1. RF? → FH, Lifestyle, Diet, Environment/profession, etc.
2. Main symptoms?
3. Pre-neoplastic conditions/lesions? (polyps, leucoplasia, CIN, Barrets)

1. Lab
2. Imaging
1. MRI
2. CT
3. US
4. PET
5. scinti

⇒ tumor resence? size? spread (local, regional, distant)?

1. Endoscopy
2. FNA → cytology
3. Biopsy → histo + special tumor characteristics

STANDARDIZATION FOR:

1. Tx-decision + evaluation/response
2. Prognosis

1. size
2. invasiveness (adj. structures)
3. number of involved structures

superficial → clinical exam

partially accessible to palpation → imaging and/or intrstrumental

deep → imaging!

• number (single vs. multiple)
• size
• location (regional vs. extra-regional)
• mobility (fixed or non-adherent)

1. breast+ENT → Palpation
2. deep → Imaging

>[1]cm in [short] axis.

Abdomen + Thorax

📷

axillary 📷

1. male, white, >40y
2. Generalized lymphadenopathy (≥2 regions)
3. Lymphadenopathy ≥4-6w* (Øreturn to baselike after 12w)
4. B-Symptoms
5. supraclavicular location

1. Lungs
2. Liver
3. Bone
4. Brain
5. distant LN (extra-regional LN)

Notice that CT catches almost everything → order scinti if bone involvement suspected

MRI for brain

F → does not modify

pathological TNM after chemo/RT

TNM after recurrance

less advanced

clinical stages (0-IV)

• Brain tumor
• Endometrial + Cervix
• ST sarcomas

CLINICAL STAGING:

early stage → 0-IIb

locally advanced → IIIa-IIIc

metastatic → IV

TNM:

early stage → T≤2 N≤1 (OR T3N0)

locally advanced → T1/2 N2+; T3N+, T4N0, or N3

metastatic → M1

1. History → how fast did the symptoms progress?
2. Inflammatory signs (edema, congestion)
3. Imaging → RECIST: measure size + progression of size
4. Lab → monitor tumor markers

→ ask for:

weight loss? (+fatigue?)

physical acitivity? → walking, self-care

work capacity?

⇒ decides which Tx can be done

• acute complications / toxicity
• tumor regression (RECIST)

1. natural tumor history
2. risk of recurrence

1. Immediate post-tx → first control after 2month
2. Maximum risk → 2m - 5y
3. relative security → >5y

• aggressiveness of tumor
• Tx-fails

☢️ Radiotherapy

survival

The abscopal effect is a hypothesis in the treatment of metastatic cancer whereby shrinkage of untreated tumors occurs concurrently with shrinkage of tumors within the scope of the localized treatment.