CONFIRMING DIAGNOSIS A biopsy (by incision or by aspiration) is essential to confirm primary malignant bone tumors. Bone X-rays and radioisotope bone and computed tomography scans show tumor size. Serum alkaline phosphatase level is usually elevated in patients with sarcoma.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Introduction: Malignant Neoplasms:
Diagnostic methods
(Professional Guide to Diseases (Eighth Edition))
A thorough medical history and physical examination should precede sophisticated diagnostic procedures. Useful tests for the early detection and staging of tumors include X-ray, endoscopy, isotope scan, computed tomography scan, and magnetic resonance imaging, but the single most important diagnostic tool is a biopsy for direct histologic study of tumor tissue. Biopsy tissue samples can be taken by curettage, fluid aspiration (pleural effusion), fine-needle aspiration biopsy (breast), dermal punch (skin or mouth), endoscopy (rectal polyps), and surgical excision (visceral tumors and nodes).
An important tumor marker, carcinoembryonic antigen (CEA), although not diagnostic by itself, can signal malignancies of the large bowel, stomach, pancreas, lungs, and breasts. CEA titers range from normal (less than 5 ng) to suspicious (5 to 10 ng) to suspect (over 10 ng). CEA serves many valuable purposes:
❑as a baseline during chemotherapy to evaluate the extent of tumor spread
❑to regulate drug dosage
❑to prognosticate after surgery or radiation
❑to detect tumor recurrence.
Although no more specific than CEA, alpha-fetoprotein — a fetal antigen uncommon in adults — can suggest testicular, ovarian, gastric, and hepatocellular cancers. Beta human chorionic gonadotropin may point to testicular cancer or choriocarcinoma. Other commonly used tumor markers include prostate-specific antigen to detect and monitor prostatic cancer, and CA-125, useful for monitoring ovarian, colorectal, and gastric cancers.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant melanoma:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
A skin biopsy with histologic examination can distinguish malignant melanoma from a benign nevus, seborrheic keratosis, and pigmented basal cell epithelioma; it can also determine tumor thickness. Physical examination, paying particular attention to lymph nodes, can point to metastatic involvement. (See Staging malignant melanoma, page 135.)
Baseline laboratory studies include complete blood count with differential, erythrocyte sedimentation rate, platelet count, liver function studies, and urinalysis. Depending on the depth of tumor invasion and metastatic spread, baseline diagnostic studies may also include chest X-ray and a computed tomography (CT) scan of the chest and abdomen. Signs of bone metastasis may call for a bone scan; CNS metastasis necessitates a CT scan of the brain.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Lymphomas, malignant:
Diagnosis
(Handbook of Diseases)
A positive diagnosis requires histologic evaluation of biopsied lymph nodes of tonsils, bone marrow, liver, bowel, or skin or of tissue removed during exploratory laparotomy. A biopsy differentiates malignant lymphoma from Hodgkin’s disease.
Other tests include bone and chest X-rays, lymphangiography, a liver and spleen scan, computed tomography scan of the abdomen, and excretory urography. Laboratory tests include a complete blood cell count (which may show anemia), uric acid level (elevated or normal), serum calcium level (elevated if bone lesions are present), serum protein level (normal), and liver function studies.
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Source: Handbook of Diseases, 2003
Bone tumors, primary malignant:
Diagnosis
(Handbook of Diseases)
A biopsy (by incision or by aspiration) is essential for confirming a primary malignant bone tumor. Bone X-rays and radioisotope bone and computed tomography (CT) scans show tumor size. Serum alkaline phosphatase levels are usually elevated in patients with sarcoma.
Clinical tip Bone X-rays, CT scans, and magnetic resonance imaging are all useful in assessing tumor size. Bone scans and CT scans of the lungs are important in checking for metastatic disease.
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Source: Handbook of Diseases, 2003
Brain tumors, malignant:
Diagnosis
(Handbook of Diseases)
In many cases, a definitive diagnosis follows a tissue biopsy performed by stereotactic surgery. In this procedure, a head ring is affixed to the skull, and an excisional device is guided to the lesion by a computed tomography (CT) scan or magnetic resonance imaging (MRI).
Other diagnostic tools include a patient history, a neurologic assessment, skull X-rays, a brain scan, a CT scan, MRI, and cerebral angiography. Lumbar puncture shows increased pressure and protein levels, decreased glucose levels and, occasionally, tumor cells in cerebrospinal fluid (CSF).
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Source: Handbook of Diseases, 2003
Malignant melanoma:
Diagnosis
(Handbook of Diseases)
A skin biopsy with histologic examination can distinguish malignant melanoma from a benign nevus, seborrheic keratosis, and pigmented basal cell epithelioma; it can also determine tumor thickness. Physical examination, paying particular attention to lymph nodes, can point to metastatic involvement.
Baseline laboratory studies include a complete blood count with differential, erythrocyte sedimentation rate, platelet count, liver function studies, and urinalysis. Depending on the depth of tumor invasion and metastasis, baseline diagnostic studies may also include a chest X-ray and computed tomography (CT) scan of the chest and abdomen. Signs of bone metastasis may call for a bone scan; CNS metastasis, a CT scan of the brain.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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