oncology assessment&diagnosis

1. assessment

1) grading

  • Classifies the cellular aspects of cancer.
grade 1 Cells differ slightly from normal cells and are well differentiated. (mild dysplasia)
grade 2 Cells are more abnormal and are moderately differentiated. (moderate dysplasia)
grade 3 Cells are very abnormal and are poorly differentiated. (severe dysplasia)
grade 4 Cells are immature (anaplasia) and undifferentiated. A cell of origin is difficult to determine.

2) staging

  • Classifies the clinical aspects of cancer and the degree of metastasis at diagnosis.
stage 0 carcinoma in situ
stage 1 tumor limited to the tissue of origin, localized tumor growth
stage 2 limited local spread
stage 3 extensive local and regional spread
stage 4 distant metastasis

3) ★ factors that influence cancer development → primary prevention

  • chemical carcinogen: drugs, tobacco, industrial chemicals
  • physical carcinogen: ionizing radiation, ultraviolet radiation, chronic irritation, tissue trauma
  • viral carcinogen (oncoviruses): Epstein-Barr virus, hepatitis B virus, human papillomavirus
  • helicobacter pylori infection
  • obesity
  • dietary factors: preservatives, contaminants, additives, nitrates
  • immune function: AIDS, organ transplant recipients
  • genetic predisposition
  • age


2. diagnostic test

1) early detection → secondary prevention
(Cf.) tertiary prevention: to prevent long term complication)

  • skin inspection
  • breast self-examination and clinical breast examination
  • mammography
  • Pap (Papanicolaou’s) test
  • testicular self-examination
  • rectal exams and stools for occult blood
  • sigmoidoscopy, colonoscopy

2) warning signs of cancer

  • any sore that does not heal
  • obvious change in wart or mole
  • thickening or lump in the breast or elsewhere
  • unusual bleeding or discharge
  • change in bowel or bladder habits
  • indigestion
  • nagging cough or hoarseness

3) biopsy

  • The biopsy is the definitive means of diagnosing cancer and provides histological proof of malignancy.
  • needle (aspiration of cells) / incisional (removal of a wedge of suspected tissue from a larger mass) / excisional (complete removal)
    → frozen section / permanent paraffin section
  • Ensure that informed consent has been obtained. Assess the results of coagulation tests.
  • The procedure usually is performed in an outpatient surgical setting. 국소마취. 5∼15분 소요. Prone or side-lying position.
  • Prepare the client for the diagnostic procedure and provide postprocedural instructions. 24hr 동안 bleeding 관찰. 48hr 동안 contact sports 피할 것.