Diagnosis of cancer includes screening tests which is often asymptomatic, clinical presentation of suspicious symptoms, clinical diagnostic evaluation testing to determine extent of tumor, and the pathology to confirm malignancy. Screening includes annual skin inspection, pap test, breast self-exam (BSE), clinical breast examination (CBE), mammography, testicular self-exam (teens to early 20s), digital rectal examination, prostate specific antigen (PSA), fecal occult blood test and colonoscopy (Pitman et al., 2017). Diagnostic aids include genetic screen in families with higher than normal incidence of cancer, tumor markers, computerized tomography (CT), fluoroscopy, ultrasonography (ultrasound), endoscopy, nuclear medicine imaging, positron emissions tomography (PET), and radioimmunoconjugates. Biopsy must be done by getting abnormal cells,, and this could be done through fine needle aspiration of tissue, aspiration of fluid (pleural or ascites), and surgical biopsy, the tissue or fluid sample is then sent to pathology for cytology testing (Skouras and Parks, 2015).
Final step of diagnosis is staging and grading, however, stage means the size of tumor and extent of disease, and grade means degree of lost cell differentiation. Staging determines the prognosis and guides the treatment plan. The extent of tumor invasion is made through gathering findings from physical examination, imaging, and pathology reports. Chest x-rays (CXR) can help assess for a presence of a mass to the lungs but cannot positively identify that mass as a cancer. CT scans and MRI scans are more sensitive and can be used for staging cancer but again, these cannot diagnose cancer. PET scans produce a 3D image of the body. Areas of cancers are shown by the increased metabolic activity. For the PET scan a nuclear tracer is injected into the veins and the tracer is taken up by the active tissue. PET scans can also show lesions too small to appear on CT scans (Skouras and Parks, 2015).
Cancer staging using the TNM system includes T which means to what extent (Size, severity) of the tumor? N signifies if it has spread to nearby lymph nodes? M means is there metastasis?
Primary Tumor is T, and treatment staging means that the tumor cannot be evaluated. T0 staging means there is no evidence of primary tumor. However, T1, T2, T3, T4 staging describes the size or the extent of the primary tumor. NX is regional lymph nodes which cannot be evaluated. N0 means there is no regional lymph node involvement. N2, N3, N4 means number of lymph nodes and extent of spread. Distant Metastasis is M. MX means distant metastasis which cannot be evaluated. M0 means there is no distant metastasis found. M1 means distant metastasis is present. The staging system I-IV includes stage 0 which means no sign of cancer cells, Stage 1 means positive malignant cells, no lesion superficial lesion only (in situ), Stage II means lesion is through muscle layer organ, Stage III means malignant cells found in local nodes, and Stage IV means malignant cells/tumors found in distal nodes (Ehrenberg, R. 2016).