tailieunhanh - Chapter 077. Approach to the Patient with Cancer (Part 4)

Defining the Extent of Disease and the Prognosis The first priority in patient management after the diagnosis of cancer is established and shared with the patient is to determine the extent of disease. The curability of a tumor usually is inversely proportional to the tumor burden. Ideally, the tumor will be diagnosed before symptoms develop or as a consequence of screening efforts (Chap. 78). A very high proportion of such patients can be cured. However, most patients with cancer present with symptoms related to the cancer, caused either by mass effects of the tumor or by alterations associated with. | Chapter 077. Approach to the Patient with Cancer Part 4 Defining the Extent of Disease and the Prognosis The first priority in patient management after the diagnosis of cancer is established and shared with the patient is to determine the extent of disease. The curability of a tumor usually is inversely proportional to the tumor burden. Ideally the tumor will be diagnosed before symptoms develop or as a consequence of screening efforts Chap. 78 . A very high proportion of such patients can be cured. However most patients with cancer present with symptoms related to the cancer caused either by mass effects of the tumor or by alterations associated with the production of cytokines or hormones by the tumor. For most cancers the extent of disease is evaluated by a variety of noninvasive and invasive diagnostic tests and procedures. This process is called staging. There are two types. Clinical staging is based on physical examination radiographs isotopic scans CT scans and other imaging procedures pathologic staging takes into account information obtained during a surgical procedure which might include intraoperative palpation resection of regional lymph nodes and or tissue adjacent to the tumor and inspection and biopsy of organs commonly involved in disease spread. Pathologic staging includes histologic examination of all tissues removed during the surgical procedure. Surgical procedures performed may include a simple lymph node biopsy or more extensive procedures such as thoracotomy mediastinoscopy or laparotomy. Surgical staging may occur in a separate procedure or may be done at the time of definitive surgical resection of the primary tumor. Knowledge of the predilection of particular tumors for spread to adjacent or distant organs helps direct the staging evaluation. Information obtained from staging is used to define the extent of disease either as localized as exhibiting spread outside of the organ of origin to regional but not distant sites or as metastatic to