| Ch 14 | Page 6 / 21 | |
| Cancer follow-up |
Simple supervision | |
Clinical supervision is the easiest way to monitor patients. Except in the case of deep tumours, it offers good indications on disease development.
Questioning is centred on side effects and facilitates the detection of many relapses:
- Headaches due to intracranial hypertension,
- Vomiting, relapsing dysphagia, transit disorders,
- Urinating disorders,
The clinical examination remains very valuable:
- For palpating nodes (especially supra-clavicular nodes),
- Thorax percussion and auscultation in search of effusion,
- Head and neck examination,
- Abdominal palpation,
- Pelvis examinationn.
The clinical examination, via the physician’s calm and methodical nature, reassures the patient who is more likely to complain of symptoms that he/she would probably not mention if simply seated in front of the doctor. It also allows the physician to ask more personal questions (on sexuality or urinary function for example) which appear a perfectly natural part of a well conducted examination. The doctor’s hands calm the patient.
Certain systematic examinations are often performed:
- Scanner of thorax, abdomen or pelvis
- Mammography of the breast treated by lumpectomy and of the other breast.
- Systematic endoscopies (for instance after colon surgery to detect other polyps).
- Bone scanning (which is positive 3 to 6 months before any radiological abnormality) or iodine scanning for thyroid cancer.
A few clinical publications have shown the efficiency of such examinations for the early detection of relapses. However, once more, no study has ever proved the clinical interest of earlier detection, and consequently the relevance of such close supervision on patient survival.
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