Diagnosis and Biopsy

7/29/2019 Diagnosis and Biopsy

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DIAGNOSIS IN ONCOLOGY

Dr. Teguh Aryandono

Division of Surgical Oncology

Faculty of Medicine , GMU


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DIAGNOSIS

To answer the questions

- Is there any malignancy

- Prognosis

- Decision of treatment


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Patients and families

Suffered from cancer?

Can I be cured?

How long can I live?

What symptoms ?


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DIAGNOSIS

Answer that questions

Plan treatment

Guiding the patient and family


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DIAGNOSIS

Anamnesis

Physical examination

Diagnostic imaging

Laboratory examination

Diagnostic pathology


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Characteristic of information

Organ of origin

Histological grade

Local extension (T)

Lymph node extension (N)

Distant metastasis (M)


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STAGING :TNM

Tumor with same histologic type, from the

same origin, grow and spread with the same

pattern

AJCC, WHO, FIGO


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Clinical Staging

Anamnesis, physical examination, simple

laboratory methods, radiodiagnostic and

endoscopy

Find everywhere


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Radiologic staging

With modern radiology equipment

- CT Scan

- Lymphography

- MRI


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Surgical Staging

Intraoperative findings

Infiltration of tumor to surrounding tissues


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Pathological Staging

Include histologic evaluation : tumor

invasion, lymph node metastasis etc

In breast cancer :

node 1- 3 (N1) differ from 4 or more (N2)


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Clinical stage T1, radiologicalstage T2, surgical stage T3


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Prognosis

Tumor

Patients

- age

- nutrition

- immunological statusAlso : DOCTOR


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Anamnesis and Clinical

examinationNo 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


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Anamnesis

Symptoms

- Local : pain, function,bleeding, swelling etc

- Metastasis : lung, liver, bone, brain

- Product of metastasis: anorexia, febrile,

leucocytosis


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Anamnesis

Localization of tumor

Risk factors

- smoking- Alcohol

- Environment : asbes,benzen

- Radiation : sunlight

- Synthetic estrogen

- Virus

- Family history of cancer


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Bone metastasis

Breast ca : 73%

Lung ca : 33%

Kidney ca : 24%

Colorectal ca : 22%

pain, pathologic fracture


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Lung metastasis

30% of cancer patients

Usually peripheral location ,no symptom

Dyspnea and chest pain : malignant pleural

effusion


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Liver metastasis

More than 50% alimentary tract cancer

metastasis to the liver

Asymptomatic

Pain, in the shoulder

Malaise, anorexia, fever


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Brain metastasis

30% from cancer patients

Lung, breast cancer, melanoma

Cephalgia

- direct extension to nerve or meninges

- increase intracranial pressure


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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


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Causes of lymph node

enlargementMalignant 43%

- Malignant lymphoma 37%

- Metastasis 63%

. Lung cancer 53%

. Head and neck cancer 14%

. Other tumors 33%


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Nonmalignant 57%

- No diagnosis 75%

- Infection 15%

- Granulomatous inflamation 5%

- others 5%


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Anamnesis and physical

examinationNo 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


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Anamnesis and physical

examinationVeryimportant

Diagnosis in the early stage

Guidance for further examinations

Prevent complication, manage in the early

stage or give palliation


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Diagnostic Imaging

Conventional radiology

Digital radiography

CT scan

Echography

MRI (Magnetic Resonance Imaging)

Scintigraphy


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Diagnostic Imaging

Primary tumor

Metastasis

- Lymph node- Bone

- Lung

- Liver- CNS / Brain

- Peritoneal


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Interventional radiology

Biopsy guided with

- Echography

- CT Scan

- (MRI)

- (Fluoroscopy)


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Laboratory Diagnosis

No specific examination

Tumor markers


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Tumor markers

Can be measured quantitatively by

biochemical or immunochemical in tissue or

body fluid


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Tumor markers

To detect a cancer and organ where possibly

resides

To establish the extent of tumor burdenbefore treatment

To monitor the response to treatment


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Essential to understand

Sensitivity

Spesificity

Positive predictive value

Negative predictive value


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Screening and follow-up

asymptomatic patients AFP

Beta HCG

CEA

CA125


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BIOPSY


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Techniques for obtaining

tissue


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Aspiration Biopsy

Cytology analysis

Major surgical resection should not be

undertaken solely on the basis of evidenceof aspiration biopsy


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Needle Biopsy

- obtaining a core of tissue

- sufficient for diagnosis of most tumor types

- soft tissue and bone sarcoma : difficult


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Incisional biopsy

Small wedge of tissue from a larger tumor

mass

Preferred method for soft tissue and bonesarcoma


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Excisional biopsy

Excision of entire suspected tumor tissue

with little or no margin of surrounding

normal tissue


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Principles guide of all surgical

biopsies


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Needle tracts or scars should be placed

carefully , so they can be conveniently

remove as part of the subsequent definitesurgical procedure

Extremity : longitudinal


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Not to contaminate new tissue planes during

biopsy

Large hematome >> tumor spread


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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

Documents

Diagnosis and Biopsy