How to interpret the oncological diagnosis?
The classification of the oncological diseases helps a doctor to describe a stage of cancer (the spread of tumor process), and also to estimate risks for the patient and assign an appropriate treatment.
There are several principles for estimation of oncological neoplasms.
Classification of cancer according to stages:
The classification was accepted in 1956, and still, it is used for the fast description of a patient’s condition. It points the sizes, spread, and presence of metastases:
Stage 1: limited tumor (up to 2 cm). For some tissues, sizes at the 1st stage may be up to 5 cm;
Stage 2: a tumor has the same sizes, but there is 1 metastases in the regional lymph node;
Stage 3: a tumor enlarges up to 5 cm and more, consolidates, grows through the surrounding tissues. There are multiple metastases in the regional lymph nodes;
Stage 4: a tumor can be any size with at least 1 metastases in the remote organ, or in the neighboring organs.
It is necessary to understand that a stage of skin cancer and pancreatic cancer is determined according to the different criteria. Above mentioned stages describe the only general principle of classification.
Some types of tumors can be over 5 cm, but they are treated easily. Herewith, little malignant neoplasms (up to 1 cm) can metastasize fast (i.g., melanoma). Early diagnostics plays a key role in such cases.
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TNM international classification
This classification allows oncologists are describing the level of the tumor and metastatic spread. It used for the detection of type and volume of surgical intervention, chemotherapy methods, radiation influence.
- T points the size of a primary tumor;
- N - lymph nodes affection;
- M- metastases in the remote organs.
These letters together with the numbers point the size of the tumor (for T), a quantity of affected lymph nodes (for N), and presence of secondary focuses (for M).
Examples of oncological diagnosis interpretation
- T1N0M0 corresponds to cancer stage 1, where a primary tumor up to 2 cm, the lymph nodes are not affected, and there are no metastases;
- T1N1M0 - stage 2, there is 1 affected lymph node;
- T0N3M1. In this example, a primary tumor is not detected, that is possible in case of rapid metastasizing cancer. A colony of cells spread the metastases immediately to the lymph nodes and remote organs (lung or liver).
Metastases are pointed with numbers 0 or 1. The quantity of remote metastases are not pointed out: they are present (at stage 4), or they are absent.
Specific symbols in the TNM tumor classification
- TX: there is a primary tumor, but due to the technical reasons, it is impossible to be estimated;
- Tis (abbrev. in situ) - malignant cells are detected, but they have not grown into tissues deeply (the prognosis for a patient is good);
- NX - there is no ability to estimate the area of affected lymph nodes.
Doctors can use substages of type N2a and T1b:
- additional T - multiple tumors in a particular part of a body;
- Y points that the stage has been detected immediately after intensive chemotherapy or surgery;
- V - recur process or venous invasiveness;
- L - affection of lymphatic ways (X - is supposed, 0 - is absent);
- Pn - a presence of perineural invasion (a tumor penetrated in the nerve that is specific for cancer of the head, neck, prostate, and bowel.
Criterion which describes a tumor budding (for hollow organs)
- P1 - a neoplasm is within mucosal tissue;
- P2 - a tumor is in the submucosa;
- P3 - cancer penetrates in the muscular layer;
- P4 - a process is beyond the hollow organ.
Classification of sentinel lymph nodes
Such symbols are used:
- pN1(sn) - a lymph node is affected with oncoprocess;
- pNO(sn) - the changes in the lymph node are not detected;
- pNX(sn) - a node can be estimated (because of technical reasons).
Classification of tumors according to their histological structure
The more primitive and smaller cells are, a tumor is more dangerous: low-differentiated tumor spread fast and make multiple metastases.
It is measured by levels of differentiation or malignancy grade, and is pointed with G letter:
- G1 - high-grade tumor, it rarely metastasizes that makes a prognosis better;
- G2 - moderately-grade process;
- G3-4 - low-grade and non-grade tumors, correspondingly - a high level of malignancy;
- GX - impossible to detect a grade of malignancy.
C-factor or classification of tumors by the accuracy
Taking into the account a quantity of disputable situations, oncologists agreed to point approximate accuracy of prognosis in the advanced cases, or C-factor:
- С1 - external signs and standard examination point on the malignant process: a survey, palpation, X-ray, endoscopy. A doctor takes into account all the patient’s complaints and symptoms (bleedings, weight loss, etc.);
- C2 - C1 data is confirmed with special diagnostics: MRI, PET-CT, angiography, Ultrasound, scintigraphy;
- C3 - above mentioned diagnostic procedures plus biopsy with cytology;
- C4 - biopsy was received in the process of surgical intervention, a cytologic test is done;
- C5 - a data received as a result of the autopsy.
Classification of postoperative tumor - R-category
A criterion of the effectiveness of treatment which describes a tumor after a therapy:
- R0 - a tumor is absent;
- R1 - microscopy detects a rudimentary tumor;
- R2 - a neoplasm is detected without microscopy;
- RX - to estimate a presence or absence of a tumor is impossible.
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