CHAPTER 7 Management of malignant disease
Screening
• The natural history of the cancer should be established, i.e. its development from a latent phase to symptomatic disease.
• A test should be available to detect the latent stage; the test should be sensitive and specific to the cancer and be acceptable and safe to the patient.
• Early detection of the cancer should lead to a benefit in terms of cost of treatment and survival of the patient.
Examples of screening programmes being carried out at present are:
Premalignant conditions
Examples of premalignant conditions include:
• GI tract: leukoplakia (mouth and tongue), Plummer–Vinson syndrome, Barrett’s oesophagus, villous adenoma, familial polyposis coli, ulcerative colitis, Crohn’s disease, Ménétrièr’s syndrome.
General symptoms and signs of malignant disease
They may be broadly classified as follows:
Diagnostic procedures
Biopsy
This is mandatory, and may be carried out in a variety of ways:
• Fine-needle aspiration using a 22G needle: smear produced on slide; read by experienced cytologist
• Excisional biopsy: the complete removal of a discrete lesion without a wide margin and without it being considered curative of the malignancy
Staging and grading of cancer
Clinical staging
An example of this is the Manchester Classification of carcinoma of the breast (→ Ch. 10). This is based purely on clinical findings but is somewhat imprecise.
Clinical and pathological staging
A method that is based on pathological staging only is Dukes’ Classification for colorectal carcinoma (→ Ch. 14).