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Medical Oncology
Clinical Division of Oncology
Department of Medicine I
Medical University of
Vienna, Austria
BASIC PRINCIPLES
OF ONCOLOGICAL DIAGNOSIS
 Anamnesis
 Familial history (genetic predisposition)
 Evaluation of risk factors
 Evaluation of physical status
 Laboratory
 Radiological assessment
 Invasive methods - histological evaluation
 Staging (TNM)
Clinical Division of Oncology
Department of Medicine I
Medical University of
Vienna, Austria
Clinical Oncology:
STATISTICAL BASICS
20% of all Austrians die of cancer.
There are about 35.000 newly diagnosed cancers in
Austria/Year.
Men have a high frequency of prostatic cancer (20.5%),
lung cancer (16%) and colon carcinoma (14.7%).
Women have a high frequency of breast cancer (25.5%)
and colon carcinoma (14.2%).
The most frequent tumour is colorectal cancer.
Lung cancer has the highest mortality (24.1% of all male
cancer cases).
Clinical Division of Oncology
Department of Medicine I
Medical University of
Vienna, Austria
Symptoms of malignant diseases
Systemic Symptoms:
loss of appetite
loss of weight
fatigue
fever
night sweat
Intractable, worsening cough
Hemoptysis, Hemoptoe
Dyspnea, Hoarseness
Palpable tumour mass
Rectal (fecal) bleeding
Oedema of the face and neck
Clinical Division of Oncology
Department of Medicine I
Medical University of
Vienna, Austria
Laboratory parameters
suggestive of malignancy
Blood count + differential (Anaemia? leucocytes?
platelets?)
Blood chemistry (Transaminases, Bilirubin, alkal.
Phosphatase, Laktatdehydrogenase, Calcium, Sodium,
Potassium, Iron)
Erythrocyte sedimentation rate
Electrophoresis
Clinical Division of Oncology
Department of Medicine I
Medical University of
Vienna, Austria
Tumourmarkers
Tumourmarkers are:
• not sensitive for early detection (with the potential
exception of PSA, beta-HCG, AFP)
• not specific.
Accordingly, they should not be regarded as tools for
early detection of cancer or tumour search.
However, they might be helpful for assessment of
response to therapy and follow up.
Clinical Division of Oncology
Department of Medicine I
Medical University of
Vienna, Austria
Tumourmarkers
CEA, CA15.3, CA12.5, CA 19.9, MCA
TPS
beta-HCG
AFP
PSA
Beta-2-Microglobulin
Clinical Division of Oncology
Department of Medicine I
Medical University of
Vienna, Austria
Tumourmarkers in the follow
up of various cancers
HISTOLOGY / LOCALISATION
MARKER
ADENOCACRCINOMA
BREAST CANCER
GASTROINTESTINAL CARCINOMAS
OVARIAN CANCER
HEPATOCELLULAR CARCINOMA, TESTICULAR CANCER
CEA
CA 15.3
CA 19.9
CA 12.5
AFP
SQUAMOUS CELL CARCINOMA
NEUROENDOCRINE CARCINOMA
SCC
NSE
PROSTATE CANCER
GERM CELL CARCINOMA (z.B. SEMINOMA)
PSA
b-HCG
Clinical Division of Oncology
Department of Medicine I
Medical University of
Vienna, Austria
TUMOURMARKERS
LABORATORY PARAMTERS….
SYMPTOMS....
.... ARE ONLY INDIRECT CLUES FOR CANCER.
THE ONLY CLINICALLY RELEVANT PROOF IS
HISTOLOGICAL VERIFICATION.
Clinical Division of Oncology
Department of Medicine I
Medical University of
Vienna, Austria
Clinical staging of
carcinomas
Conventional radiology
Sonography
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Bone scan
(Positron emission tomography - PET)
Clinical Division of Oncology
Department of Medicine I
Medical University of
Vienna, Austria
CARCINOMA DIAGNOSIS
Remember
Treatment must not be given in the
absence of a clear-cut histological
diagnosis.
Clinical Division of Oncology
Department of Medicine I
Medical University of
Vienna, Austria
Therapeutic
options
 Surgery
 Radiation
 Medical Oncology
Clinical Division of Oncology
Department of Medicine I
Medical University of
Vienna, Austria
Medical Oncology
 NEOADJUVANT THERAPY
 ADJUVANT THERAPY
 THERAPY OF METASTATIC DISEASE
Clinical Division of Oncology
Department of Medicine I
Medical University of
Vienna, Austria
NEOADJUVANT
THERAPY OF CANCER
Administration before surgery in order to
 decrease tumor bulk/size
 Modification of tumour biology
 estimate the effectiveness of given therapy
Clinical Division of Oncology
Department of Medicine I
Medical University of
Vienna, Austria
GOAL OF THERAPY IN
METASTATIC DISEASE
 Maintain organ function
 Palliation of symptoms
 Prolongation of survival
Clinical Division of Oncology
Department of Medicine I
Medical University of
Vienna, Austria
Medical Oncology
Remember
The effectivity of a certain
therapy for a certain tumour can
not be translated into other
tumours.
Clinical Division of Oncology
Department of Medicine I
Medical University of
Vienna, Austria