CONFIRMING DIAGNOSIS Clinical features and patient history suggest a benign tumor of the ear canal; otoscopy confirms it. To rule out cancer, a biopsy may be necessary.
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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
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
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
Pituitary tumors:
Diagnosis
(Handbook of Diseases)
❑ Magnetic resonance imaging (MRI), cranial computed tomography (CT) scanning, or skull X-rays with tomography show enlargement of the sella turcica or erosion of its floor; if growth hormone secretion predominates, X-ray films show enlarged paranasal sinuses and mandible, thickened cranial bones, and separated teeth. MRI and CT scan show the location and size of the adenoma.
❑ Carotid angiography shows displacement of the anterior cerebral and internal carotid arteries if the tumor mass is enlarging; it also rules out intracerebral aneurysm.
❑ Cerebrospinal fluid analysis may show increased protein levels.
❑ Endocrine function tests may contribute helpful information, but results are often ambiguous and inconclusive.
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Source: Handbook of Diseases, 2003
Spinal neoplasms:
Diagnosis
(Handbook of Diseases)
❑ Spinal computed tomography scan or magnetic resonance imaging shows the location and size of the tumor, or evidence of compression.
❑ Spinal tap shows clear yellow cerebrospinal fluid (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. A CSF smear may show malignant cells of metastatic carcinoma.
❑ X-rays show distortions of the intervertebral foramina, changes in the vertebrae, 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 the anatomic relationship of the tumor to the cord and the dura. If the obstruction is complete, the injected dye can’t flow past the tumor.
Note: This study is dangerous if cord compression is nearly complete because withdrawal or escape of CSF will actually 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.
❑ Frozen section biopsy at surgery identifies the tissue type.
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Source: Handbook of Diseases, 2003
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