Dharamshila Narayana Superspeciality Hospital

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Diagnosis and Staging

Physical Examination to feel lumps and swelling in head, neck and jaw, also examine the inside of the mouth and areas of pain, and checks the workings of facial nerves and muscles. The specialist at the hospital will ask about your general health and any previous medical problems, before examining you. They may arrange blood tests to check your general health.

Frozen Section - Frozen section and intra-operative pathology consultations are essential for good cancer surgery. Frozen sections ensure adequate clear margins during tumour resections and where ever required, provide an intra-operative histological diagnosis where pre-operative evaluation may not have done so. Thus second surgeries with the attendant risks of anaesthesia are totally avoided and we are able to provide our patients with the best Surgical Oncology Services.

The following tests are commonly used to diagnose salivary gland cancer:

CT (computerized tomography) scan

A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless but takes from 10-30 minutes. CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand.

MRI (magnetic resonance imaging) scan

This test is similar to a CT scan but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure that it’s safe for you to have an MRI scan.

Before the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you’ll be given earplugs or headphones. You′ll be able to hear, and speak to, the person operating the scanner.

Biopsy

The doctor may use a fine needle and syringe to take a sample of cells from the affected area to examine under a microscope. Alternatively, a small piece of tissue may be taken from the area. This procedure is usually performed under either a general or local anaesthetic.

Staging

The stage of a cancer is a term used to describe its size and whether or not it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps the doctors decide on the most appropriate treatment for you.

TNM staging

The most commonly used staging system is called the TNM system:

  • T refers to the tumour size.
  • N refers to whether or not lymph nodes are affected
  • M refers to whether or not the cancer has spread to other parts of the body (metastases).

The T, N and M will often have numbers attached to describe the detail. For example, a T1 tumour may be very small and just in one layer of tissue, whereas a T4 tumour may be a larger size and spread through several layers of tissue.

The exact details of the T, N and M will depend on the type of cancer.

Number staging

In addition to TNM staging, you’ll probably hear the doctors use a number staging system. There are usually three or four number stages for each cancer type.

Stage 1 describes a cancer at an early stage when it′s usually small in size and hasn’t spread, whereas stage 4 describes cancer at a more advanced stage when it has usually spread to other parts of the body. Stages 2 and 3 are in-between these stages.

The number stages are made up of different combinations of the TNM stages. So a stage 1 cancer may be described as either T1, N0, M0 or T2, N0, M0.

Number stages may also be further subdivided to give more detailed information about tumour size and spread. For example, a stage 3 cancer may be subdivided into stage 3a, stage 3b and stage 3c. A stage 3b cancer may differ from a stage 3a cancer in either the tumour size or if the cancer has spread to lymph nodes.

Talking about staging

In the last few years, staging systems have become increasingly complex and they now describe the size and spread of different types of cancer in much greater detail. This can be very helpful in planning the details of treatment or predicting outcomes.

However, doctors will often use a much simpler approach when talking about staging. They might use words like ‘early’ or ‘local’ if the cancer hasn′t spread, ‘locally advanced’ if it has begun to spread into surrounding tissues or nearby lymph nodes, or ‘advanced’ or ‘widespread’ if it has spread to other parts of the body. Your doctors can give you more information about the stage of your cancer.

Grading

Grading refers to the appearance of the cancer cells under the microscope, and gives an idea of how quickly the cancer may develop.

Low-grade means that the cancer cells look very like normal cells; they are usually slow-growing and are less likely to spread. In high-grade tumours the cells look very abnormal, are likely to grow more quickly, and are more likely to spread.

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