- Igor Vladimirovich Pershukov is a professor, Doctor of Medical Sciences, Doctor of Philosophy (PhD), and head of the Department of Hospital Therapy with a course in Radiological Diagnosis and Oncology at Jalal-Abad State University. He is a fellow of the American College of Cardiology (FACC) and the American Society of Cardiovascular Angiography and Interventions (FSCAI).
He emphasizes that the key aspects of tumor diagnosis are a holistic approach to investigation and mandatory morphological confirmation of the diagnosis.
The comprehensive approach includes analyzing the patient's complaints, collecting the medical history, and applying all necessary examination methods aimed at identifying the primary tumor focus and metastases in regional and distant areas.
Morphological confirmation of the diagnosis is achieved through histological (biopsy, trepanobiopsy) or cytological examination. For cytology, smears, prints, tumor punctures, fluids from cavities, washings, sputum, and urine can be used.
All malignant tumors are classified according to the TNM system, which allows for assessing the disease stage and treatment outcomes for each patient.
The T criterion describes the state of the primary tumor focus:
- T0 — no evidence of primary tumor;
- Tis — pre-invasive cancer;
- T1, T2, T3, T4 — various degrees of enlargement and/or spread of the tumor.
The N criterion defines the state of regional lymph nodes:
- Nx — the state of lymph nodes cannot be assessed;
- N0 — no metastases in regional lymph nodes;
- N1, N2, N3 — increasing degree of lymph node involvement in the pathological process.
The M criterion reflects the presence or absence of distant metastases:
- Mx — the presence of distant metastases cannot be assessed;
- M0 — no distant metastases;
- M1 — presence of distant metastases.
Diagnostic difficulties may arise due to the syndrome of metastases from malignant tumors with an unidentified primary focus. In such patients, metastases may be found in lymph nodes, bones, the brain, lungs, liver, and other organs, but the primary source remains undetected.
Pershukov points out several reasons for the delayed diagnosis of malignant tumors in Kyrgyzstan:
- the absence of a national cancer control program;
- insufficient training of doctors in oncology;
- low level of public awareness about cancer diseases;
- limited use of cytological and morphological methods in clinical practice.
“For example, in Russia, morphological verification of the diagnosis reaches about 80%. In the remaining 20% of patients, the diagnosis is not morphologically confirmed, which can lead to medical errors and consultations with 'healers,'” he adds.
Thus, the relevance of the problem of early diagnosis of malignant tumors remains high.
It is worth noting that timely diagnosis is possible. For instance, in Russia, localized forms of breast cancer (T1–2N0M0) are detected in only 30% of patients. However, in some medical institutions with proper organization of examinations and active detection, localized forms of breast cancer are diagnosed in 70% of patients.
In the 21st century, methods of DNA diagnostics for cancer are actively developing. Unlike tumor markers, which are products of cellular activity, DNA diagnostics focus on studying a person's own DNA and identifying genetic defects,” asserts Pershukov.
The professor also reports that blood and natural secretions can be used for DNA diagnostics:
- urine (in kidney and bladder cancer);
- stool (in colorectal cancer);
- sputum (in lung cancer);
- saliva (in cancers of the oral cavity and throat, salivary glands).
“Thus, in the near future, blood and urine tests will include not only biochemical and cytological but also genetic studies,” concludes Professor Pershukov.
