Clinical aspects of cancer
CLINICAL ASPECTS OF CANCER
Malignant tumors can manifest as pain, weakness, neuropathy, nausea, lack of appetite, seizures, hypercalcemia, hyperuricemia, obstructive syndrome. Death usually comes as a result of sudden or progressive insufficiency of one or more organs.
Pain in cancer patients is often the result of metastasis to the bone, nerve damage or nerve plexus, pressure exerted by the tumor mass or effusion. Active struggle against pain syndrome is an important component in the treatment of cancer and maintaining a high quality of life.
Cardiac tamponade can be the result of a tumorous pericardial effusion and often develops rapidly. The most common cause of tamponade is breast cancer, lung cancer or lymphoma. The presence of a pericardial effusion may be accompanied by pain in the chest, aggravated in a supine position and weakened when sitting. Patients with cardiac tamponade show signs and symptoms of a decrease in cardiac output (for example, dizziness or fainting).On examination, muffled heartiness of tones, pericardial friction noise and paradoxical pulsation can be detected. Radiography determines the spherical cardiac shadow. For diagnostic and therapeutic purposes, pericardiocentesis should be performed and the issue of pleuropericardial window or pericardiectomy should be considered.
A pleural effusion should be drained if it is symptomatic and monitoring of the resurgence of effusion is necessary. With rapid resumption, the question of the introduction of sclerosing drugs, re-drainage using a catheter or tubular drainage is considered. The use of palliative surgical pleurectomy is one of the treatment options for hydrothorax during the progression of malignant disease.
Compression of the spinal cord can be the result of the aggressive spread of a malignant disease and requires immediate intervention. Symptoms include back pain, paresthesia of the lower extremities, dysfunction of the intestine and bladder. The diagnosis is confirmed by CT or MRI. Treatment must begin immediately and usually consists of the use of glucocorticoids, radiation therapy, surgery and chemotherapy.
Collecting a complete history and examining the patient helps to identify early signs of malignant growth.
Anamnesis.The doctor must take into account the presence of predisposing factors, family cancer cases, external influences (including smoking), previous and current diseases (eg, autoimmune diseases, immunosuppressive therapy, hepatitis B and C, HIV infection, abnormal Pap test, papilloma virus infection). Symptoms suggesting a malignant tumor include weakness, weight loss, fever, night sweats, coughing, hemoptysis, bloody vomiting, bloody stools, changes in digestion, persistent pain.
Inspection.On examination, attention should be paid to the skin, lymph nodes, lungs, mammary glands, abdomen, and testicles. It is also important to study the prostate, rectum, vagina.
Surveys.A set of necessary examinations in patients with symptoms of cancer includes the determination of tumor markers in the blood serum, molecular studies, imaging examinations, and biopsy.
Serum tumor markers can confirm the presence of a specific cancer. However, their definition is not used for screening. The concentration of a-fetoprotein may increase with hepatocellular carcinoma and testicular carcinoma, embryonic antigen in colon cancer, p-human chorionic gonadotropin in choriocarcinoma and testicular carcinoma, serum immunoglobulin for multiple myeloma, bcr-abl- with chronic myelogenous leukemia, CA5 - in ovarian cancer, CA 27-29 - with breast cancer, prostate-specific antigen and prostatic acid phosphatase - in prostate cancer. By limiting the number of tested tumor markers on the basis of preliminary examination data, it is possible to minimize the probability of obtaining both false-positive and false-negative results.
Molecular analysis with the determination of the gene expression profile allows the identification of a tumor subtype (for example, a subtype of lymphoma or leukemia), indicates the origin of metastatic cancer in an unidentified primary lesion (eg, lung cancer) and helps in the recognition of primary (or acquired) chemoremia.
Imaging methods include radiography, ultrasound, CT scan and MRI. These studies help identify the pathology, determine the homogeneity of the tumor mass (solid or cystic tumor), size and relationship with the surrounding tissues, which can be of great importance for surgical intervention or biopsy.
A biopsy study confirms the diagnosis, establishes the nature of the tissue, and is mandatory if you suspect cancer. The choice of the biopsy site is determined taking into account the optimal access to the tumor and the degree of invasiveness. In the presence of lymphadenopathy, the use of an aspiration biopsy can help in determining the type of tumor, and if it is ineffective, an open biopsy is performed. Other methods used to perform a biopsy are bronchoscopy used in mediastinal or central pulmonary tumors; liver cutaneous biopsy for suspected liver damage and a biopsy performed under CT or ultrasound control. If these methods are not applicable, an open biopsy is performed. Pre-consultation with a surgeon or oncologist.
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