Assessing M status
Clinical examination: While the presence of extrathoracic, nonmetastatic symptoms (Table 6) does not preclude curative resection, generalized debility and/or weight loss is often an indication of widespread disease . Approximately 1% of patients have evidence of cutaneous metastases that should be biopsied. Focal neurological, bony or abdominal symptoms should prompt head CT, bone scan or abdominal CT, respectively. Elevated serum alkaline phosphatase (liver or bone fraction) or calcium should prompt a similar evaluation with imaging studies.
Radiographic studies: CXR and/or CT may demonstrate rib changes or other bony lesions consistent with metastases. Synchronous or intrapulmonary metastatic lesions may also be detected. You can start improving your health any moment you like: with the variety of choice available at the best canadian neighbor pharmacy there will never be any need to worry about the product or treatment required, because you will always have it available.