Making the Diagnosis
Cancer is diagnosed with a number of tests but usually a biopsy is needed. This is where a sample of the lesion/growth is sent to the laboratory to be examined under the microscope. This can tell the doctors exactly what type of cancer is present and guides them to what sort of treatment might be best.
Samples can be obtained with different techniques:
- Fine needle aspirate (FNA): a small needle is inserted into a lump and some cells are sucked out and sent to the laboratory. If the lump is on the surface of your body the doctor will do this in the consultation room with some local anaesthetic injected into the skin so the procedure won’t hurt. If the tumour is inside your body an FNA can still be done but it is done with guidance from a CT scanner or ultrasound so the doctor can see where the needle needs to go. This is done by a specialist radiologist (a doctor trained in the speciality of x-rays).
- Biopsy: a small piece of a lesion is cut out and sent to the laboratory. If it is on the outside of your body this procedure is done with local anaesthetic (makes the area numb so it doesn’t hurt). Sometimes it can be done by putting tiny telescopes into areas they can’t reach to take the biopsy. Sometimes an operation is required to be sure about the diagnosis.
- Endoscopy: a flexible tube with a viewing lens and a fibre optic light on the end is passed through natural body orifices (openings) to view the colon (colonoscopy), stomach (gastroscopy) or lungs (bronchoscopy).
- Laparoscopy: similar to endoscopy, but requires a small cut (incision) to be made in the body such as the abdominal (tummy) wall. The laparoscope is then pushed through the incision to look for possible areas of cancer, which can then be biopsied. When this type of procedure is done in the chest it is called a thoracoscopy or mediastinoscopy.
Other tests are often needed to establish the diagnosis and extent of a cancer. These include blood and urine tests, CT or MRI scans, ultrasounds, nuclear medicine scans.
Once the diagnosis is established you will meet with various specialists to talk about what treatment options are available and the benefits and risks of those treatments as well as what the diagnosis means. It is a good idea to have a support person with you for these consultations as a lot of information is often given and it can be hard to take it all in. It is a good idea to write down a list of questions you might want to ask.