diagnosis and biopsy
TRANSCRIPT
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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