Diagnosis and Pathobiology
Franklyn De Silva, Jane Alcorn in The Elusive Road Towards Effective Cancer Prevention and Treatment, 2023
Overcoming the various psychological, social, economic, and family barriers is essential to ensure the best diagnosis and required treatment of cancer patients [96]. Diagnosis of cancer involves an effort to precisely confirm the origin of the malignancy in terms of the anatomical site and the cell type(s) involved [97]. Components of the diagnostic process may include screening, histological evaluation, biopsy, tumor staging, pathological evaluation, specimen processing and evaluation, predictive tumor markers, imaging, physical examination, endoscopies (e.g., colonoscopy, cystoscopy, bronchoscopy, colposcopy, arthroscopy, hysteroscopy, laparoscopy, laryngoscopy, proctoscopy, thoracoscopy, mediastinoscopy, sigmoidoscopy, gastroscopy, ureteroscopy, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, neuroendoscopy, virtual endoscopy, capsule endoscopy, photodynamic endoscopic diagnosis, multiphoton endoscopy), artificial intelligence, and laboratory testing [97–112]. The diagnostic outcomes, then, can help to identify the treatment objective, which might include primary treatment, cure, adjuvant treatment, or palliative treatment [113]. Although all these processes can lead to delays in diagnosis and/or misdiagnosis of cancer [114], we will limit discussion to components closely linked to the cellular and molecular biology of cancer.
Principles of oncology
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Accurate diagnosis is the key to the successful management of cancer. Precise diagnosis is crucial to the choice of correct therapy; the wrong operation, no matter how superbly performed, is useless. An unequivocal diagnosis is the key to an accurate prognosis. Only rarely can a diagnosis of cancer be confidently made in the absence of tissue for pathological or cytological examination. Cancer is a disease of cells and, for accurate diagnosis, the abnormal cells need to be seen. Different tumours are classified in different ways: most squamous epithelial tumours are simply classed as well (G1), moderate (G2) or poorly (G3) differentiated. Adenocarcinomas are also often classified as G1, 2 or 3 but prostate cancer is an exception, with widespread use of the Gleason system. The Gleason system grades prostate cancer according to the degree of differentiation of the two most prevalent architectural patterns. The final score is the sum of the two grades and can vary from 2 (1+1) to 10 (5+5) with the higher scores indicating poorer prognosis.
The Precision Medicine Approach in Oncology
David E. Thurston, Ilona Pysz in Chemistry and Pharmacology of Anticancer Drugs, 2021
One of the most important growth areas for the application of precision medicine technologies is in screening for the risk of disease development. At present, the various cancer types are initially detected in individuals through a combination of blood, urine, and fecal tests, physical examinations and MRI and CT scans, followed by biopsies if appropriate. However, technologies are becoming available that allow unique DNA sequences associated with a tumor, or tumor cells themselves, to be detected in body fluids such as blood, urine, or saliva at an early stage of the disease. This should eventually allow healthy individuals to have frequent, relatively noninvasive, tests to check for the presence of precancerous or tumor cells at a very early stage should they wish to obtain this information. The potential advantage of this is that cancers are easier to treat if diagnosed early, and this also has financial advantages for health care systems. A number of screens in present use and at the research stage are discussed below. At the genetic level, a predisposition to a particular type of cancer may be inherited (e.g., BRCA1 and BRCA2 in breast and ovarian cancer), and screens available for this are discussed below in Section 11.6.3.
Advances in liquid biopsy on-chip for cancer management: Technologies, biomarkers, and clinical analysis
Published in Critical Reviews in Clinical Laboratory Sciences, 2018
Amogha Tadimety, Andrew Closson, Cathy Li, Song Yi, Ting Shen, John X. J. Zhang
Liquid biopsy involves gathering information about a disease through a liquid sample rather than a tissue sample [7,12,13,21–23]. Typically, cancer is diagnosed through clinical pathology, with a tissue biopsy or imaging to screen or diagnose various types of cancer. Liquid biopsy provides a promising approach for early diagnosis, therapeutic and prognostic decision making, and monitoring through minimally invasive fluid sample collections rather than a more invasive biopsy [22]. Liquid biopsy also is expected to be lower cost because of the ease of sample collection and its ease of use in the clinic. Before liquid biopsy technologies can be discussed in full detail, it is important to understand the types of biomarkers and their biogenesis in cancer. The main biomarkers that have been studied in liquid biopsy for cancer include circulating tumor cells (CTCs), extracellular vesicles called exosomes, and circulating nucleic acids such as DNA and miRNAs [13,21–23]. These biomarkers are shed off into the bloodstream, urine, saliva, or CSF from the tumor site and can be detected in the fluid and further analyzed to improve clinical understanding of the patient condition, as shown in Figure 3.
Cancer symptom response as an oncology clinical trial end point
Published in Expert Review of Quality of Life in Cancer Care, 2018
Laura C. Bouchard, Neil Aaronson, Kathleen Gondek, David Cella
Additional concerns related to both OS and PFS as end points in oncology clinical trials are the toxicities of the treatments being investigated and symptoms related to cancer itself. Treatments that are capable of producing complete tumor responses can also produce life-limiting fatigue, nausea/vomiting, pain, diarrhea, distress, and other symptoms. In addition, cancer itself can cause symptoms including fatigue and pain, among others. These toxicities and symptoms can limit the range of appropriate patients within a target population and, ultimately, their ability to remain on treatment [5–7]. Thus, additional end points are necessary to determine the implications of OS and PFS beyond the benefits of increased survival time, with or without evidence of progressive disease. That is, even if a treatment demonstrates a clear OS or PFS benefit, how is it tolerated by patients? This is especially relevant as long-term oral therapies are being used more and more frequently.
Evaluating the relationships between multiple symptoms; altered nutritional status, and their effects on the quality of life of patients diagnosed with cancer in Palestine: an explorative study
Published in Progress in Palliative Care, 2022
Mutaz Dreidi, Intima Alrimawi, Maha Atout
Cancer alters quality of life (QoL) not only because of the disease itself but also because of its treatment and side effects.6,7 The QoL – including physical, emotional, mental, social and behavioral components – of cancer patients is significantly influenced by disease-related symptoms.8 Many symptoms are linked with the progression of cancer, such as difficulties in the patient’s daily life activities, e.g. work, sleep and personal activities.9 For example, pain, fatigue, dyspnea, dizziness and numbness are a few symptoms experienced by patients with different types of cancer. They may limit the patient’s ability to be satisfied with themselves; coping with the symptoms presents a significant daily challenge for oncology patients.9–12 These symptoms usually occur as a group of manifestations that are related to each other, and which may interfere with QoL and nutritional status.13 When two or more of these symptoms are correlated, the term ‘symptom cluster’ is used to describe the phenomenon.10 For instance, some symptoms might be the reason for the existence of others (e.g. pain could generate fatigue, nausea and depression).14
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