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
General symptoms and signs of malignant disease
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
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).