Diagnosis of Non-Small Cell Lung Cancer
Non-Small Cell Lung Cancer Diagnosis: Book Excerpts
Diagnostic Tests for Non-Small Cell Lung Cancer: Online Medical Books
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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.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant spinal neoplasms:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
❑Spinal and lumbosacral magnetic resonance imaging confirm spinal tumor.
❑ X-rays show distortions of the intervertebral foramina; changes in the vertebrae or collapsed areas in the vertebral body; and localized enlargement of the spinal canal, indicating an adjacent block.
❑ Myelography identifies the level of the lesion by outlining it if the tumor is causing partial obstruction; it shows anatomic relationship to the cord and the dura. If obstruction is complete, the injected dye can't flow past the tumor. (This study is dangerous if cord compression is nearly complete because withdrawal or escape of cerebrospinal fluid (CSF) will allow the tumor to exert greater pressure against the cord.)
❑ Radioisotope bone scan demonstrates metastatic invasion of the vertebrae by showing a characteristic increase in osteoblastic activity.
❑ Computed tomography scan shows cord compression and tumor location.
❑ Frozen section biopsy at surgery identifies the tissue type.
❑ Lumbar puncture may be normal, abnormal, or nonspecific. It may show clear yellow CSF as a result of increased protein levels if the flow is completely blocked. If the flow is partially blocked, protein levels rise, but the fluid is only slightly yellow in proportion to the CSF protein level. Cytology of the CSF may show malignant cells of metastatic carcinoma.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Lung cancer:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Typical clinical findings may strongly suggest lung cancer, but firm diagnosis requires further evidence.
❑Chest X-ray usually shows an advanced lesion, but it can detect a lesion up to 2 years before symptoms appear. It also indicates tumor size and location.
❑ Sputum cytology, which is 75% reliable, requires a specimen coughed up from the lungs and tracheobronchial tree, not postnasal secretions or saliva.
❑ Computed tomography (CT) scan of the chest may help to delineate the tumor's size and its relationship to surrounding structures.
❑ Bronchoscopy can locate the tumor site. Bronchoscopic washings provide material for cytologic and histologic examination. The flexible fiber-optic bronchoscope increases the test's effectiveness.
❑ Needle biopsy of the lungs uses biplane fluoroscopic visual control to detect peripherally located tumors. This allows firm diagnosis in 80% of patients.
❑ Tissue biopsy of accessible metastatic sites includes supraclavicular and mediastinal node and pleural biopsy. Directed needle biopsy may be performed in conjunction with CT scan.
❑Thoracentesis allows chemical and cytologic examination of pleural fluid.
Additional studies include preoperative mediastinoscopy or mediastinotomy to rule out involvement of mediastinal lymph nodes (which would preclude curative pulmonary resection).
Other tests to detect metastasis include bone scan, bone marrow biopsy (recommended in small cell carcinoma), CT scan of the brain or abdomen, and positron emission tomography.
After histologic confirmation, staging determines the extent of the disease and helps in planning the treatment and predicting the prognosis. (See Staging lung cancer.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Lung cancer:
Diagnosis
(Handbook of Diseases)
Typical signs and symptoms may strongly suggest lung cancer, but a firm diagnosis requires further evidence, including the following:
❑ Chest X-ray usually shows an advanced lesion, but it can detect a lesion up to 2 years before symptoms appear. It also indicates tumor size and location.
❑ Sputum cytology is marginally helpful in obtaining a diagnosis. It requires a specimen coughed up from the lungs and tracheobronchial tree, not postnasal secretions or saliva.
❑ Computed tomography (CT) scan of the chest may help to delineate the tumor’s size and its relationship to surrounding structures.
❑ Bronchoscopy can locate the tumor site. Bronchoscopic washings provide material for cytologic and histologic examination. The flexible fiber-optic bronchoscope increases the test’s effectiveness.
❑ A needle biopsy of the lungs uses biplane fluoroscopic visual control or CT guidance to detect peripherally located tumors. This allows a firm diagnosis in 80% of patients.
❑ Tissue biopsy of accessible metastatic sites includes supraclavicular and mediastinal node and pleural biopsies.
❑ Thoracentesis allows chemical and cytologic examination of pleural fluid.
Additional studies include preoperative mediastinoscopy or mediastinotomy to rule out involvement of mediastinal lymph nodes (which would preclude curative pulmonary resection).
Other tests to detect metastasis include a bone scan, positron emission tomography scan, bone marrow biopsy (recommended in small cell carcinoma), and a CT scan of the brain or abdomen.
After histologic confirmation, staging determines the extent of the disease and helps in planning treatment and predicting the prognosis. (See Staging lung cancer.)
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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