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Early Detection And Diagnosis Of Cancer | by Walter E. O'Donnell



This book is a comprehensive practical guide to the essential facts about most types of cancer-how to look for and diagnose cancer in the physician's office and what to do about it initially. It is not a definitive treatise or reference work on the subject of cancer and all its ramifications. A number of excellent volumes of this scope are available to those who wish to pursue the subject in depth.

TitleEarly Detection And Diagnosis Of Cancer
AuthorWalter E. O'Donnell
PublisherC. V. Mosby Company
Year1962
Copyright1962, C. V. Mosby Company
AmazonEarly Detection And Diagnosis Of Cancer
-Foreword
In the control of cancer, early detection and correct diagnosis rightfully demand the utmost in terms of effort, imagination, and competency. The attitude of the physician is the most important single...
-Preface
This book is a comprehensive practical guide to the essential facts about most types of cancer-how to look for and diagnose cancer in the physician's office and what to do about it initially. It is no...
-What Is Not In This Book?
Bibliography. The already voluminous world cancer literature is increasing at the rate of about 5000 references annually. We feel that any attempt to do justice to even a representative portion of the...
-Chapter I. The Cancer Problem
Cancer is truly one of the major public health problems of our times. There were approximately 40 million persons in the United States over 40 years of age in 1935 and about 64 million in 1960, and it...
-Detection Of Cancer In The Asymptomatic Patient
Recognition of the imperative need for the detection of cancers in their early stages has resulted in directing attention in the last decade or so to the asymptomatic, presumably healthy adult. Effort...
-Detection And Correction Of Precancerous Lesions For Actual Cancer Prevention
Although the terms premalignant and precancerous leave much to be desired since they imply a degree of predictability and a magnitude of risk seldom supported by the facts, considerable prominence is ...
-Chapter II. The Cancer Detection Examination
Cancer detection can be defined as the search for and identification of cancer or its precursors in the asymptomatic, presumably healthy individual by means of a standardized routine examination. D...
-Cancer Detection Tests
Cancer detection tests can be divided rather simply into two groups: (1) those which purport to indicate the presence of the disease anywhere in the individuals body and (2) those which point to the p...
-General Cancer Tests
The desire for a general cancer detection test which would screen large population groups is an obvious and natural one, but it seems no closer to fulfillment today than when the quest began in earnes...
-Selection Of Patients For Examination
It is not practical, possible, or necessarily desirable to examine all persons for the possible presence of cancer, let alone make provision for examination on a repetitive basis. Some selectivity ...
-Preparation For The Examination
Instructions regarding the examination may be given verbally, but if at all possible it is preferable to provide the patient with a set of printed do's and dont's in order to avoid any misunderstandin...
-Obtaining And Recording Information
The history to be obtained and recorded varies greatly according to: 1. The familiarity of the physician with the patient. 2. The scope of the examination over and beyond cancer. 3. Whether i...
-History. Review Of The Chart
If the patient has been seen before for complete examination, it is very important to review the findings noted on the history and the physical and laboratory examinations during prior visits. Such a ...
-Physical Examination
The complete physical examination of the apparently healthy adult can be carried out within the confines of a single ordinary examining room. Furthermore, although assistance is always helpful, especi...
-Physical Examination of Head And Neck
This part of the examination can be done with the patient seated on the end of the examining table facing the doctor. The type of chair designed for ear, nose, and throat examinations can be used if a...
-Physical Examination of Breasts
Good light, preferably from a source located behind, above, and to one side of the examiner, is essential. The patient is uncovered to the waist. 1. With the patient sitting (a) Inspect the breasts...
-Physical Examination of Female Genitalia
With the patient in the customary lithotomy position and with the headlight used as a source of illumination, the examination is carried out as follows: 1. Inspect the external genitalia, urethral ...
-Physical Examination of Rectum
Presumably the patient will have come to the office prepared or the enema will already have been given in the office, and thus the patient will be ready for examination at this point. If this is no...
-After The Physical Examination Laboratory Studies
A number of the laboratory tests may have been done before the history and physical examination. It is usually preferable to defer the venipuncture for blood specimens until the conclusion of the exam...
-Test For Occult Blood In The Stool Background
This is a chemical test performed on the stool for the detection of occult blood. A definitely positive test is usually interpreted as indicating the presence of bleeding somewhere in the gastrointest...
-Tubeless Gastric Analysis. Background
This test is designed to determine the presence or absence of gastric acidity. Its greatest advantage is that it eliminates the necessity for passing a tube into the stomach as with the older method. ...
-Vaginal And Cervical Smears. Obtaining The Smear
The technique for obtaining smears is described in an earlier section of this chapter as part of the physical examination (pp. 62 to 64). Handling Of Specimens 1. Smears should be kept in the fi...
-Chapter III. Skin
The most important of the lesions included under the heading of skin cancer are epidermoid carcinoma (either squamous cell or basal cell) and melanoma. They are of particular significance to the pract...
-Epidermoid Carcinoma Predisposing Or Etiologic Factors
Although no specific etiology is apparent in most individual cases of carcinoma of the skin, a number of intrinsic or extrinsic factors are thought to play a role in the over-all picture. Probably the...
-Ulcers, Scars, Draining Sinuses, And Fistulas. Squamous Cell Carcinoma, Basal Cell Carcinoma
Ulcers, Scars, Draining Sinuses, And Fistulas A number of cases of skin cancer have been reported in conjunction with these conditions. The exact relationship is not clear, and the best that can be...
-Melanoma And Its Precursors
Melanoma is a rather rare form of cancer but, because of its potential virulence and its relationship to pigmented nevi, it is of considerable importance to the practitioner. Predisposing or etiolo...
-Classification Of Nevi
1. Intradermal nevus 2. Junctional nevus 3. Compound nevus 4. Blue nevus (Jadassohn-Tieche) 5. Pre-pubertal melanoma (juvenile melanoma) Intradermal Nevus 1. The so-called common mol...
-Steps In The Detection And Diagnosis Of Skin Cancer
1. Examine the entire skin surface of every patient on whom a complete examination is done. This is often not accomplished because: (a) The patient may not be required to disrobe entirely. (b) T...
-Chapter IV. Head And Neck
Primary cancer of the head and neck region occurs mainly in the following sites: 1. Mouth (hps, gums, buccal mucosa, palate, tongue, floor of the mouth, tonsils, and pharynx) 2. Larynx 3. Thy...
-Cancer Of The Mouth
This consists of lesions involving the lips, gums, palate, buccal mucosa, tongue, floor of the mouth, tonsils, and pharynx. Epidemiology. Incidence Men Women ...
-Clinical Manifestations Of Oral Cancer (Lips, Gums, Buccal Mucosa, Palate, Tongue, Floor Of The Mouth, Tonsils, And Pharynx)
Localized Lesion Symptoms 1. May be none, especially if the lesion involves relatively insensitive structures with rather limited functional requirement. 2. Often the patient sees the lesion in ...
-Steps In The Diagnosis And Initial Management Of The Mouth Cancer Suspect
1. Biopsy any suspicious lesion in the mouth. This may be done in one of three ways (Fig. 39). In performing incisional biopsy by whatever technique, it is important to obtain a piece of adjacent norm...
-Cancer Of The Larynx
Epidemiology. Incidence Men Women 5,000 new cases each year 500 new cases each year 1.98 of male cancer incidence ...
-Cancer Of The Thyroid
Carcinoma of the thyroid represents less than half of 1% of the over-all cancer problem as represented in incidence and mortality statistics, but it is of considerable importance to the physician for ...
-Clinical Manifestations Of Thyroid Cancer
Localized Lesion Symptoms 1. Often none. Lesion may be found by physician during routine examination. 2. Many patients will have a history of pre-existing goiter often dating back many years. Th...
-Steps In The Diagnosis And Initial Management Of The Thyroid Cancer Suspect
1. Look for thyroid cancer whenever a patient presents with nodes in the neck and the primary lesion is not obvious. 2. Careful palpation of the thyroid gland and neck with special reference to: ...
-Indications For Surgery For Thyroid Lesions
This is best considered in two general settings: 1. When the lesion is clinically suspicious 2. When the lesion is not clinically suspicious The first category normally presents no great diff...
-Chapter V. Lung
Despite the rather grim picture that cancer of the lung commonly presents from the standpoint of operability and curability, it is of considerable importance to the physician for the following reasons...
-Other Respiratory Tract Cancer
Patients with epidermoid cancer anywhere in the respiratory or upper alimentary tract should be identified as being at high-risk for the development of new lesions in the same general area but not nec...
-Other Tumors of Head and Neck
Rarely occurring pulmonary tumors include the salivary gland type tumors (or cylindromas) which tend to run a malignant course and the benign hamartomas which typically present as coin lesions. M...
-Screening Presumably Well Adults For Lung Cancer-Detection. X-Ray
At the present time routine x-ray examination of the chest is the only method generally available for the detection of lung cancer in the asymptomatic individual, and even this has recently come under...
-Clinical Features Of Lung Cancer
For reasons which have been stated previously and which will be re-emphasized in the diagrammatic representation to follow, it is often very difficult to separate the localized from the advanced disea...
-Advanced Lesion. Advanced Disease Due To Local Extension
Direct invasion of adjacent structures or metastases within the thorax may produce all of the foregoing symptoms and signs to a greater or lesser degree. In addition, however, there are other clinical...
-Sputum Studies-Cytology
The first step in the management of the lung cancer suspect after the initial x-ray films are taken should not be bronchoscopy or further x-ray studies but rather the procurement of sputum for cytolog...
-Sputum Studies-Cytology. Continued
(a) Saliva is light and transparent before the alcohol shrinks it into white strands or balls. (b) Sputum usually presents as clusters of small opaque globules, usually dark in color but occasional...
-Chapter VI. Breast
Breast cancer is a problem of major importance to the practicing physician for the following reasons: 1. It is the most common cancer among women. Estimates indicate that I of every 20 women in the...
-Pathology. Origin Of Lesions
Most breast cancer is adenocarcinoma, which arises from the mammary duct epithelium. The terminal ramifications of the mammary duct system are organized in clusters that form lobules. In its early ...
-Pathologic Features Influencing Prognosis
Some estimation of the prognosis of a particular lesion is possible on the basis of certain pathologic features. These are summarized in Table 7. It should be apparent that these criteria are by no...
-Screening Presumably Well Women For Breast Cancer-Detection
Inspection and palpation are the only practical methods of surveying women for breast cancer. Periodic x-ray examination of the breast (mammography) has been proposed by some, and it is under intensiv...
-Steps In The Diagnosis And Initial Management Of The Breast Cancer Suspect
Here it is exceedingly difficult to lay down hard and fast rules. Experience and clinical judgment with regard to breast cancer is particularly difficult to transfer to paper. The reader must be acute...
-Chapter VII. Uterus And Female Genital Tract. Uterus-Cervix And Endometrium
Malignant disease of the uterus is comprised almost exclusively of two lesions: epidermoid cancer of the cervix and adenocarcinoma of the endometrium. The more common is the cervical disease, but both...
-Carcinoma In Situ
Before proceeding to a discussion of the pathology of invasive cervical cancer, it is essential to deal with the concept of carcinoma in situ. This is also called intraepithelial, and sometimes preinv...
-Invasive Carcinoma Of The Cervix
This is the more conventional or classical form of cervical cancer. The term invasive carcinoma includes a wide spectrum of lesions, ranging from a very minute localized type of cancer that is invisib...
-Screening Presumably Healthy Women For Cervical Cancer-Detection
The best and, in fact, only method of detecting asymptomatic cervical cancer involves routine annual pelvic examination, including cytologic study, of all married or parous women 30 years of age and o...
-Steps In The Diagnosis And Initial Management Of The Cervical Cancer Suspect
The physician may be confronted by one of two typical situations in which he has to rule out the presence of cancer: 1. The cervix may have appeared perfectly normal or benign, but the cytologic re...
-Endometrium. Epidemiology. Incidence
11,000 new cases per year 4.3% of female cancer incidence Mortality 4,000 deaths per year 3.2% of female cancer mortality Rates Incidence per 100,000 11.9 Mortality per 100,000 5.0 A...
-Screening Presumably Healthy Women For Localized Endometrial Cancer-Detection. Method
The detection method of choice for carcinoma of the endometrium is the same as that described for cancer of the cervix-routine annual pelvic examination, including cytologic study by means of smears. ...
-Clinical Features Of Carcinoma Of The Endometrium-Diagnosis
Symptoms 1. There may be none. The patient may be asymptomatic. 2. Discharge from the vagina. 3. Vaginal bleeding. May be merely spotting or frank hemorrhage. Especially in the postmenopausal...
-Chapter VIII. Stomach And Upper Gastrointestinal Tract. Stomach
Cancer of the stomach is a relatively common lesion with a discouragingly low curability rate at the present time. Not only is it difficult to detect or diagnose in the localized or asymptomatic stage...
-Gastric Ulcer Vs. Gastric Cancer
It will be noted that the clinical and morphologic picture of a gastric ulcer may often be presented by gastric cancer. Controversy has raged for over fifty years as to whether carcinoma of the stomac...
-Screening Presumably Well Adults For Stomach Cancer And Its Precursors-Detection. Symptoms And Signs
The routine history and physical examination are ordinarily of no assistance in the detection of stomach cancer, although occasionally some of the features to be noted later may be present in latent f...
-Clinical Features In The Symptomatic Patient-Diagnosis
Localized Lesion Symptoms There are no diagnostic, characteristic, or pathognomonic symptoms of stomach cancer. As indicated previously, the lesion may occasionally be detectable when it is entirel...
-Steps In The Diagnosis And Initial Management Of The Stomach Cancer Suspect
Once an individual is suspected of having stomach cancer on the basis of symptoms, signs, or leads from the detection procedures outlined, there are certain diagnostic steps which are essential to the...
-Reasons For Error In X-Ray Diagnosis
1. Peculiarities of the lesion. A very small lesion or one that is primarily intramural or one that is located in one of the relatively blind areas of the stomach (e.g., cardia, fundus, anterior or po...
-X-Ray Technique
Gastric cytologic study involves the collection of aspirated material from the stomach and its concentration, staining, and screening for malignant cells. To increase the number of cells available for...
-Reasons For Error In Cytologic Diagnosis
These are essentially the same as those listed under reasons for error in x-ray diagnosis. They include the following: 1. Peculiarities of the lesion 2. Imperfection in technique of specimen col...
-Reasons For Error In Gastroscopic Diagnosis
The previously cited factors of peculiarities of the lesion and lack of follow-up, technique, and limited competence of the examiner apply to gastroscopy as well as to x-ray and cytologic studies. ...
-Benign Vs. Malignant Gastric Ulcers
It is important at the outset to stress once more that it is absolutely impossible with 100% accuracy to differentiate between benign and malignant ulcers of the stomach by any means short of laparoto...
-Chapter IX. Colon And Rectum
Only in the case of carcinoma of the uterine cervix is an opportunity for detection, early diagnosis, and even actual cancer prevention, presented comparable to that afforded by the rectum and colon. ...
-Pathology. Classification Of Carcinoma Of The Rectum And Colon
The vast majority of all the malignant tumors occurring in the colon and rectum are adenocarcinomas of varying degrees of differentiation. Squamous carcinoma of the anal canal is a relatively rare les...
-Classification Of Polyps
The term polyp is a misnomer, but time and universal usage have endowed it with a permanence in the field which is probably unwise and undoubtedly futile to challenge. The more precise and correct wor...
-Distribution Of Polyps Of The Rectum And Colon
On the basis of figures compiled on autopsy and surgical specimens, most workers believe that polyps and cancer have a closely parallel distribution throughout the rectum and colon. The distal bowel i...
-Screening Presumably Well Adults For Colon And/Or Rectum Cancer And Its Precursors. Detection
The most important steps in the screening of presumably healthy adults are as follows: 1. Sigmoidoscopy 2. Digital examination of the rectum 3. History, i.e., the eliciting of latent symptoms...
-Clinical Features In The Symptomatic Patient. Localized Lesion
Although obviously there is a great deal of overlapping, the clinical features of cancer of the lower bowel can probably most conveniently be detailed by arbitrarily dividing the area into three separ...
-Steps In The Diagnosis And Initial Management Of The Colon And/Or Rectum Cancer Suspect
The extent to which a physician should personally carry out the management of a lesion of the rectum or colon is a matter for decision by the individual. The practitioner will have played his crucial ...
-X-Ray Studies of Of The Colon And/Or Rectum Cancer
A few additional statements are in order on the subject of x-ray studies in tumors of the rectum and colon. 1. The conventional barium enema is not sufficient by itself for the detection or diagnos...
-X-Ray Studies of Of The Colon And/Or Rectum Cancer. Continued
(c) The summit of the lesion is the portion most likely to prove suitable for partial biopsy. The pedicle should be avoided in a partial biopsy because of the likelihood of bleeding. (d) A small-mo...
-Chapter X. Urinary Tract And Male Genitalia. Kidney. Epidemiology. Incidence
Men Women 6,000 new cases per year 4,000 new cases per year 2.3% of male cancer incidence 1.6% of female cancer incid...
-Clinical Features Of Cancer Of The Kidney
Localized Lesion Symptoms 1. Blood in the urine. Gross hematuria is present at some time in about 75% of patients with kidney cancer and is the first manifestation in around 40%. (a) Reddish or ...
-Cytologic Examination Of The Urinary Sediment
Collection of urine for cytologic study is something that can be done on the first visit to the office. It is particularly important when the renal lesion is thought to arise in the kidney pelvis r...
-Bladder. Epidemiology. Incidence
Men Women 11,000 new cases per year 4,500 new cases per year 4.3% of male cancer incidence 1.8% of female cancer inci...
-Classification Of Bladder Tumors
There are many methods of classifying bladder tumors. A relatively uncomplicated and satisfactory one is as follows: 1. Papilloma-a papillary lesion that is microscopically benign. 2. Carcinoma-...
-Clinical Features Of Bladder Cancer. Localized Lesion
The clinical manifestation of localized carcinoma of the bladder fall into one of several categories. 1. The patient may be asymptomatic. 2. Hematuria. This is present in virtually all cases of ...
-Cancer Of The Prostate. Epidemiology
A word of explanation must preface any statistics on cancer of the prostate. The figures which follow deal with the disease as it is ordinarily thought of-a clinically manifest and diagnosable entity ...
-Screening Presumably Well Adult Males For Cancer Of The Prostate-Detection
The only feasible method at present for detecting prostatic cancer in its asymptomatic and possibly early stages is digital examination through the rectum. Such an examination with the index finger...
-Male External Genitalia. Penis
Penile cancer, almost always squamous cell carcinoma, is rare in individuals who maintain good penile hygiene and is essentially unknown in males circumcised in infancy. On the other hand, in some gro...
-Chapter XI. Blood And Blood-Forming Organs. Leukemia
Leukemia is generally regarded as cancer of the blood-forming organs, specifically those concerned with the production of the various white blood cells. It has certain rather unique features which ...
-Clinical Features Of Leukemia-Diagnosis. Acute Leukemia
Symptoms 1. Onset usually abrupt, simulating acute septic condition; occasionally there may be a prodromal period of malaise; or abnormal bleeding after tooth extraction, etc. may be the first symp...
-Examination Of Bone Marrow in Leukemia Diagnosis
1. It is always desirable and often imperative to have at least one base line marrow study. As will be noted below, there are times when the diagnosis of leukemia can be made only by means of bone mar...
-Malignant Lymphomas
The term malignant lymphoma is actually a rather arbitrary generic grouping of several diseases which appear to have as a common denominator the neoplastic growth of lympliatic and/or reticuloendothel...
-Nonlocalized Disease. Constitutional Or Systemic Manifestations
These signs and symptoms may be the early presenting features of the malignant lymphomas or may not appear until later. At one time or another they will usually be found in almost all patients with no...
-Steps In The Diagnosis And Initial Management Of The Malignant Lymphoma Suspect
The possibility of the malignant lymphomas must always be kept in mind in clinical situations involving obscure lymphadenopathy, fever of unknown origin, blood dyscrasias, or any of the extremely vari...
-Source Material
Epidemiologic Statistics The statistically inclined reader may wish to follow the authors through the methods used to derive the data presented in the epidemiology sections throughout this book. It...







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