Examination of the tumor

2021-02-06 12:00 AM

Puncture cells: use a syringe with a fine needle, inject directly into the tumour, or can be combined with aspiration under the guidance of ultrasound

Outline

 A tumor, whether benign or malignant, needs to be detected early, must be examined carefully to get a correct, accurate diagnosis and have the best treatment for tumors. To have preliminary diagnoses before sending to specialized facilities, any physician can do. A tumor can be discovered by accident by a patient or discovered through a physical exam or a mass health examination in the community.

Define

Currently there are many definitions of tumors. We refer to the most commonly accepted definitions.

Definition of Abeyant A tumor is a neoplastic organism, the result of amplified proliferation from the cells of an organism in the body, which tends to exist and grow indefinitely.

Definition of Willis According to Willis tumor is an abnormal organization that grows indefinitely and persists despite taking away its stimulating factors.

Some common features

From the above definitions, we draw some general features, having the following characteristic properties:

U is a neophyte (Neoplasm) but has a structure bearing the identity of the organization that gave birth to it.

For example, a breast tumor is benign (fibroids of the mammary gland) or a cancer, but its nature is the cells that carry the characteristics of the mammary gland organization, or the organization of the milk pathway.

It is necessary to distinguish a tumor from an infectious organization, which clinically also touches a tumor, but in fact it is just a pseudo-tumor because:

It just changed a pre-existing structure; it was not a fresh organization.

It has the characteristics of an infectious organism and exists associated with the infectious process.

All organs in the body can develop tumors.

There are tumors that cannot be detected by clinical examination, especially tumors that are small or deep in the body.

An organ in the body can have benign and malignant tumors, sometimes including benign and malignant tumors that coexist at the same time.

For example: On one mammary gland of a patient there may exist a fibroid in addition to a breast cancer.

Examination of the tumor

Examination to detect and evaluate a tumor requires meticulousness, must be comprehensive, sometimes done many times and must combine clinical and subclinical

Clinical examination

Request

The examination must be carried out in a clinic, or in a patient's room with necessary conditions according to the specialty.

Patients can be examined in a lying, sitting or special positions depending on the location of the tumor. For example:

Patients can sit while examining goiter, examining tumors.

The patient lies to examine tumors in the abdomen.

The patient is in an obstetric position during the examination of tumors of the anorectal region or tumors of obstetrics and gynecology ...

The area to be examined must be clearly revealed, For example:

Goiter examination: must clearly reveal the neck area, the upper part of the chest.

Breast examination: must clearly reveal the chest, neck and armpits.

Must be examined gently, according to a certain order and always compare and compare with the healthy side.

Specific examination 

Look

To determine the location of tumors, especially tumors that are shallow, with the naked eye can be preliminary evaluated.

Identify changes in the skin and organization immediately on the tumor or around the tumor: there is skin ulcer, bleeding, edema, enlargement of blood vessels around the tumor or not.

Preliminary determine the boundaries, the size of the u.

Touching with Tumors

Determining the size, which can be combined with tools and measures to accurately assess the size of the tumor. For malignant tumors, an accurate assessment of the tumor size is a necessary requirement to have an appropriate treatment regimen.

Determination of density: soft, firm, hard ...

Boundary assessment: Clear limit common in benign tumors.

Touch also to assess the level of tumor mobility, tumors that do not invade nearby organizations are often mobile.

With related lymphatic systems: it is necessary to touch carefully to detect the presence or absence of the lymph node, the number, density of the lymph node, the mobility and the size.     

For example: 

For goiter: must determine the lymph nodes in the carotid artery, the posterior spinal lymph nodes, the paranasal ganglia and the epigastric region.

For breast tumors: to evaluate the axillary lymph nodes, the external mammary lymph nodes, the lymph nodes between the chest muscles (Rotter interpectoral lymph nodes), the supernova lymph nodes.

With tumors of the external genital area, rectal area, perineal layer: Must carefully examine the inguinal lymph node system and bilateral pelvic lymph nodes.

For gastrointestinal cancers, the triose lymph nodes must be detected in the left upper quadrant.

Type

Mainly to assess deep tumors in the abdomen, chest, changes in the size of the tumor, organs including tumor growth: gastric tumors, liver tumors, tumors in the peritoneal cavity and posterior cavity cornea, lung tumors, secretions in the abdomen or pleural cavity due to tumors ...

Listen    

It is also necessary when examining lung tumors, tumors that manifest pressure or enlargement of blood vessels: goiter, tumors located in the path of large blood vessels ...

Preclinical examination

Subclinical examination for preliminary evaluation, an initial diagnosis. However, if you want to evaluate properly and accurately, you must combine with subclinical means to support the clinical, but do not need to do too many duplicate tests, annoying. Costly and time consuming for the patient.

Cytology (cytology)

Cytology was born in the last century, in 1825, proposed by Dr. Lebert, and it was Lebert who proposed a method of diagnosing cytology with fine needle aspiration and today its role is indispensable in the diagnosis, treatment, monitoring and prevention of tumors and especially malignant tumors.

This is a simple, inexpensive, and easy-to-do method that any facility can do and can be applied to many locations of the tumor in the body.

This method is sensitive and reliable. The difference between the cells and the pathology is negligible.

Cytological methods:

Cellular peeling: means finding cells from secretions (in sputum, gastric juice, peritoneal fluid, pleural fluid ...) or finding cells by smear directly on the surface of the tumor out (find vaginal cells through the Papanicolaou test).

Puncture cells: use a syringe with a needle, poke directly into the tumor, or can be combined with aspiration under the guidance of ultrasound. This is a good method; the template is accurate.

Cell test value:

If the result (+) means finding the correct cell to diagnose, then it is valid for diagnosis.

If the result (-) that does not mean the diagnosis negates, because there are cases of (-) fake poke in the wrong place.

Today, people still mention more about false (+) cases, that is, the cases of confusion in diagnosis, especially for malignant tumors, can confuse some special cases with morphology. of some cells with changes that are easy to confuse with the image of cancer cells. However, these cases are not very high and depend on the ability of the template reader.

Histology (Histology)

It is worth diagnosing. It both evaluates the morphology of the tumor cells, and evaluates the structure of the tumor marker. However, an institution's test must pass:

The patient sample should be large enough to accommodate the template and when it is necessary to make multiple templates.

Must get the right place required.

A benign tumor can either biopsy or remove the tumor as pathological surgery.

A malignant tumor, if possible, should remove the whole tumor for pathological surgery, or do immediate pathological surgery to have a result right on the operating table and have a timely surgical method, avoiding metastases caused by surgery Art causes, especially tumors: melanoma, testicular K ...

X-ray

Very valuable for diagnosing tumors in the deep: lung tumor, stomach tumor, kidney, bone ...

Especially nowadays, with the advancement of increasingly advanced equipment and technology, people can detect quite accurately even deep tumors that cannot be reached clinically, and very small tumors. Diameter is only 1 cm.

X-rays can be simple (unprepared) or combined with contrast (gastric scan, kidney UIV scan, spinal scan, angiogram, milk pathway ...). Special methods of TDM (Tomodensitometry), CT (Computed Tomography), MRI (Magn├ętic Resonnance Imaging), MRI (Magn├ętic Resonnance Imaging), combined with radioisotope imaging, can be used. (Scintigraphy) applied in the scan of goiter, kidney ...

Ultrasound (Echographia)

Nowadays, it is widely used to detect, diagnose and monitor the treatment of tumors. Although it does not determine the diagnosis, it does suggest a method for definitive diagnosis. Ultrasound is a good means to early detect and monitor tumors of the gastrointestinal tract, urinary tract, respiratory tract and deep in the abdominal cavity, chest ...

Tests for fluids

Includes tests to detect and track the existence and development of tumors in the body.

Blood tests for leukemia types.

Detect some abnormal enzymes appear when there is a tumor in the body:

Substance a FP (Alpha-fetoprotein): is a substance only available in the fetal period and at birth about 10,000-150,000 mcg / ml, in adults about 1-15 mcg / ml, especially high in hepatoblastoma play.

CEA is also a substance glycoprotein, found in colon, lung, and stomach cancers.

Acid phosphatase is abundant in prostate cancer.

HCG hormone indicates a cancer of the placenta and testicles, normal in the blood is 0.4 mcg / ml.

Distinguish benign or malignant tumors

The distinction between a benign and a malignant tumor has a very important meaning. That distinction is sometimes very easy with some small tumors, but in some cases, it is very difficult, it must be closely combined between clinical thorough examination and subclinical methods to distinguish.

Benign tumours

Clinical

Most tumors grow slowly, with tumors that exist at birth (hemangioma). There are detectable tumors during the formation of the body and also exist for a long time with the patient: simple goiter, lump, open tumor, benign bone tumor ...

U is usually soft or firm density.

Soft density: goiter, hemangioma, melanoma, adipoma and other benign soft tissue tumors ...

Solid and elastic density: fibroids of all kinds such as fibroids, prostate fibroids, fibroids.

Boundaries are usually clear, as most are surrounded by fibrous sheaths.

Usually, mobile is easy because it is non-invasive to nearby organs and does not spread.

If removed, the tumor does not recur.

In terms of cytology and organization

In terms of cytology: Benign tumors have cell proliferation and surrounding stroma, but there is no structural reversal of the cell and the change in morphology between cells.

Organizational aspect: In benign tumors there is no organizational structure reversal.

Malignant tumours

Clinical

When there is a clinically detected malignant tumor, monitoring progress shows that the tumor grows very quickly. Normally a tumor when detected is 1cm3 in diameter (equivalent to 1 billion cells) and takes about 7-10 years. But when it is discovered, sometimes it develops to a full stage of only a very short time, for example, liver cancer, stomach cancer, lung cancer ...

Tumor density is usually solid.

The surface is often lumpy and rough due to the uneven growth of the tumor.

Boundaries are not clear, little or no mobile because they often encroach on neighboring organizations. That is why it is impossible to remove the tumor, but to remove the tumor and it is easy to recurrence.

Malignant tumors usually metastasize by three routes: adjacent invasive, lymphatic metastasis and blood sugar metastasis.

In terms of cytology and organization

The cytological melanoma test must be based on four criteria:

Human change.

The relationship of the cause and protoplasm.

Relationship between cells together.

With a malignant tumour, cytologically, there are characteristic alterations: hyperplasia, dysplasia, aplasia (finding nuclei, multiplication) and aplasia (i.e., no proliferation full development of cell lines from young to old, mainly only young cells).

Organizational aspect: often there is a reversal of the structure of the tumor (i.e., there is an invasion of a malignant organization and surrounding buffer structure).