Diagnosis and Staging Flashcards
Medical History
Essential part of a ca. diagnosis -differential diagnosis -drives workup -family hx -known risk factor not all cancers present with symptoms suspicious signs and symptoms that warrant further work-up
Red Flag symptoms?
unexplained fatigue wt loss >10lbs night sweats bleeding/bruising unexplained fever poor healing
general guide for suspicious symptoms
cancer is not usually the cause of these symptoms
abnormal signs and symptoms lasting several weeks: seek care
early stage cancer usually not painful
do not wait to feel pain before seeking care
symptoms not caused by cancer cells themselves
symptoms usually caused by:
increasing tumor burden
organ dysfunction related to tumor
cutaneous changes related to tumor
(cancer affecting other organs)
Suspicious symptoms ROS General
fatigue and/or weakness without cause night sweats (NOT sweating at night, soaked) prolonged fever > 1 week, without etiology, low grade generalized pruritis (bee symtoms) weight changes: gain or loss without cause or purpose
Suspicious symptoms ROS HEENT
hoarseness that does not resolve (thyroid, throat, lung, lymph)
difficulty swallowing
prolonged non-tender, enlarged lymph nodes (axilla or groin)
expistaxis - prolonged (leukemia/bone marrow)
Suspicious symptoms ROS respiratory
non-resolving cough
Suspicious symptoms ROS chest/breast
change in size or shape of breast or nipple
change in texture or skin
edema of all or part of a breast (even if no distinct lump)
breast skin irritation or dimpling
breast or nipple pain
nipple retraction
erythema, scaling, or thickening of nipple or skin
nipple discharge
Suspicious symptoms ROS GI
early satiety
pain or discomfort after eating (normal with gallblader probl)
changes in appetite (usually anorexia)
hematochezia (blood in stool - bright)
abdominal pain
change in bowel movements: diarrhea or constipation
Suspicious symptoms ROS Genitourinary
dysuria
hematuria
abnormal vaginal bleeding or discharge
Suspicious symptoms ROS integumentary
new or changing mole (thin ABCDs of skin ca.)
non-healing lesion
thickening or new lump on or under skin (lymph node)
petechiae/purpura
Suspicious symptoms ROS Neurologic
headaches - especially with N/V or vision changes
new onset weakness
acute onset seizures
Pt education: symptoms
7 warning signs spell CAUTION
CAUTION
C - change in bowel or bladder habits
A - a sore that doe snot heal in a normal amount of time
U - unusual bleeding or discharge
T - thickening of breast tissue or a lump
I - indigestion and/or difficulty swallowing
O - obvious changes to moles or warts
N - nagging cough
Physical Exam
head to to
Performance status - use to assist in determining patients’ ability to tolerate treatment options
Performance status
-use to assist in determining patients’ ability to tolerate treatment options
-used in clinical trials to determine eligibility
–most use ECOG status
–phase I vs phase III or IV, earlier trial inc PS needed
several different scales:
2 Performance scales
ECOG * eastern cooperative oncology group: 0-5 dead
Karnofsky - 0%-100%
Lab studies
Evaluate baseline information prior to developing treatment plan
Universal stand of care labs
baseline information
marrow function
hepatic function
renal function
tumor lysis
Universal standard of care labs
CBC with differential
basic metabolic panel
hepatic function
Common labs
coagulation panel
pancreatic enzymes
lactate dehydrogenase (LDH)
Imaging studies
confirms tumor existence and location
confirms extent of spread of tumor if metastasized
anatomical Vs functional status (CT vs PET)
*information for biopsy/surgery
Anatomical studies
image the anatomy to help detect abnormalities
- xrays
- computed tomogaphy (CT)
- mammography (type of xray)
- magnetic resonance imaging (MRI)
- nuclear sans (bone scan..)
Functional studies
image the working processes of the body
- Tissue metabolism, organ efficiency, neural signaling
- magnetic resonance spectroscopy
- Positron emission tomography (PET) - hot spots
- octreotide scan
X-ray
2 day image quick and efficient inexpensive non-invasive used often in multiple myeloma: quickly see lytic bone lesions limitations: obesity
Ultasound in cancer diagnosis
non-invasive
high frequency sound waves
images made from reflection of waves
uses: liver, kidney, breast, ovarian, effusions (ascities, peicardial), transvaginal
Computed tomography (CT)
most common diagnostic imaging tool in onc
combines xrays with sophisticated computers
3D omputer model
allows examine of body one slice at a time to pinpoint specific areas
caution in use of IV contrast with renal disease pts (check CREAT levels, metformin, shelfish allergy)
contrast - helps to highlight
Magnetic Resonance imaging MRI
uses a magnetic field and radio waves
create detailed images of the organs and tissues
magnetic field temporarily realigns hydrogen atoms in your body
not exposed to ionizing radiation
preferred for bone, musculoskeletal, CNS
limitations: metal implants, tolerability (claustrophibia)
Positron Emission Tomography (PET)
reveal tissue and organ function
uses radioactive drug (tracer), usually glucose
tracer collects in areas that have higher level of chemical activity - often correspond to areas of disease, can correspond with normal tissue, bright spots or “hot spots”
used mainly for lymphoma and melanoma
Bone scan
inject radioactive tracer: F-FDG, sugar
metabolically active areas uptake the tracer and light up on images
reported uptake as an SUV
not all tumors will uptake tracer b/c slow growing (broncho-alveolar)
expensive
diagnostic for: esophageal, colorectal, melanoma, lymphoma, NSCLC, thyroid, breast, lung nodunes
GI series
barium studies upper GI series lower GI series limitations: fasting required, bowel prep useful for assessment in colon cancer *must tolerate drinking barium
Diagnosis
accurate diagnosis needed to determine treatment
must have tissue to make diagnosis (biopsy)
tissue or cells are examined histologically to determine malignancy from benign
microscopic diagnosis
