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, [glossary term:] 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.
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.
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.