ONCOLOGY 8

Diagnosis

Endoscopy provides a rapid method of examination and obtaining

material for biopsy. It is suitable for GI tract, urinary tract

and respiratory tract.

Imaging through radiology and newer techniques like ultrasound,

CT scanning and NMR are also efficient diagnostic means.

Pathologic review of tissue for microscopic examination is a

dependable method of diagnosis.

The means of obtaining material are:

* Fine Needle Aspiration Cytology (FNAC) is now widely

available for superficial and deeply situated swellings

(approached with the help of imaging techniques)

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ONCOLOGY 7

7. Presentations

* It can present as a swelling usually painless.  

  Occasionally in inflammatory carcinoma breast, there is pain

* Obstruction of lumen of organ of origin

  - dysphagia in Ca oesophagus

  - vomiting in Ca Stomach

  - Pain (colic) Intestine

  - Retention urine Ca prostate

* Hemorrhage

  - Hematuria GU Ca

  - Hematemasis Stomach Ca

  - Rectal bleeding in rectal carcinoma

* Compression adjoining structures

  - Pressure on vena cava

  - Nerve root pain

* Metastasis

  - Pleural effusion

  - ascetic

  - Pathologic fracture

* Asymptomatic

  - Usually discovered on investigation of vague ill health

    cases

 

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ONCOLOGY 6

5. TUMOUR GRADING

This histoligic tumour grading is achieved by using criteria of :

* degree of nuclear polymorphism ie. resemble parent cell,

number of mitosis

* Good differentiated areas or poor diffrentiated area

Tumours with predominant poor differentiation have poor

prognosis. The tumours are thus graded as well, moderate or

poorly differentiated.

6. TUMOUR STAGING

Most systems are based on the criteria of:

T - Tumour size

N - Lymph node metastasis

M - Distant metastasis

This TNM staging records the clinical extent of tumour progress

of different cases in different centres and makes possible

comparison of results of treatment protocols. 

For this purpose TNM staging after surgery is more reliable.

 

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ONCOLOGY 5

4. OTHER FACTORS

* The evidence presented as regards aetiology of cancers is

no doubt, incomplete.

* There are many factors of race and geographic differences

that become apparent when cancers are studied regionally.

* It is possible the way of life and environment play a very

large part in deciding what cancers appear in great

frequency in different geographic regions.

* Some of the differences observed, in different parts of the

world are listed below:

1. There is a very low incidence of cancer of the breast

in Japan .

2. There is very low incidence of cancer of the skin in

Negroes.

3. There is high incidence of cancer of the naso- pharynx in

China .

4. There is a high incidence of primary cancer of the

liver in south and west Africa.

5. There is a high incidence of the cancer of the stomach

in Scandinavia Iceland and Japan .

There is thus reason to believe that there are other factors

which influence the incidence of cancer besides the ones

mentioned and it is also likely that more than one of the factors
may be in play in a case of cancer

 

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ONCOLOGY 4

 IMMUNOLOGIC FACTORS

It is correct to assume that considering the large number of cell

divisions that take place within any living organism, there would

be some cell-division that would result in the production of cell

deviates that do not respond to controlling mechanisms.

- These cells  if allowed to multiply could demonstrate  all  the

  characteristics  that  we associate with  malignancy  i.e.rapid

  growth,  invasion  of local tissues and metastasis  to  distant

  organs.

- It is,therefore, surprising that different species  demonstrate

  only a few cases of malignancies. Some explaination needs to be

  considered.

          

   * Burnett  in  1970  put  forth  the  concept  of  an  immune-

     surveillance  system.This  system in  essence,possesses  the

     ability  of  detecting  the  surface  differences  of  these

     deviant  cells  and as a consequence  eliminates  them  from

     within the host.

   * This competence is EXPRESSED through the lymphoid system and

     if their system is alert it would be capable of  eliminating

     relatively  small  number of cells.There  is  evidence  that

     genetic  factors  may  be  responsible  in  determining  the

     effectiveness  of  this  immune  system.   Guinae  pigs  and

     rabbits are resistant to induction of all viral tumours.

   * Failure of this immune surveillance system could occur  when

     there is immunosuppression, this has been demonstrated to be

     true,   in  cases  of  human  renal  transplantation   where

     immunosuppression  is used as a technique to  faciltate  the

     acceptance of the transplant(to depress rejection).

   * Immune  suppression  could occur, naturally in old  age  and

     other inter-current disorders like prolonged illness.

   * Immune  tolerance could be another mechanism for evasion  of

     this surveillance system.

    - It has been shown that experimental animals, if exposed  to

      specific antigens before maturation, can induce a state  of

      immune tolerance to these antigen. 

    - Another  mechanism   could   be a   reduction  or  loss  of

      antigens from the cells-surface of tumour cells.

    - This has been referred to as antigenic modulation

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