- Igor Pershukov is a professor, Doctor of Medical Sciences and Philosophy (PhD), as well as the head of the Department of Hospital Therapy 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).
According to him, the key aspects of tumor diagnostics are a holistic approach to investigation and mandatory morphological verification of the diagnosis.
The holistic approach includes analyzing patient complaints and their medical history, as well as applying all necessary examination methods to identify the primary tumor and metastases in regional and distant lymph nodes.
Morphological verification can be achieved through histological (e.g., biopsy or trepanobiopsy) or cytological studies. Materials for cytological analysis can include smears, punctures from the tumor, fluids from cavities, urine, sputum, and washings.
All malignant tumors are classified according to the TNM system, which helps determine the stage of the disease and assess the effectiveness of treatment for each patient.
The T criterion describes the primary tumor focus:
- T0 — no evidence of primary tumor;
- Tis — pre-invasive cancer;
- T1, T2, T3, T4 — various degrees of tumor enlargement or spread.
The N criterion reflects the status of regional lymph nodes:
- Nx — status of lymph nodes cannot be assessed;
- N0 — no metastases in regional lymph nodes;
- N1, N2, N3 — increasing degrees of lymph node involvement in the pathological process.
The M criterion demonstrates the presence or absence of distant metastases:
- Mx — presence of distant metastases cannot be assessed;
- M0 — no distant metastases;
- M1 — distant metastases are present.
The complexity of diagnosis can be exacerbated by the syndrome of metastases from a malignant neoplasm of unknown primary origin. In such patients, metastases are found in lymph nodes, bones, the brain, lungs, and liver, while the primary tumor remains undetected.
According to Professor Pershukov, among the main reasons for late diagnosis of malignant tumors in Kyrgyzstan are:
- the absence of a national cancer control program;
- insufficient training of doctors in the field of oncology;
- low level of public awareness about oncological diseases;
- lack of application of cytological and morphological methods in healthcare practice.
"For example, in Russia, morphological verification of the diagnosis reaches 80%. In the remaining 20% of patients, the diagnosis is not confirmed, which can lead to medical errors and referrals to incompetent specialists," he adds.
Thus, the problem of early diagnosis of malignant tumors remains extremely relevant.
The professor emphasizes that timely diagnosis of malignant tumors is possible. For instance, in general across Russia, localized forms of breast cancer (T1–2N0M0) are detected in 30% of patients, while in certain medical institutions, with proper organization of examinations, localized forms of breast cancer are found in 70% of patients.
In the 21st century, DNA diagnostics of cancer is actively developing. Unlike tumor markers, which are products of cell activity, DNA diagnostics examines the organism's own DNA and identifies genetic defects," reports Pershukov.
For DNA diagnostics, various samples can be used: blood and natural secretions of a person:
- urine (in kidney and bladder cancer);
- stool (in colon cancer);
- sputum (in lung cancer);
- saliva (in cancers of the oral cavity, throat, and 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.
