than it is determined by x-ray. Thus, this method is useful in the diagnosis of malignant tumors, especially with obvious lysis of the bones (for example, in multiple myeloma). Routine radiography is the study of choice in such cases.
DEGREE OF MALIGNANT CANCER TUMOR.
The degree of malignancy is a histological measure of tumor aggressiveness. Determined by biopsy based on the morphological features of tumor cells, including the characteristic features of the nucleus, cytoplasm, nucleoli, frequency of mitosis and the number of necrosis.For many tumors, a scale of malignancy has been developed.
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