BASIC DIAGNOSTIC AND MANAGEMENT

OF TUMORS

William Hamdani
Department of Surgery
Medical Faculty of Hasanuddin University
2012
Principles in Management of Tumors
1. Diagnosis.
2. Staging / Stadium.
3. Performance status .
4. Treatment planning.
5. Treatment Implementation.
6. Follow-up / Reconstruction / Rehabilitation.
Step 1 : Diagnosis

 Diagnosis :
- Anamnesis
- Physical Examination
- Laboratory Test and Imaging studies
- Biopsy
Anamnesis
o Natural History
o Risk Factors
o Past Treatment or Disease
o Family History
Physical examination
 Basic Principles are :
- Inspection
- Palpation
- Percution
- Auscultation
Physical examination
 Inspection :
- Skin change overlying the tumor
- Dilated veins
- Skin dimpling
- Uninodular or multinodular
- Surface of the tumor ( smooth or lobulated )
- Location of the tumor
Physical examination
 Palpation :
- Location of Tumor
- Soliter or multiple tumors
- Size of tumor
- Tumor consistency
- Irregularity of Tumor border
- Fixation to adjecent tissue
- Regional lymph node enlargement
Laboratory Test

 Hormone ( Thyroxine hormone, TSH ... )

 Tumor marker ( CEA, CA 15-3 ... )
Imaging Studies
 X- Rays
 Ultrasonography ( USG )
 CT Scan
 Mammography
 Magnetic Resonance Imaging ( MRI )
 PET Scan
Biopsy
Pathologic diagnosis of a malignant tumor can be
achieved using a number of biopsy techniques
 Needle biopsy
- Fine-needle aspiration (FNA)
- Tru-Cut / Core Biopsy

 Open Biopsy :
- Excisional biopsy
- Incisional Biopsy
The Gold Standard for Diagnosis :
Histopathologic Examination
Principles in Management of Tumors
1. Diagnosis.
2. Staging / Stadium.
3. Performance status .
4. Treatment planning.
5. Treatment Implementation.
6. Follow-up / Reconstruction / Rehabilitation.
Step 2 : Staging / Stadium
 Staging is the assessment of a patient’s tumour burden

 It is performed prior to therapy and can be subdivided

into :
clinical,
radiological, and
pathological.
Step 2 : Staging / Stadium
 Before deciding on definitive treatment for a newly
diagnosed cancer, staging the disease is necessary to
plan optimum treatment.
 The most common method of denoting the stage of the
disease is the TNM (tumor, node, metastases) system
 The stage of disease predicts the probability of patient
survival.
Step 2 : Staging / Stadium
 The aim of Staging are :
- Knowing the extent of the disease ( Stadium of the
disease )
- Deciding on definitive treatment
- Evaluating treatment
- Prognostic of the cancer patient
- To campare two or more treatment
- As a tool for communication between the expert
 Staging System :
- AJCC ( American Joint Committee on Cancer )
- UI CC ( Union Internationale Contre Le Cancer )

 Staging :
T = Tumor
N = Node
M = Metastasis to distant organ
T = Tumor Size
N = Enlargement of regional Lymph Node due to
tumor metastasis
M = Distant Metastasis
 Primary tumour (T)

Tx—primary tumour cannot be assessed.

T0—no evidence of primary tumour.

Tis—carcinoma in situ.

T1, T2, T3, T4—increasing size and/or local extent of

primary tumour.
 Regional lymph nodes (N)
Nx—regional lymph nodes cannot be assessed.
N0—no regional lymph node metastases.
N1, N2, N3—increasing involvement of regional
lymph nodes.
 Distant metastases (M)
Mx : presence of distant metastases cannot be assessed.
Mo : no distant metastases.
M1 : distant metastases.
 Distant metastases (M)
Mx : presence of distant metastases cannot be assessed.
Mo : no distant metastases.
M1 : distant metastases.
 M1 is often subdivided according to the following
notation:
Pulmonary—PUL.
Osseous—OSS.
Hepatic—HEP.
Brain—BRA.
Skin—SKI.
Peritoneum—PER.
Marrow—MAR.
Pleura—PLE.
Principles in Management of Tumors
1. Diagnosis.
2. Staging / Stadium.
3. Performance status .
4. Treatment planning.
5. Treatment Implementation.
6. Follow-up / Reconstruction / Rehabilitation.
Step 3 : Performance status

- Karnofsky Score : 0 - 100

- W H O Score : 0 – 4

- ECOG Score
KARNOFSKY PERFORMANCE STATUS SCALE DEFINITIONS RATING (%) CRITERIA

100 Normal no complaints; no evidence of disease.

Able to carry on normal activity and to Able to carry on normal activity; minor signs or
work; no special care needed. 90
symptoms of disease.
Normal activity with effort; some signs or
80
symptoms of disease.
Cares for self; unable to carry on normal activity
70
or to do active work.
Unable to work; able to live at home and
Requires occasional assistance, but is able to
care for most personal needs; varying 60
care for most of his personal needs.
amount of assistance needed.
Requires considerable assistance and frequent
50
medical care.

40 Disabled; requires special care and assistance.

Severely disabled; hospital admission is indicated

30
although death not imminent.
Unable to care for self; requires equivalent
of institutional or hospital care; disease Very sick; hospital admission necessary; active
20
may be progressing rapidly. supportive treatment necessary.

10 Moribund; fatal processes progressing rapidly.

0 Dead
 The ECOG score (published by Oken et al in 1982)
also called the WHO or Zubrod score

0 Asymptomatic (Fully active, able to carry on all predisease activities without

restriction)

1 Symptomatic but completely ambulatory (Restricted in physically strenuous

activity but ambulatory and able to carry out work of a light or sedentary
nature. For example, light housework, office work)

2 Symptomatic, <50% in bed during the day (Ambulatory and capable of all
self care but unable to carry out any work activities. Up and about more
than 50% of waking hours)

3 Symptomatic, >50% in bed, but not bedbound (Capable of only limited self-
care, confined to bed or chair 50% or more of waking hours)

4 Bedbound (Completely disabled. Cannot carry on any self-care. Totally

confined to bed or chair)

5 Death
Principles in Management of Tumors
1. Diagnosis.
2. Staging / Stadium.
3. Performance status .
4. Treatment planning.
5. Treatment Implementation.
6. Follow-up / Reconstruction / Rehabilitation.
Step 4 : Treatment planning

 Treatment Planning depend on :

- Histopathologic type of cancer
- Stadium ( Early stage or late stage )
- Curative or Palliative treatment
- Patients Performance Status
STEP 5 : TREATMENT IMPLEMENTATION

Step 5 : Treatment Implementation.

 Successfull of the treatment depend on :

- Doctor competency
- Hospital Facilities
- Patients demand
Principles in Management of Tumors
1. Diagnosis.
2. Staging / Stadium.
3. Performance status .
4. Treatment planning.
5. Treatment Implementation.
6. Follow-up / Reconstruction / Rehabilitation.
Step 6 : Follow-up / Rehabilitation & Reconstruction
 After completion of treatment, the cancer patient have
to be follow-up :
- For the first 2 years
* Physical examination every 2 months
* X-Rays, Laboratory test and Imaging studies :
every 6 months
Step 6 : Follow-up / Rehabilitation & Reconstruction

 At the third year and then : if no evidanced of recurrent

* Physical examination can be extend to every 6 months

 Follow-up must be continue until 20 years

RECONSTRUCTION AND REHABILITATION

Step 6 : Follow-up / Rehabilitation & Reconstruction


Thank You
4 objectives in rehabilitation of patients with cancer:
- Psychosocial support
- Optimization of physical functioning
- Vocational counseling
- Optimization of social functioning