Tumor diagnosis

1. Stages of the tumor
process. Classification.
Diagnosis of tumors

2. Stages of the tumor process.
Stage I - diffuse nonspecific hyperplasia.
Stage II - focal proliferates.
Stage III - benign tumor.
Stage IV - malignant tumor.

3. Clinical groups of cancer patients.
I A - patients with suspected cancer.
I B - benign tumors and precancerous
diseases.
II - hematoblastosis, subject to special
methods of treatment.
II A - malignant tumors subject to radical
treatment.
III - patients cured of malignant tumors.
IV - late stages of malignant tumors.

4. TNM classification
International symbols used to characterize
tumor process. The modern clinical and
morphological classification provides for the
division of patients with malignant
neoplasms, depending on the extent of the
process, into 4 stages. This classification is
based on the TNM system developed by the
committee of the International Union
Against Cancer.

5. T symbol (tumor, tumor) - description (characteristic) of the primary
tumor, has seven options.
T0 - the primary tumor is not verified, although there are metastases.
T - pre-invasive carcinoma (carcinoma in situ) - the tumor is
localized within the layer in which it arose.
T1 - a small tumor (no more than 2 cm in diameter), limited to the
original tissue.
T2 is a small tumor (no more than 4 cm in diameter) that does not go
beyond the affected organ.
T3 - a tumor of significant size (up to 6 cm in diameter), germinating
serous membranes and capsules.
T4 is a tumor that grows into surrounding tissues and organs.
TX is a tumor, the size and boundaries of which cannot be precisely
determined.

6. Displacement of the esophagus
X-ray examination: the aberrant right subclavian artery (a.
Lusoria) passes through the posterior mediastinum and forms an
impression on the esophagus in the form of a strip-like defect
running obliquely.
The right-sided aortic arch forms impressed not on the esophagus
along the posterior-right wall. Enlarged lymph nodes of the
posterior mediastinum (metastases, lymphosarcoma,
lymphogranulomatosis) form an impression on one of the walls
of the esophagus or push it back

7. Symbol N (nodulus, node) - reflects the degree of damage to
the lymph nodes, has five options.
NX - insufficient data to determine the nature of the lesion of
the lymph nodes.
N0 - no signs of lymph node involvement.
N1 - lesion of one lymph node located at a distance of up to 3
cm from the primary focus, the diameter of the affected node is
less than 3 cm.
N2 - lesion of one node, the diameter of which is 3-6 cm, or
several lymph nodes, the diameter of which is less than 3 cm,
but they are located at a distance of more than 3 cm from the
primary tumor.
N3 - lesion of one lymph node, the diameter of which is 6 cm,
or several nodes, the diameter of which is 3-6 cm, but they are
located at a distance of more than 3 cm from the primary
tumor.

8. Symbol M (metastases) - reflects the presence of
individual metastases due to hematogenous or
lymphogenous dissemination.
The M symbol has three variants.
MX - insufficient data to determine prevalence.
M0 - there are no signs of distant metastasis.
M1 - there are (single, multiple) distant metastases.

9. Cardiospasm (esophageal achalasia)
X-ray examination: on the plain chest X-ray - expansion of the
shadow of the mediastinum to the right; when contrasting - a
relatively uniform expansion of the esophagus along its entire
length, conical narrowing of the abdominal esophagus, food in
the esophagus, impaired contractile function of the esophagus,
absence of a gas bubble in the stomach, thickening of the folds
of the esophageal mucosa

10. The principle of determining the stage of the
disease in malignant neoplasms can be
formulated only in a general form, since there
is an individual feature for each localization
of cancer. Grouping by stages depending on
various combinations of the indicated
symbols makes it possible to simplify and
unify the quantitative and qualitative
description of the tumor.

11. The degree of morphological differentiation of tumor tissue.
1 - highly differentiated.
2 - the average degree of differentiation.
3 - low degree of differentiation.
4 - undifferentiated.

12. DIAGNOSTICS OF MALIGNANT TUMORS
The key to success in the treatment of malignant
tumors is their early diagnosis. It is known that at
the stage of tumor development, cancer in situ
can be cured in 100% of cases. When treating
cancer in stage I, a complete cure is achieved in
80-90%, in stage III - only in 30% of patients.
The relevance of the issue of timely diagnosis of
malignant tumors is associated with the high
prevalence and wide variety of their clinical
course.

13. When collecting anamnesis, you should pay attention to
the following data:
1) unmotivated change in well-being, increased fatigue,
loss of appetite and weight;
2) change in habits, the appearance of aversion to any type
of food or food smells;
3) the appearance of pathological secretions (sputum with
blood, blood or mucus in the feces);
4) violation of patency of hollow organs (dysphagia,
vomiting, persistent constipation, bloating);
5) the appearance of previously non-existent visible or
palpable formations or ulcerations, for example, on the
skin, mucous membranes of the lips and oral cavity.

14. In visual forms of cancer (skin, lip, oral cavity,
mammary gland, rectum, external genitalia), the
most important symptom is the presence of a
visible or palpable tumor. If the patient has a
long-term chronic disease, it is possible to
change his pre-existing symptoms, which should
also alert the doctor. Besides
Moreover, it is necessary to pay attention to the
lack of effect from the treatment of a chronic
disease, which previously brought success. It is
necessary to ask the patient about his bad habits
(smoking, chewing tobacco, eating hot food).

15. An important role is played by an
oncological anamnesis, in particular, the
treatment of a patient in the past for tumors
of other localizations or the presence of
malignant tumors in blood relatives.If you
suspect a certain oncological pathology, for
example, the lungs, it is necessary to
question the patient purposefully, asking
leading questions, as he often cannot
highlight the main complaints, focusing on
minor ones, which makes it difficult to
establish a true diagnosis.

16. Clinical examination of the patient plays an important
role, especially in the presence of visual forms of
cancer. Particular attention during examination and
palpation should be paid to the regional lymph nodes.
When examining cancer patients, palpation of the
abdominal cavity is mandatory. A digital examination
of the rectum gives a lot of information about the
presence of the tumor and its extent. Some metastases
can be found on examination through the rectum.
Information can also be obtained from auscultation and
percussion, especially if there is free fluid in the pleural
and abdominal cavities.

17. INSTRUMENTAL METHODS FOR
DIAGNOSING TUMORS
The most commonly used for examining the
population with suspected oncological
pathology are radiation diagnostic methods.
The most common of them is radiological. Not
a single patient with a suspected tumor can
currently do without an X-ray examination.
This method is especially widely used in mass
screening of the population during prophylactic
examinations to identify pathology of the lungs
and mammary gland.

18. The use of the X-ray method makes it
possible to resolve the issue of the presence
or absence of pathological changes in a
particular organ. In the future, clarifying
research methods are used.
The X-ray method makes it possible to
assess the dynamics of the pathological
process with special treatment. Pulmonary
tomography, angiography, pyelography and
dr.

19. X-ray computer
tomography (CT), which allows
transverse scanning and obtaining a
differentiated image of tissues and organs,
the radiopacity of which is distinguishable
by 0.5%. Computed tomography can
detect small tumors even in the brain,
kidneys, pancreas,
organs of the small pelvis.

20. Increasingly, when examining cancer patients, it
is used magnetic resonance imaging (MRI). The
advantages of this method include the practical
absence of radiation exposure. The MRI method
is based on the phenomenon of nuclear magnetic
resonance (registration of the energy emitted by
hydrogen nuclei after preliminary exposure to a
broad-spectrum radio frequency pulse).

21. Among the advantages of MRI, it should also
be noted that there is no need to use contrast
agents, the ability to obtain an image in any
plane (including three orthogonal anatomical
projections), and a high resolution of
contrasting soft tissues.
MRI is used in the diagnosis of almost all
types of human tumors.

22. Ultrasound examination (ultrasound) has become
one of the most widespread radiation research
methods in recent years. The advantage of the
method is its high resolution and harmlessness,
which makes it possible to repeat the study many
times. With the help of ultrasound, almost all
organs and soft tissues can be examined.

23. Tumors of the lungs, stomach, intestines, bones, brain and
spinal cord are inaccessible for echography.
In cases where the use of the above methods does not
allow us to accurately establish the nature of the disease
or the extent of tumor spread, the method of radionuclide
diagnostics is used, which is based on the ability of
radiopharmaceuticals (chemical compounds labeled
certain radionuclides) selectively accumulate in various
organs, tissues, tumors. Registration of gamma radiation
emitted during the decay of a nuclide makes it possible to
obtain an image (scintigraphy) of the organ under study.

24. Scintigraphy allows detecting tumors or
metastases at least 2 cm in size in places
inaccessible for X-ray examination, or long
before their X-ray imaging (sometimes up to 6
months) in the form of "cold" or "hot" foci.
"Cold" lesions indicate organ tissue
replacement pathologically altered tissue,
which does not accumulate a
radiopharmaceutical that is tropic to the tissue
of the organ, "hot" - about an increased
accumulation of the isotope, which is
selectively fixed in the tumor.

25. Emission computed tomography has greatly
expanded possibilities of radionuclide diagnostics.
This method provides accurate measurement of the
tumor lesion and visualization of low-contrast
structures that are not detected by scintigraphy. A
promising method for diagnosing tumors and
metastases is radionuclide immunoscintigraphy
using monoclonal antibodies.

26. The endoscopic method occupies one of the leading
places in diagnostics, as it allows you to visually
assess the nature of pathological changes in the
organ. This method in the presence of a tumor
(stomach, intestines, bronchi) allows you to
determine its localization, size, growth boundaries
and, most importantly, to take material for
morphological verification of the diagnosis.
The endoscopic diagnostic method allows detecting
cancer at the earliest stages of development, when
the tumor reaches several millimeters in size. In the
diagnosis of such small tumors, endoscopic
methods in complex with biopsy and cytological
examination are much more effective than

27. Material for cytological examination can be
obtained by scraping from a tumor,
flushing, puncture. The most informative is
the forceps biopsy of the tumor tissue
followed by histological examination.
Endoscopic research methods have become
practically obligatory for the corresponding
pathology: bronchoscopy, esophagoscopy,
gastroscopy, colonoscopy, sigmoidoscopy,
laparoscopy, colposcopy, thoracoscopy.

28. MORPHOLOGICAL METHOD FOR TUMOR
DIAGNOSTICS
A special place in oncology is occupied by morphological research
methods - cytological and histological.
None of the existing special methods of treatment (surgical,
radiation, drug) can be carried out without morphological
verification of the diagnosis. Failure to comply with this rule leads
to an incorrect diagnosis, to the unreasonable conduct of special
treatment, as a result, severe, sometimes crippling operations are
performed, radiation therapy with severe radiation injuries or
chemotherapy, which has a teratogenic and carcinogenic effect, is
performed. The exclusion of the diagnosis of a malignant tumor
without a morphological examination may be erroneous, which
delays the timing of the start of special treatment and worsens it.
long-term results

29. Cytological research method. The material for
research can be cells that are independently excreted
from the tumor and excreted, and cells obtained by
aspiration during puncture of the tumor. The material
for research in the first case is sputum, urine,
prostate secretions, discharge from the nipple of the
breast, cervix and vagina, rectum. Material from
hollow organs can be obtained by washing with
isotonic sodium chloride solution, by imprints or
scraping from the surface of tissues using a cotton
swab or special brushes.

30. Aspiration cytology involves the study of cells
obtained by puncture of tumor formations
from the thyroid, breast, salivary and prostate
glands, lymph nodes, tumors of the lungs and
mediastinum, tumors of soft tissues and bone
marrow. Puncture allows you to obtain
cytological material from the pleural and
peritoneal cavities, spinal canal, pericardium
and synovial sheaths. With the help of sternal
puncture, bone marrow tissue is also obtained
for cytological examination.

31. The malignant transformation of cells can be judged
on the basis of a set of signs that characterize the
cells of the neoplasm and their relationship with
other cells. The main groups include pronounced
atypia compared to normal cells, which consists
in the polymorphism of the size and shape of cells,
an increase in the nucleus relative to the size of the
cell, the formation of giant nuclei, the eccentric
arrangement of the nucleus, the presence of several
nuclei in one cell

32. the number of mitoses, nuclear hyperchromia and
vacuolization of the cytoplasm, a large number of "naked"
nuclei.
The size of tumor cells ranges from 4 to 60 ¬. Most often,
they are larger than the cells of the original tissue and can
have various shapes: oval, round, fusiform, cylindrical,
triangular, stellate, polygonal, etc. The shape of the nuclei
of malignant cells is also diverse and can be oval, bean,
fusiform, crescent and irregular. The boundaries of
malignant cells are often blurred, uneven.
One of the main morphological signs of malignant tumors
is the formation of multinucleated giant cells.
A malignant tumor is characterized by a large number of
mitoses.