Cancer diagnosis

Early diagnostics of cancer is the main task in oncology, determining the effectiveness of treatment and, ultimately, the life expectancy of the patient. This problem is especially relevant in connection with the steady growth of cancer incidence. In addition, oncological diseases have a significant feature of the appearance of the first signs of the disease already at an advanced stage, which significantly reduces the possibilities of early diagnostics. Often, the first signs of a tumor, developing, as a rule, against the background of chronic diseases, are disguised as symptoms of the latter and complicate the recognition of the oncological process.

Therefore, the success of the fight against cancer depends mainly on the work of the polyclinic. It is important that at the very first stage of the patient's appeal all measures are taken to exclude or confirm the diagnosis of a malignant disease.

The reasons for medical errors in diagnosing malignant diseases are varied. These include insufficient knowledge of the semiotics of malignant tumors, and tactical errors - long-term observation and treatment of chronic inflammatory processes without verification of the diagnosis, the appointment of inadequate treatment methods (physiotherapy for malignant tumors of soft tissues). As a rule, the cause of errors is the lack of oncological alertness.

The founders of the Russian school of oncologists N. N. Petrov, P. A. Gertsen, A. I. Savitsky developed the principles of oncological service and the foundations of early diagnosis of malignant tumors, emphasizing the need to cultivate oncological alertness in doctors and prevent unfounded optimism in relation to patients with mild disease symptoms.

Oncological alertness comes down to the following:

• knowledge of the symptoms of malignant tumors in the early stages;
• precancerous diseases and their treatment;
• principles of organizing oncological care, which allows for the immediate referral of a patient with a suspected tumor to the appropriate specialist;
• a thorough examination of each patient who has consulted a doctor of any specialty in order to exclude possible oncological disease;
• in difficult diagnostic cases - suspicion of an atypical or complicated oncological disease.

Cancer diagnosis in the preclinical period is possible with active screening or accidentally during examination. The absence of clinical symptoms does not mean that the tumor is in the early stages of development, since even advanced cancer can be asymptomatic. But the chances of detecting a tumor in the early stages are much higher. It is important to understand the difference in the following concepts:

• detection of a neoplasm in the preclinical period is its discovery before the appearance of clinical symptoms;
• early detection corresponds to the detection of a tumor before it spreads to adjacent anatomical structures, when the presence of regional and distant metastases is unlikely;
• timely detection corresponds to the stage of tumor development at which special radical treatment is possible, but there is no absolute certainty in the absence of distant micrometastasis;
• late detection corresponds to an advanced stage of tumor development, in which the disease is in the final stage of development and radical treatment is not feasible.

Obviously, the most promising is the detection of oncological disease at the preclinical stage. The main obstacle to tumor diagnostics at this stage is the absence of complaints from the patient, as a result of which he has no reason to consult a doctor. Therefore, the only way of early diagnostics is an active search.

Active search is implemented through screening (selection). The screening system can be organized comprehensively, covering various organs and systems of the body, or by individual, most probable localizations of neoplasms. For example, a widely known and long-used system of examinations aimed at detecting pathology in the lungs and mediastinum is preventive fluorography, mammography in women over 40, taking cytological smears from the cervix during a gynecological examination, digital rectal examination in men over 50, and a hemocult test. Preventive examinations are of certain importance in the early detection of oncological diseases.

For every cancer patient, cancer diagnosis includes two stages:

• primary diagnostics of cancer, which is carried out by doctors at a polyclinic, a rural district hospital, a medical center at an enterprise, or a fluorographic station. Having suspected or diagnosed a tumor in a patient, the doctor must determine the affected organ, if possible, the extent of the spread of the malignant process, and urgently refer the patient to the appropriate dispensary;
• refined diagnostics of cancer, which is carried out in an oncology dispensary, hospital or clinic. At this stage, using modern special methods, the exact localization of the tumor, the nature and extent of its spread in the organ, metastasis, concomitant diseases, and the functional state of the patient are determined. Refined diagnostics of cancer ends with an accurate formulation of a clinical diagnosis, which takes into account all the individual characteristics of the course of the disease. A mandatory condition is the study of the morphological structure of the tumor.

The formulation of the diagnosis of cancer patients should always end with the determination of the stage of the disease. Cancer diagnostics ends with the establishment of the stage of the disease, it serves as one of the main criteria for choosing the method and volume of treatment measures. In addition, the exact determination of the clinical stage of the disease allows for the correct prediction of its course, rational planning of subsequent observation and reliable assessment of the results of treatment.

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