The first aspect of oncology is that cancer often gets diagnosed after it calls attention to itself either by causing a symptom (pain, bleeding, cough, headache, fatigue virtually anything) or through an abnormal growth (a lump"). If these are brought to a doctor's attention, tests are ordered to investigate the reason for the symptom, and a biopsy (surgical sampling) of any abnormality is performed straightaway.
The material obtained from a biopsy is analyzed by a pathologist (a physician expert at making diagnoses from the appearance of tissue under the microscope), who may make the diagnosis of cancer. Under the microscope, cancer reveals itself as cells growing in a disorganized pattern, in contrast to the organized appearance of normal tissues.
In addition to diagnosing the type of cancer, the pathologist will also assign it a grade," which relates to how aggressively it appears to be growing and how likely it is to spread. A cancer can be low, intermediate, or high grade, in order of least to most aggressive. A prominent example of how grade influences cure is in prostate cancer, in which each cancer is assigned a Gleason score between 2 and 10. The Gleason system divides prostate cancers into those that are low grade (2–4), intermediate grade (5–6), and high grade (8–10); a score of 7 can be intermediate or high grade depending on details of the pathology report. The higher the Gleason score, the lower the chances for cure after treatment with surgery or radiation.
As indicated in John's case, pathologists play a critical role in diagnosing and interpreting cancer. Because the pathologist's impression is in part subjective and may be imprecise, it is sometimes necessary to obtain a second pathologic opinion on a biopsy sample to make certain of the diagnosis.
One of the most common ways for cancer to be detected today isduring a screening test, such as a mammogram or examination of the inside of the colon by colonoscopy.
Prostate cancer is screened for withpalpation of the prostate gland (called a digital rectal exam) and measurementof the PSA (prostate specific antigen) in the blood; PSA isa protein shed by prostate cancer cells into the bloodstream. Routinescreening for some cancers has been proven to save lives and is one reasonthat cancer death rates are declining. Screening offers the best opportunityto catch a cancer when it is at its earliest and smallest phase ofgrowth.
Unfortunately, there are no effective screening tests as of yet for a number of cancers, and the disease is not often detected during a routine physical examination or blood testing. Most cancers are detected when they cause symptoms that lead a person to seek medical help.
When cancer causes symptoms
More often than people realize and contrary to popular belief, a cancer diagnosis is not always a straightforward affair. Cancer may cause symptoms that develop gradually, over months, or suddenly, necessitating urgent medical attention. These symptoms may be caused by the primary tumor or by a cancer's distant metastases tumors causing a problem in another organ (this is explained in the discussion below). Indeed, cancer declares itself in many ways, and some of them can be misleading. This is a common source of frustration and angst for patients and their primary physicians alike.
Symptoms from a cancer often mimic those caused by common ailments, so doctors first think of the more common reasons for a person to exhibit a symptom, and rightly so. It is certainly possible that a headache may be caused by a brain tumor, but it is far more likely that there is a benign cause, such as tension or migraine. Stomach pain can be a sign of stomach cancer, but it is much more likely to be caused by an ulcer. A cough can be a sign of lung cancer, but it is far more likely to be caused by the more common ailments of a cold, postnasal drip, or asthma. If symptoms persist or worsen, further tests are performed and may uncover a cancer.
Another way cancer can masquerade is if it occurs in a person who has a chronic disorder and the symptoms are similar to those caused by that ailment. For example, a person with chronic back pain from arthritis who develops more back pain in the same region would be thought, at first, to have a worsening of arthritis. If a cancer is lurking, too, it may take time before the patient and physician realize that this pain is different and perhaps not responding to the usual remedies.
If the symptoms are tolerable and the person chooses to live with them, some months may pass before further testing is performed. When the cancer is ultimately found, the patient may feel that the doctor missed" the diagnosis earlier. But the doctor may be very skilled and diligent and treated the patient according to the likeliest situation, that the symptoms were simply a worsening of arthritis. In time, an MRI or a CT scan of the affected region would be done and reveal a tumor rather than arthritis; a biopsy would be done to diagnose cancer. It would have been impossible for the doctor to know from the outset that the new symptoms were caused by cancer.
This case illustrates the complexity of medicine and the challenges in being a physician. It also underlines the difficulty in being a patient, in conveying symptoms accurately and in monitoring a symptom that is not improving. More than any test, the patient's words, that something is just not right," will lead the doctor to find the root of a medical problem. My perceptive mother was way ahead of her time, many years ago, when she inculcated me with this wisdom: Listen to your patients, they will let you know what is wrong with them.
They know their bodies better than anyone else." Another way cancer can present itself is when a metastasis, rather than the primary cancer, causes symptoms. An example would be a person who develops pain in the region of the liver. A CT scan is ordered, and it shows growths in the liver that look like cancer deposits that have spread to the liver from another location (this is much more common than primary liver cancer). Because one of the more common places for this to happen is from the colon, a colonoscopy is performed. During this procedure, a tumor is found in the colon, and biopsy reveals colon cancer. Here symptoms caused by the spread of cancer ultimately led to the identification of the primary cancer.
An emergency diagnosis
Tom came to the emergency room of our hospital because of a sudden onset of headaches, blurred vision, and uncontrolled twitching of one of his arms. A neurologist evaluated him, diagnosed him as having a seizure, and ordered an MRI of his brain. The MRI showed numerous tumors growing in his brain that were characteristic of cancer that had spread from another location in the body.
Tom was admitted to the hospital for further evaluation. Because he was a smoker, a CT scan of his chest was performed, which revealed a tumor in one of his lungs. Biopsy of the tumor revealed lung cancer, and he was diagnosed with stage IV lung cancer because of distant metastases to the brain. Tom received antiseizure medicines, steroids (medicines related to cortisone) that reduce brain swelling caused by tumors, and brain radiation. After his condition improved, he was discharged from the hospital with plans to treat the rest of his cancer as an outpatient.
Tom's story illustrates how cancer can sometimes strike suddenly and dramatically, causing a person to seek urgent medical attention. Like heart attacks and stroke, cancer emergencies require immediate treatment. Because the possibility of cancer is usually not foremost in the mind of a patient who seeks emergency care, a cancer diagnosis under these circumstances often creates tremendous stress. Martin was a fortynine- year-old man who had been in excellent physical condition until sudden severe shortness of breath and dizziness led him to be rushed by ambulance to our hospital.
A chest X-ray and CT scan showed that a large mass in the middle of his chest (in a region called the mediastinum) was impeding the flow of blood to his lungs and brain. Martin rapidly underwent biopsy of the mass, and it disclosed an aggressive lymphoma. His condition was worsening by the hour, and he needed treatment urgently. Yet he and his wife, Anne, were very analytical, highly intelligent people who wanted to know all about lymphoma and the different treatment options before they would consider treatment. Their friends also told them to get a second opinion before commencing treatment. They were not sure what to do.
For Martin's welfare, I needed to put a halt to his and Anne's indecisiveness. I told them firmly that they needed to make a leap of faith and do something extremely important: trust me. Ordinarily, I explained, I would never dissuade a cancer patient from seeking a second opinion. But in this situation, there was no time to get one at another center. It was not even safe to transfer Martin to a larger hospital, for this would unacceptably delay his treatment. Our hospital had the expertise to make him better, I said, and they needed to let us try. A second opinion could certainly be obtained once Martin was out of danger and discharged from the hospital in better condition.
This meeting was one of several between us in just two days, so Martin and Anne were ready to put their trust in me and commence treatment for his cancer. Fortunately, his lymphoma responded beautifully to chemotherapy and immune treatments, and within days of his first treatment he was feeling better. On discharge, he had a second opinion consultation that agreed with our strategy. It is now more than four years since his diagnosis, and he has been back to normal health for some time; Martin's lymphoma is, we hope, cured.
Advice for the newly diagnosed
Being newly diagnosed with cancer in the hospital is one of the most difficult circumstances in which you and your loved ones can find yourselves. In Martin and Anne's case, he was sick and needed treatment before leaving the hospital. The couple wanted to trust their oncologist but weren't sure if they could or should. Yet whether you are in a hospital or at home, every newly diagnosed cancer patient faces similar immediate issues.
First, if you have suddenly become sick and the cause is cancer, you must try to come to terms with the fact that a mysterious and frightening disease is the cause of this dramatic change of health, rather than a more familiar, non-life-threatening condition. Second, you must consider accepting complicated therapies, such as chemotherapy or radiation, that may cause significant side effects. And you and your family have to make decisions about which oncologist and which cancer center to place your trust in. If you need hospitalization, you may need to rely on a new hospital and new health care providers whom you did not seek out in thefirst place.
All cancer patients should feel confidence in their oncologist, surgeon, and radiation therapist as well as the center in which they will receive treatment. Since this confidence is something that must be deserved and earned, however, you should try to evaluate if the hospital and physicians have the expertise and capability to treat your type of cancer. This usually means asking about the training and experience of the doctors, the reputation and accreditation of the hospital for the treatment of cancer, and whether the hospital has a research program that provides access to clinical trials. Outpatients who are not experiencing any symptoms from cancer have more time to make these decisions.
Oncology nurses, family therapists, spiritual advisers, and other professionals should be available to assist the oncologist in addressing the many emotional and psychological needs of a cancer patient and his or her family members. Although these needs may seem secondary in the whirlwind of trying to figure out how best to save a life, it is actuallyat these times that you can take the measure of a cancer program: Are you and your loved ones being supported with information, education,and caring professionals who have the time to guide you through thisdifficult moment in your life?
The answer should be yes. It takes a communityof dedicated professionals to care for a cancer patient. This careshould be delivered in a pleasant, warm, and welcoming environment. If the right care can be delivered near one's home or work, then that isthe optimal situation.
If you are hospitalized and do not feel that the facility you are in is expert enough in your type of cancer, you should inquire about the feasibility of being transferred to a more specialized center. An outpatient can more easily seek other opinions elsewhere. Above all, if you have cancer, you should be made to feel that your oncologist is your advocate and that he or she will tell you where the most appropriate place is for the treatment of your cancer, whether this is a regional hospital or another facility.
Our website is not responsible for the information contained by this article. Webworldarticles.com is a free articles resource thus practically any visitor can submit an article. However if you notice any copyrighted material, please contact us and we will remove the article(s) in discussion right away.
This article was sent to us by:
George Zenitti at
06262010
1. URINARY SEPTICAEMIA: TREATMENT
All articles in this directory are property of their respective authors. Additionally, read our Privacy Policy
© 2010 WebWorldarticles.com - All Rights Reserved. Partners: Gunblade Saga