A malignant tumor is a continual and abnormal growth of a cell group in one of the body's organs which leads in the end to the destruction of that organ where it started and then spreads to others.   A benign tumor grows slowly and does not cause destruction of the organ where it started except after a long period.  Moreover, it is unable to infiltrate to neighboring tissue.

The early stages of the disease are completely free of any symptoms, yet there are signs of danger which should be heeded and a specialized physician must be seen.  These signs are:  discolored swellings on the skin, ulcers which do not respond to treatment, unusual secretions, hemorrhage from any body cavity, hoarseness of voice, difficulty in swallowing in addition to the appearance of any subcutaneous or breast lump.

There are 6 million patients struck with cancer each year.  In Egypt there are   100,000 new patients each year 10% of which are children.  Cancer is the second cause of death in advanced countries and the fourth in developing countries

Tumors and the laboratory

When the treating physician sends a sample to the lab for pathological analysis, in most cases the patient expects an answer to the traditional question:  Is the tumor malignant or benign?

The nature of the questions indicates that the majority of patients miss out on an important fact, which is the existence of a group of tumors which cannot be classified as benign or malignant.  This group may recur in the same location from which it was extracted.  In this particular case, the patient is required to constantly follow up so as to allow for immediate intervention in the unfortunate instance that the tumor reappears or is transformed from benign to malignant.

The most obvious problem facing the doctor examining the tumor or tissue sample is the lack of sufficient data on the sample received or data on the patient such as age, gender, clinical diagnosis, X-rays in the case of  orthopedic or pulmonary tumors, as well as other tests done by the patient particularly tumor markers.

In many instances, the patient refuses to submit tests done at a different lab or denies having done them in the first place.  This is a very serious issue since the purpose of the patient's visit to the lab is diagnosis and not testing his/her physician's skill.

Undoubtedly such specific diagnosis depends basically on the specialized doctor's experience in pathology and his personal conviction.  There are no equipment or magic dyes to automatically diagnose tumors.  It is always best to have more than one doctor examine the same sample in the same lab.  This is a kind of consultation valid in many medical centers abroad and in certain centers in Egypt.

Types of samples for testing:

Cytology samples:

Urine, sputum, pulmonary infiltration, ascites & Pap smears. These cells are known for ease of their collection without any need for surgical intervention, yet there is an important fact which must be emphasized:  The examination of these cells within the kit is an excellent means of confirming the presence of a tumor. However, this method cannot be relied upon to prove there is no tumor.  For example, the urine sample if examined and proved free of any cancer cells does not mean there is no bladder tumor, since these tumors do not secrete sufficient cells in the urine to indicate their presence.  In such cases another more complicated method, endoscopy, under anesthesia, is resorted to, to take a bladder biopsy which may be positive.

Therefore, what the patient sees as contradictory in the diagnosis is in fact a result of lack of knowledge on his part as to the capabilities and limitations of each testing and diagnostic method.

Tissue Samples:

Samples such as breast, prostate, liver and kidney tissue etc...In most cases it is preferable to take the sample without surgery and with as little trouble and cost as possible using sonar equipment and CT scans to identify the location of the tumor and take a sample of it using special needles.

Although this kind of sample is taken relatively easily, yet it is known for its miniscule size which in some cases is one millimeter.  Naturally, it is required of the doctor taking this sample under sonar equipment or CT scanners to take the sample from the afflicted area and not the healthy one. It is also required of the Pathologist to decide from this tiny sample, the presence of a cancerous tumor or not, which does happen and with the utmost accuracy in 90% of the cases.  Nonetheless, some of the most experience doctors in this field, about 10%, may fail to reach a diagnosis. 

For example in the case of prostate or kidney tumors, the tumor may be present in only a small part of the organ. Therefore if the sample is taken from the healthy area, the test result will be negative which is really not the case.

Now, if the sample is taken correctly and the clinical diagnosis confirms that the result is negative but the treating doctor is convinced that there is a malignant tumor, then in this case it is imperative to resort to a more radical surgical procedure such as extraction.  The patient needs to understand that this procedure is first and foremost for his/her benefit so that he/she does not live with a concealed tumor and does not receive treatment consequently exposing his/her life to danger.

Tumor Markers:

Technical advancement in the methods of clinical diagnosis have introduced a series of tests to indicate the presence of tumors by means of a blood sample requiring no surgery.  These are known as Tumor Markers and some of these may be used directly on the tissue.  As a matter of course, these specialized tests require special equipment and kits that are able to produce accurate and correct results.

Uses of Tumor Markers:

1. Early Detection of Tumors:  By means of having these tests done periodically prior to the appearance of any symptoms and thus raising the cure rate.

2. Differentiation between Malignant and Benign Tumors: The markers may aid in this differentiation because usually malignant tumors are accompanied by a large increase in the measured hormone or enzyme, contrary to benign tumors.  The most important example of this are the kidney tumors.

3. Tumor Follow-up:  Particularly after chemotherapy or radiology, to find out the extent of success of the treatment and after surgery to be sure the tumor does not recur or spread to other organs.  

4. Selection of Treatment:  In the case of breast tumors for example, tests may be done directly on the tissue to find out the extent of response to treatment with anti-hormones.

5. Discovering the Source  of the Tumor:  US health authorities have listed the following tests among those to be done periodically once each 3 years between ages 20 -30 and once each year for ages 30-50 and once each 6 months thereafter:

6.  

Organ-specific tumor markers    Prostate:   PSA (Total, Free & Complex PSA)   Testis:       β-HCG, AFP  Breast:      CA15.3, CA125, MCA, CEA, TPA, Estrogen & Progesterone Receptors  Bladder:    TPA   TPS   CEA   CA50  Kidney:      Renin, Erythropoietin  Pheochromocytoma:  VMA, Metanephrine, Catecholamines (Adrenaline, Noradrenaline., Dopamine)  Cervix / Uterus: SCC, CEA, TPS  Ovary:      CA125, CA15.3, β -HCG  Liver:        CEA, AFP, CA125, Ferritin  Pancreas:  CA19.9, CEA, CA125, CA50  GIT:           CA19.9, CEA, TPA  Stomach:   CEA, CA19-9, CA72-4   Gastrinoma:   Gastrin  Carcinoid:    Serotonin    5-HIAA  Lung:    NSE, CEA, TPA  Neuroblastoma: VMA  Thyroid: Calcitonin, TBG, NSE  Pituitary:  ACTH, GH, PRL  Leukemia & Lymphoma:         LDH, β 2Microglobulin, Ferritin, Protein Electrophoresis, CD markers

The problem does not end upon issuing the lab results, since each of these markers is influenced by factors unrelated to the tumor it diagnoses.  For example, CEA is affected by smoking; AFP by pregnancy.  As a matter of fact it rises 12 times its normal rate during the fifth month of pregnancy.  It also rises in case of liver infections.   PSA is affected by prostate infections in men and it is absolutely not permissible to use this marker if the physician has used an endoscope to extract a sample of the prostate, except after at least 10 days from such procedure, since this kind of intervention increases PSA in the blood above its normal ranges, a matter of grave concern in the follow up of this patient's tumor.

Therefore, the correct clinical diagnosis of benign or malignant tumors depends basically on the experience of the specialized physician and his personal conviction.  Preferably this should be done as a consultation of the case. The sample must be taken correctly and sent in whole (not in sections) to the lab.   It is also preferable that the lab receive the entire patient's file including the preliminary clinical diagnosis, X-rays and tumor markers.  In all cases it is advisable to refer to the same physician who requested the tests since he is the general coordinator of all the specializations and he alone can decide on another sample more radically extracted if necessary.

10 commandments for averting Cancer

1. Stop smoking immediately (smoking is a definite path to cancer)

2. Abstain from alcoholic beverages (these cause cancer particularly of the digestive system)

3. Avoid obesity and excessive weight since it exposes you to cancer of the breast, uterus and colon

4. Avoid exposure to sun rays particularly if you are fair skinned.  Use ultraviolet sun block when out in the sun.

5. Immediately treat bilharzias to avoid bladder cancer.

6. For Women also:  Head to a specialized lab and do a Pap smear test and   breast tumor markers once each year regardless of the appearance of any symptoms.

7. Reduce intake of fats and butter in your food.  Replace red meat with chicken and fish.  Eat more fruits and vegetables as well as foods containing fibers since they protect the body against cancer

8. See a doctor immediately if you discover any health changes which last more than two weeks.

9. For Women:  Carry out breast self-examination once every month.

10. Follow the rules of industrial hygiene in the workplace where harmful chemicals such as asbestos, certain dyes, arsenic components, nickel, tar and radiology are present.

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