Kuliah Class Inter I

DIAGNOSIS IN ONCOLOGY
Prof. Dr. dr. Teguh Aryandono,

SpB(K)Onk
Division of Surgical Oncology
Faculty of Medicine , GMU
DIAGNOSIS
To answer the questions
- Is there any malignancy
- Prognosis
- Decision of treatment
Patients and families
 Suffered from cancer?
 Can I be cured?
 How long can I live?
 What symptoms ?
DIAGNOSIS
 Answer that questions
 Plan treatment
 Guiding the patient and family
DIAGNOSIS
 Anamnesis
 Physical examination
 Diagnostic imaging
 Laboratory examination
 Diagnostic pathology
Characteristic of information
 Organ of origin
 Histological grade
 Local extension (T)
 Lymph node extension (N)
 Distant metastasis (M)
STAGING :TNM
 Tumor with same histologic type, from the
same origin, grow and spread with the same
pattern
 AJCC, WHO, FIGO
Clinical Staging
 Anamnesis, physical examination, simple
laboratory methods, radiodiagnostic and
endoscopy
 Find everywhere
Radiologic staging
 With modern radiology equipment
- CT Scan
- Lymphography
- MRI
Surgical Staging
 Intraoperative findings
 Infiltration of tumor to surrounding tissues
Pathological Staging
 Include histologic evaluation : tumor
invasion, lymph node metastasis etc
 In breast cancer :
node 1- 3 (N1) differ from 4 or more (N2)
Clinical stage T1, radiological
stage T2, surgical stage T3
Prognostic and Predictive factors
 Prognostic factor
- All factors in connection with disease free
and overall survival, without adjuvant
treatment
- Clinical, pathological, biological
 Predictive factor
- connection with response to treatment
Prognosis
 Tumor
 Patients
- age
- nutrition
- immunological status
Also : DOCTOR
Anamnesis and Clinical
examination
 No symptom and sign under 1 gram ( 1
cm3)
 Anamnesis and physical examination not
sensitive
 Still important : tumor at this stage can be
cured with locoregional treatment
Anamnesis
 Symptoms
- Local : pain, function,bleeding, swelling etc
- Metastasis : lung, liver, bone, brain
- Product of metastasis: anorexia, febrile,
leucocytosis
Anamnesis
 Localization of tumor
 Risk factors
- smoking
- Alcohol
- Environment : asbes,benzen
- Radiation : sunlight
- Synthetic estrogen
- Virus
- Family history of cancer
Bone metastasis
 Breast ca : 73%
 Lung ca : 33%
 Kidney ca : 24%
 Colorectal ca : 22%
pain, pathologic fracture
Lung metastasis
 30% of cancer patients
 Usually peripheral location ,no symptom
 Dyspnea and chest pain : malignant pleural
effusion
Liver metastasis
 More than 50% alimentary tract cancer
metastasis to the liver
 Asymptomatic
 Pain, in the shoulder
 Malaise, anorexia, fever
Brain metastasis
 30% from cancer patients
 Lung, breast cancer, melanoma
 Cephalgia
- direct extension to nerve or meninges
- increase intracranial pressure
Physical Examination
 Depends on localization of tumor
 Intrathoracal or intrabdominal : difficult
 Superficial : skin, soft tissue, breast,
relatively easy
 Lymph node : very important
more than 1 cm : abnormal
supraclavicular : abnormal
Causes of lymph node
enlargement
Malignant 43%
- Malignant lymphoma 37%
- Metastasis 63%
. Lung cancer 53%
. Head and neck cancer 14%
. Other tumors 33%
 Non malignant 57%
- No diagnosis 75%
- Infection 15%
- Granulomatous inflamation 5%
- others 5%
Anamnesis and physical
examination
 No specific sign and symptom
 Depends on primary tumor and metastasis
 Clinical presentation : asymptomatic to
multiple organ failure and disturbance of
regulation mechanism
 Complicated by diagnostic methods,
sometimes give more morbidity
Anamnesis and physical
examination
Very important
 Diagnosis in the early stage
 Guidance for further examinations
 Prevent complication, manage in the early
stage or give palliation
Diagnostic Imaging
 Conventional radiology
 Digital radiography
 CT scan
 Echography
 MRI (Magnetic Resonance Imaging)
 Scintigraphy
Diagnostic Imaging
 Primary tumor
 Metastasis
- Lymph node
- Bone
- Lung
- Liver
- CNS / Brain
- Peritoneal
Interventional radiology
 Biopsy guided with
- Echography
- CT Scan
- (MRI)
- (Fluoroscopy)
Laboratory Diagnosis
 No specific examination
 Tumor markers
Tumor markers
Can be measured quantitatively by
biochemical or immunochemical in tissue
or body fluid
Tumor markers
 To detect a cancer and organ where
possibly resides
 To establish the extent of tumor burden
before treatment
 To monitor the response to treatment
Essential to understand
 Sensitivity
 Spesificity
 Positive predictive value
 Negative predictive value
Screening and follow-up
asymptomatic patients
 AFP
 Beta HCG
 CEA
 CA125
BIOPSY
Techniques for obtaining
tissue
Aspiration Biopsy
 Cytology analysis
 Major surgical resection should not be
undertaken solely on the basis of evidence
of aspiration biopsy
Needle Biopsy
- obtaining a core of tissue

- sufficient for diagnosis of most tumor types
- soft tissue and bone sarcoma : difficult
Incisional biopsy
 Small wedge of tissue from a larger tumor
mass
 Preferred method for soft tissue and bone
sarcoma
Excisional biopsy
 Excision of entire suspected tumor tissue
with little or no margin of surrounding
normal tissue
Principles guide of all surgical
biopsies
 Needle tracts or scars should be placed
carefully , so they can be conveniently
remove as part of the subsequent definite
surgical procedure
 Extremity : longitudinal
 Not to contaminate new tissue planes
during biopsy
 Large hematome >> tumor spread
 Choice of biopsy technique : adequate
tissue sample for the needs of the
pathologist
 Handling of the biopsy tissue by the
pathologist is also important
- certain orientation >> mark
- Certain fixatives
CONCLUSION
 DIAGNOSIS
- Anamnesis/ history taking
- Physical examination
- Addition :
- radiology / imaging
- laboratory examination
- Biopsy : cytology
histology
 STAGING
- TNM
- UICC/ FIGO
 TREATMENT
- curative intent
- palliative intent
Surgery
Radiotherapy
Chemotherapy
Hormonal therapy
etc
PROGNOSIS
- TNM and other prognostic factors
- Overall Survival
- Disease Free Survival
Thank You

Kuliah Class Inter I

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DIAGNOSIS IN ONCOLOGY

Prof. Dr. dr. Teguh Aryandono,

- obtaining a core of tissue

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