Cancer: Diagnosis & Prognosis

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-11-27 18:19

Cancer: diagnosis & prognosis

Various diagnostic methods are used to make a reliable diagnosis and assess the spread of the disease. If the attending physician suspects cancer, a detailed medical history (anamnesis) and a detailed physical examination are carried out. It is also asked whether other family members have already had cancer. Sometimes the diagnosis is a "chance hit", for example in the context of a hospital stay because of originally completely different complaints.

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• Individual evaluation if cancer is suspected
• Secure diagnosis: the tissue provides information
• Gene analysis for personalized cancer therapy
• Disease spread in the body
• Staging using the TNM system
• The importance of the general condition

Individual evaluation if cancer is suspected

Every year around 39,000 people develop cancer in Austria. The most common types of cancer include colon, lung, prostate or breast cancer. Men are generally more affected than women, although this varies according to age group. The symptoms can be very different and unspecific and range from pain caused by a mass to paraneoplastic symptoms. These are symptoms that cannot be explained by the mechanical action of the tumor itself or by metastases. Not only the tumor mass, but also messenger substances (e.g. hormones) produced by the tumor can lead to disease symptoms.

Further examinations will depend on the tissue affected. These include above all blood tests (including any tumor markers), radiological imaging (e.g. CT, MRT), nuclear medicine investigations (e.g. if thyroid cancer is suspected).

If possible, it is important to detect cancer early so that treatment can start on time. The preventive medical check-up offers a good opportunity to “look after yourself”. For more information on early detection and prevention, see Prevention and early detection of cancer. If it is a hereditary form of cancer, other family members are also involved in preventive measures - provided they agree.

Secure diagnosis: the tissue provides information

The key examination in tumor diagnostics is the removal of a tissue sample (e.g. by means of a biopsy) or a blood sample. A cancer diagnosis must never be made definitively without a precise histological or cytological examination. With solid tumors, it is also important to examine a small part of the surrounding tissue to assess whether the cancer has spread. Under the microscope it is assessed, among other things, which cells are involved and how degenerate they are. The more a cancer cell deviates from a normal cell, the more malignant it is. This degeneracy is determined using so-called grading. Breaks into the surrounding blood and lymphatic systems, via which cancer cells can be spread throughout the body, can also be visualized with this examination method. If daughter tumors (metastases) - i.e. settlements of the primary tumor elsewhere - are examined, the cells that occur in them sometimes give information about the original tumor if it has not yet been discovered.

Modern molecular biology methods enable even more precise diagnoses and tailor-made therapies by identifying so-called markers or proteins that are characteristic of a particular tumor. Gene analyzes have also found their way into tumor diagnostics.

Gene analysis for personalized cancer therapy

Even tumors of the same type behave differently depending on their individual characteristics. A genetic analysis can be the basis for personalized treatment - especially in the case of tumors that do not respond to conventional treatments. In addition, gene expression tests can provide information on drug hypersensitivity and prognosis. Diagnostic tests are already available, eg MammaPrint and Oncotype DX for breast cancer. They are used to make treatment decisions.

Disease spread in the body

Once the diagnosis of cancer has been made, the next step is an accurate survey of the spread in the body. The earlier the disease is detected, for example in the context of a screening, the smaller the extent of the disease and the better the chances of recovery. Other prognostic factors apply to cancers of the blood and bone marrow, as the tumor is not a solid.

Assessing the extent of the disease is known as staging. There are two types of staging:

• Clinical staging is based on a physical examination, imaging procedures (e.g. X-ray and CT) and nuclear medicine methods (e.g. scintigraphy). In the so-called organ screening, all organs are examined for possible tumors.
• The pathological staging is based on the surgical procedure, for example the removal and examination of regional lymph nodes, inspection of the surrounding organs and the histological examination of the affected tissue.

Staging using the TNM system

In most cases, the staging is done using the TNM system. On the basis of this classification, the treatment can be optimally adapted and the course of a tumor can be precisely followed.

Overview of the TNM classification

description	importance
T	Size and extent of the primary tumor T1 – T4 (the higher the value, the larger the tumor)
N	N0: no involvement of the lymph nodes. N1: involvement of the lymph nodes
M.	M0: no metastases M1: presence of metastases

Source: Adapted from Harrison's Internal Medicine (2012): Volume 1, 18th edition. Berlin, own illustration

Using Roman numerals, T, N and M are combined and a detailed assignment is made. Other frequently used classification schemes are disease-specific, for example the Ann-Arbor classification for Hodgkin lymphomas or the Dukes scale for colorectal carcinomas.

The importance of the general condition

Another important factor for the prognosis is the general condition of the patient. This is classified using Karnofsky performance scores. The physical and mental reserves of those affected are also crucial in the fight against the disease.

The diagnosis of cancer represents a major turning point in the life of those affected. A clinical psychologist or a psychotherapist can also offer support during this difficult time.