If you have a symptom or your screening test result suggests cancer, the doctor must find out whether it is due to cancer or to some other cause. The doctor may ask about your personal and family medical history and do a physical exam. The doctor also may order lab tests, x-rays, or other tests or procedures.
Tests of the blood, urine, or other fluids can help doctors make a diagnosis. These tests can show how well an organ (such as the kidney) is doing its job. Also, high amounts of some substances may be a sign of cancer. These substances are often called tumor markers. However, abnormal lab results are not a sure sign of cancer. Doctors cannot rely on lab tests alone to diagnose cancer.
Imaging procedures create pictures of areas inside your body that help the doctor see whether a tumor is present. These pictures can be made in several ways:
- X-rays: X-rays are the most common way to view organs and bones inside the body.
- CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your organs. You may receive a contrast material (such as dye) to make these pictures easier to read.
- Radionuclide scan: You receive an injection of a small amount of radioactive material. It flows through your bloodstream and collects in certain bones or organs. A machine called a scanner detects and measures the radioactivity. The scanner creates pictures of bones or organs on a computer screen or on film. Your body gets rid of the radioactive substance quickly.
- Ultrasound: An ultrasound device sends out sound waves that people cannot hear. The waves bounce off tissues inside your body like an echo. A computer uses these echoes to create a picture called a sonogram.
- MRI: A strong magnet linked to a computer is used to make detailed pictures of areas in your body. Your doctor can view these pictures on a monitor and can print them on film.
- PET scan: You receive an injection of a small amount of radioactive material. A machine makes pictures that show chemical activities in the body. Cancer cells sometimes show up as areas of high activity.
In most cases, doctors need to do a biopsy to make a diagnosis of cancer. For a biopsy, the doctor removes a sample of tissue and sends it to a lab. A pathologist looks at the tissue under a microscope. The sample may be removed in several ways:
- With a needle: The doctor uses a needle to withdraw tissue or fluid.
- With an endoscope: The doctor uses a thin, lighted tube (an endoscope) to look at areas inside the body. The doctor can remove tissue or cells through the tube.
- With surgery: Surgery may be excisional or incisional.
- In an excisional biopsy, the surgeon removes the entire tumor. Often some of the normal tissue around the tumor also is removed.
- In an incisional biopsy, the surgeon removes just part of the tumor.
Cancer tissue has a distinctive appearance under the microscope. Among the traits the doctor looks for are a large number of irregularly shaped dividing cells, variation in nuclear size and shape, variation in cell size and shape, loss of specialized cell features, loss of normal tissue organization, and a poorly defined tumor boundary.
You may want to ask the doctor these questions before having a biopsy:
- Where will I go for the biopsy?
- How long will it take? Will I be awake? Will it hurt?
- Are there any risks? What are the chances of infection or bleeding after the procedure?
- How soon will I know the results?
- If I do have cancer, who will talk to me about the next steps? When?
Reference: National Cancer Institute (NCI)
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