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Cancer is a diagnosis that no one wants to hear. Fortunately we are living in an age of technological advances and constant research. Today there are several diagnostic methods available for physicians to detect and diagnose cancer. Technological advances have allowed cancer to not be a “death sentence” but in many cases treatable. It is important for an individual to know their body and be aware of changes and symptoms that occur. Early detection is the key to saving lives. When an individual develops symptoms that are not normal an appointment to their primary care physician must be made. If the physician suspects cancer he or she will refer the patient to an oncologist. The oncologist will coordinate the tests needed for the diagnosis and determine a treatment plan. A detailed patient history will be taken along with lab work and diagnostic tests (such as CAT scan, P.E.T. scan or the Fusion of the two.
There are several techniques that are used. These images produce internal pictures of the structures of the body.
- X-Rays: The most common method that physicians use to get pictures of the inside of the body. Radiologists (physicians trained in the reading of x-rays) can spot abnormal areas that might indicate the possibility of cancer.
- CAT scan: (Computerized axial tomography) this method uses a special machine that utilizes radiographic beams that create detailed computerized pictures of the body. This provides a clear image and is more precise than a regular x-ray.
- MRI: (Magnetic Resonance Imaging) This method uses a powerful magnetic field to capture detailed computer images of the body’s major organs, large blood vessels, and soft tissues. This procedure is expensive but accurate. During the procedure, which normally lasts about 30 minutes, patients must lay completely still in order to get accurate results.
- Ultrasound: High-frequency sound waves are used to determine if there is a suspicious tumor or lump and if it is solid or fluid.
- P.E.T. scan: (Positron Emission Tomography) This method produces images of the body’s biological functions. Physicians are able to evaluate the metabolic function of tumors; meaning the P.E.T. scan can show if certain lesions are benign or malignant. P.E.T. shows the progress of the disease and how the body is responding to treatment. This is available at Ashland Bellefonte Cancer Center.
- CT-P.E.T. Fusion: The combination of the two technologies that enables the physician to view the metabolic changes in the proper anatomical context of the body.
Blood tests are another method that physicians use when diagnosing cancer, these tests give important information that could indicate a problem. If the cancer is present the lab results may show the effects of the disease on the body.
- In certain cases, special tests are utilized to measure the amount of certain substances in the blood, urine, other body fluids, and tumor tissue. When certain cancers are present the levels of these substances may become abnormal.
- Tumor markers are a substance that certain tumors release indicating a presence of cancer. Tumor markers can be detected through blood tests.
- PSA blood test is used for determining prostate cancer. This test determines the amount of the prostate specific antigen. Results that show higher than normal levels of PSA can indicate cancer.
- Recently a blood test for ovarian cancer has been made available, CA-125.
- Blood tests alone can be inconclusive and other methods should be utilized in order to diagnose cancer.
It is important to understand that a diagnosis can not be made until a biopsy has been taken from the mass. The oncologist will perform a biopsy and send to a pathologist. A biopsy is the removal of living cells, tissues, or fluid in order to make a diagnosis. A pathologist is a medical physician that has specialty training in the examination of diagnosing tissues and cells and is the only physician that can actually make a diagnosis of cancer.
Biopsies can be performed several ways depending upon the size, type, and location of the tumor.
Types of Biopsies
- Fine-needle aspiration: a fine needle is used with a syringe to remove (suction) clumps of cells from a mass or tumor. To qualify for this procedure, the tumor must be large and not located near a hollow organ or blood vessel. This can often be performed without anesthesia.
- Needle Biopsy: A small core of tissue is obtained through a large-bore needle and local anesthetic.
- Incisional Biopsy: The surgical removal of a small area of tissue. This can be performed with local anesthesia and on an outpatient basis.
- Excisional Biopsy: The removal of an entire tumor for analysis through surgical removal. This procedure requires local or general anesthetic. Normally used for breast tumors that are less than an inch in diameter, procedure called a lumpectomy. Before undergoing a biopsy there are questions that you should ask your physician. Below are samples of the types of questions that you should ask.
Prior to undergoing a biopsy
- How long will the procedure take?
- Will I be awake and will it hurt?
- After the procedure how soon will the results be back?
- If the results come back indicating cancer who will talk to me about treatment?
- When will treatment begin? Should treatment begin immediately?
In some cases the true extent of a tumor’s development is not known until the patient undergoes surgery. Surgery will be performed by a surgical oncologist who can determine the size of the tumor and the extent that it has spread. This is known as tumor staging.
Tumor staging is important because it plays a vital role in determining a patient’s prognosis, what treatment and therapy is appropriate and if it is successful or not. After the pathologist has determined the classification of the tumor the diagnosis begins.
The physician will determine the “stage” or the extent of the cancer. This is how the physician determines the best treatment for a specific type of tumor. The physician may order more tests to determine if the cancer has spread and if so, to what parts of the body. Lymph nodes near the tumor may be removed to check for cancer cells. If cancer is present in the lymph nodes this may indicate that the cancer has spread to other areas of the body and to other organs. The earlier cancer is diagnosed the greater the opportunity for survival and a cure.
- Stage I: This is the simplest form and indicates that the tumor is small and confined to the area that it originated. When a tumor is diagnosed in this stage, the chance for a cure is high.
- Stage II: The tumor has spread to the surrounding tissues
- Stage III: The tumor has spread into the surrounding tissues and lymph nodes.
- Stage IV: Indicates an extensive spread, normally to many organs and other parts of the body.
This is one of the most important elements of a patient’s diagnosis. The cancer grade specifies how aggressive the cancer is and is determined by the pathologist. There are three major components when determining the grade.
- First: How the individual cells appear, are they very different from normal cells?
- Second: What is the tissue pattern? Does the pattern of cells mimic the normal makeup of tissue in that area of the body?
- Third: What is the cells’ mitotic rate? What proportions of the cells are actively dying?
The pathologist will then classify the cancer in order of low grade to high grade or aggressive. The grades are 1-4, 1 being low grade and least aggressive with 4 being high grade and most aggressive.
When your physician talks about the grade of the cancer there are certain terms that he/she might use such as differentiated, well differentiated, moderately differentiated, and poorly differentiated. These terms describe how mature the cancer cells are and how different there are from normal healthy cells that are taken from the same tissue. For example, well differentiated Grade 1 tumor means slower growth and less likely to spread unlike an undifferentiated Grade 4 tumor.
Analytical Indicators (often called prognostic) such as molecular and genetic have been identified as tests for physicians to use in determining a diagnosis. An indicator that is often used in diagnosing breast cancer is hormone receptors. If a cancer is found to be ER-positive, the surface of breast cancer cells is studded with molecules that attach to estrogen. Estrogen Receptors (ER) are found to stimulate cancer cell growth. Another indicator is PR or progesterone receptors. All breast cancer tumor tissue today is tested for the presence of ER and PR. Once the oncologist has diagnosed cancer it is important to have a full understanding of your diagnosis. It is important that you have the full name of the cancer, which should include the type and the grade (shows how the cancer cells are likely to act). If you do not have all this information, it is important that you ask your physician.
Basic questions to ask your physician concerning your diagnosis:
- What is the medical name of the cancer?
- Is there a type and subtype? If so what is the type?
- What stage is the cancer in?
- What is the grade of the cancer?
- What is my prognosis?
- Are there any characteristics that could affect the course of the disease or affect the treatment options?
- What should I expect during the course of the treatment?
After the diagnosis the treatment phase will begin.