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For most cancers, the report of the physical examination
should include the location of tumor, including site and sub
site, direct extension of the tumor to other organs or structures,
and palpability and mobility of accessible lymph nodes. The
probability of distant site involvement, such as organomegaly,
pleural effusion, ascites,
or neurological findings should be stated. In a breast cancer
case, for example, the physical examination should describe
the exact location of the tumor mass, clinical size of the
tumor, and the condition of the skin surrounding the tumor,
including changes in skin color and texture and attachment
or fixation of the mass. The exam should include the entire
axial and regional nodal area including the supraclavicular
nodes.
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Tumors of the head and neck area are evaluated with
a general exam of the face and neck. The eyes, skin,
ears, and nasal cavity should be examined in addition
to mucosal surfaces of the nasopharynx, oral cavity,
orpharynx, hypopharynx, and larynx. Digital and bimanual
palpation of the oral cavity, oropharynx, and neck should
be included in the physical exam.
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Some organ sites are not easily examined clinically. A patient
suspected of having a gastrointestinal tumor should have external
palpation of the liver and abdomen. Females should have both
a digital rectal exam and a pelvic exam. Males should have
a digital rectal exam. Suspected lung cancer patients should
have an assessment of cervical and supraclavicular nodal areas.
In all cases, other than lymphomas, nodes must be described
by a clinician as "involved" in order to be considered to
contain cancer. For example, if it is stated that the nodes
are enlarged, they are not considered to contain cancer until
there is cytological or pathologic confirmation. If there
is matting or fixation, the medical practitioner may state
that the nodes are involved with cancer.
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