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Chapter XIV. TUMOURS

Tumour is the pathological overgrowth of tissues, which arises spontaneously and is characterised by structural polymorphism and functional independence, these properties being inherited during cell division.

GENERAL EVALUATION OF THE ONCOLOGICAL PATIENT

Early detection of a malignant tumour is a prerequisite for its successful treatment.

History of the patient usually offers clues that may be suggestive of a malignant process:

•  the living conditions and habits (e. g. such carcinogenic factors as smoking or chewing of tobacco);

•  the area of living (e.g. skin cancer is much more common in those living in the South; lung cancer predominates in industrialised areas with an excessive air pollution).

At its initial stages a tumour is unlikely to produce any complaints. As the suspicion of a malignancy is sometimes based only on a few indistinct symptoms, the meticulous questioning is mandatory. It is therefore necessary to inquire whether there has been any minor change in the patient's well-being. Of great importance is what is referred to as the syndrome of minor symptoms and signs, i.e. the state of discomfort that may be indicative of a malignancy:

•  fatigability without apparent cause and a reduction in working capability;

•  rejection or unwillingness to eat certain foods

•  drowsiness;

•  apathy to what used to be of interest;

•  «a foreign body» sensation;

•  abdominal discomfort rather than pain (e.g. a feeling of heaviness);

•  lack of satisfaction after micturition or defecation, etc.

Furthermore, a change in size, colour or consistency of a pre-existing lesion (e.g. a birthmark) is not infrequently of a diagnostic value.

It has to be, however, noted that such symptoms do not necessarily suggest a malignant tumour.

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