About 500,000 new cases of cancer are registered in Russia every year, unfortunately, more than half of them are in the late stages.At the same time, if a neoplasm is detected at the first or second stage of the disease, it can be cured in about 95% of cases.A specialist in diagnostics of oncological diseases tells about which examinations need to be carried out in order to diagnose a malignant tumor in a timely manner Member of the European Medical Center, member of the International Society for Radiation Diagnostics of Oncological Diseases, the North American Society of Radiologists, the Royal College of Radiologists of Great Britain, the European Breast Cancer Screening Group, ProfessorEvgeny Libson.
Evgeny Isaakovich, why is early diagnosis so important?
Evgeny Isaakovich, why is early diagnosis so important?
Unfortunately, the cancer screening system in Russia is not effective enough. Meanwhile, today we can reduce mortality from the most common cancers by 80% if they are detected in a timely manner.
What diseases are we talking about?
First of all, breast cancer is the most common cancer in women.
Today we have the entire arsenal of diagnostic tools that can detect breast cancer at the earliest stage. First of all, this is digital mammography with tomosynthesis. It has been proven that this technique increases diagnostic efficiency by 20% compared to conventional mammography. The second is an ultrasound scan, which must be performed on an expert–class device by an experienced doctor. It is necessary to know that ultrasound is not a screening method, it is an additional procedure that is prescribed to clarify the diagnosis, but does not replace mammography. The third is an MRI scan of the breast. It is usually performed on young women with a genetic predisposition to breast cancer, carriers of BRCA 1 and BRCA2 gene mutations.
In the event that suspicious formations are found on ultrasound or mammography, a biopsy is performed. It is important that a histological examination, rather than a cytological (cell examination), be performed to determine the full status of the disease, including its morphological structure, hormonal status, and the presence of progesterone and estrogen receptors.These data are necessary for choosing the right treatment strategy.
If the lesion is visible on MRI but not visible on ultrasound and mammography, we perform an MRI-controlled biopsy. Our clinic was the first in Russia to start performing these studies.
How often should women be screened?
In most Western countries, breast cancer screening begins at age 40. Mammography is performed once a year, necessarily in 4 projections. A number of women have a high density of mammary glands. This is the so-called fibrocystic mastopathy. Contrary to popular belief, this is not a disease, but a condition of the mammary glands. But it can interfere with accurate diagnosis.Mammography is not enough for these women, and an additional ultrasound scan is necessary.
What other diseases can be detected by screening?
The second most common cancer among women is cervical cancer. If a woman regularly goes for a routine checkup and takes a PAP test, she is basically protected from this disease. In most cases, cervical cancer is caused by oncogenic types of human papillomavirus. Today, there is an opportunity to carry out preventive vaccination against this virus.
One of the most common diseases in men is prostate cancer. An annual blood test for prostate-specific antigen (PSA) is recommended, starting at the age of 50. If the disease is diagnosed, additional research is needed to determine which type of treatment is indicated for the patient. Sometimes surgery is not enough, radiation therapy is necessary. In some cases, radiation therapy can be as effective as surgery.
Colonoscopy– an examination of the large intestine, should be performed every five years, starting at the age of 50. This is an international recommendation.If a person has a predisposition to colon cancer – polyposis or ulcerative colitis – he is under the supervision of gastroenterologists who refer him for this study.
Patients are often afraid of this procedure.
Colonoscopy should not be performed without sedation – this is the last century. In addition, there is an alternative technique – CT colonography or, as it is called, "virtual colonoscopy". This is a multispiral CT scan with very thin sections, a method that does not cause any unpleasant sensations, while its sensitivity in the diagnosis of polyps of more than 1 cm is 90%.If no abnormalities were found during the first colonoscopy, subsequent examinations can be performed using CT colonography.
Recently, there has been a lot of talk about the early diagnosis of lung cancer using computed tomography.
Indeed, studies conducted in the USA and in Europe prove that the use of computed tomography as an early diagnosis method for lung cancer reduces mortality from this disease by 20%. This is a huge number. A special technique has been developed – low-dose CT, which allows CT to be performed with radiation exposure equivalent to approximately one X-ray image.
To whom is this study recommended?
We know that out of every seven lung cancer patients, six are experienced smokers. In addition to early detection of cancer, low-dose CT has another distinct advantage. The person who comes for this examination is thinking about quitting smoking. I was involved in this project in Israel - about 30% of people quit smoking, realizing that it was possible to reduce the risk by quitting smoking at the age of 50. It is important to understand: lung cancer detected in the first stage is cured in 97% of cases, but never in the later stage.
You were one of the experts in the creation of positron emission units tomographyandradiation therapyat the European Medical Center. Can you tell us in which cases a PET diagnosis is performed?
Cancer treatment is impossible today without PET diagnostics. This is the main method for assessing the prevalence of the disease at the cellular level. Unlike CT and MRI, where we see anatomical changes, PET is a molecular diagnostic that shows the metabolism in a tumor. A malignant tumor is characterized by an active consumption of glucose from the blood. PET diagnostics is based on the search for foci of accelerated glucose processing in the body. Seeing such a focus, we understand that it is most likely a malignant tumor, and thanks to simultaneous computed tomography, we can see exactly where it is located.
Previously, a person was given six courses of chemotherapy, after which a second examination was performed. Today, we can do a PET-CT scan in a month and see if the prescribed medication is working or if it needs to be replaced.
We have come to what is called a tailored approach - individualized treatment. Today, we are striving to obtain a complete genetic profile of the tumor and, as in the case of antibiotics, to determine which drug the tumor will be sensitive to and which will not.
For example, when doing a biopsy for lung cancer, we perform a genetic analysis of the tumor. And we know that if a patient has mutations in certain genes, they can be treated with pills, and they don't need surgery.
Today, everything is moving towards the field of individualized medicine, individual selection of drugs and treatment tactics. This is a field that will continue to develop and which, we hope, will help to find answers to many questions related to the treatment of oncological diseases.
Author:Evgeny Libson,Professor of Radiology, Chief Specialist in Cancer diagnostics and CT-controlled biopsies
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