Cancer Diagnosis

How is Cancer Diagnosed?

Cancer can be diagnosed through regular cancer screenings such as mammograms, colonoscopies, or gynecological exams like Pap tests. Cancer can also be diagnosed after symptoms appear such as pain, lumps, or other medical issues. The method used to diagnoses cancer often depends on the type of cancer. Below are some common methods used to diagnosis cancer:

Blood tests: During a blood test, a nurse uses a needle to draw a small amount of blood. The blood sample is then sent to the lab to tests for different things such as blood cell counts, protein levels, or tumor markers. Your doctor can tell a lot about your overall health from blood tests. Blood tests are very helpful in diagnosis blood cancers such as leukemia and lymphoma.

Biopsy: A biopsy is the removal of cells or tissues. During a biopsy a sample of the tumor or suspicious cells are removed so a pathologist can determine if the cells are cancerous. A biopsy can be a small in-patient procedure or a surgery to remove the entire suspicious area. A biopsy can also be performed with a needle that removes a very small bit of tissue or fluid.

Your doctor can use the imaging methods described below to view the tumor or suspicious cells, but a biopsy and the resulting pathology report tells if the cells are cancerous or not.

Computed tomography (CT) scan: A CT scan is an imaging test. CT scans take multiple x- rays from different angles to capture “slices” of the inside of the body. These slices are then reassembled on a computer to create a 3-D image of organs and tissues. During a CT scan you may receive contrast either through an IV or by drinking it. Contrast is a special liquid that help certain organs and tissues show up better on imaging results. During the exam, you will lie on a platform and the platform will be slid in and out of a doughnut shaped machine that takes the images.

Colonoscopies: A colonoscopy is used to examine the bowel’s interior surface for abnormalities like polyps. In this procedure, the doctor inserts a flexible tube into the bowel. The tube contains a camera. The colonoscopy lets the doctor examine the inside of the entire colon and rectum. If the doctor discovers a poly or abnormal tissue, it may be removed for further testing. Colonoscopies are used to diagnose colorectal cancer.

Mammograms: A mammogram is an X-ray image of your breast. In a mammogram, the technician presses the breasts between two firm surfaces. This spreads out the breast tissue and allows the X-ray machine to get good pictures of the breasts. The doctor will use these pictures to check for changes in the breast tissue and also to check for cancer. Mammograms are also done once a lump is detected—to show a more detailed picture of the mass.

Mammograms are used to diagnose breast cancer.

Magnetic resonance imaging (MRI): An MRI is an imaging test. Unlike CT scans or PET scans, MRIs do not use x-rays to take these images. MRIs use a powerful magnet and radio waves to create images of inside the body. MRIs are often used for imaging the breasts, brain, spine, joints, and soft tissues, but they can be used in other ways. An MRI may be done with IV contrast. During an MRI you will be slid into a doughnut shaped machine. MRI machines are generally smaller than CT or PET scan machines.

Pap tests: During a pap test a doctor uses a small brush or spatula to remove cells from the cervix. These cells can then be examined for caner or other changes. Pap tests are used to diagnose cervical cancer.

Physical Exam: During a physical exam, your doctor thoroughly checks your body for general signs of disease or changes such as lumps or swollen lymph nodes.

Positron emission tomography (PET) scan: A PET scan is an imaging test involving injection of radioactive glucose (sugar). A PET scan takes images of areas of the body that pick up the radioactive glucose. Cancer cells take up more glucose than normal cells, so cancer cells can be seen on the image. During the exam, you will lie on a platform and the platform will be slid in and out of a doughnut shaped machine that takes the images.

Skin Check: During a skin check your doctor thoroughly checks your skin for suspicious looking moles or skin changes. Skin checks are used to diagnose skin cancer and melanoma.

X-Rays: X-rays use low doses of radiation to take images of the inside of the body.

What is a pathology report?

In order to make a cancer diagnosis, a doctor needs to collect a sample of the tumor cells to be tested and examined in a lab by a pathologist. A pathologist is a doctor who identifies cancer and other diseases by studying cells under a microscope. After the pathologist studies a sample, he or she prepares a pathology report that explains the findings. Doctors use these reports to diagnosis and stage cancer.

What will be in the pathology report?

The pathology report provides all the pathologist’s findings. Your pathology report may include some or all of the following:

  • Your identification information
  • Your important medical history
  • Details on how the sample or biopsy was taken
  • Description of how the sample looked under the microscope - size, color, grade, margins, node status, etc.
  • Special tests or markers
  • A written summary of the full report

What do the words in my pathology report mean?

Here is a vocabulary list to help you through your pathology report:

  • Abnormal cells: cells that do not look or behave like healthy cells
  • Aggressive: fast growing
  • Benign: not cancerous
  • Biopsy: a procedure to take a small sample of tissue
  • Clean/ clear/ negative margins: the outer edge of the tissue sample does not contain cancer cells
  • Florescence in Situ Hybridization (FISH): a test used to find genetic mutations
  • Grade: how abnormal the cells look and how quickly the tumor is likely to grow. There are three grades for cancer cells. Grade 1 (low grade) means the cancer cells are only a little different from healthy cells and are slow-growing. Grade 2 (high grade) means the cells look very different from healthy cells and are fast-growing.
  • Histology: the way the cells look under a microscope
  • Inconclusive: with the current sample and tests, it cannot be determined if cancer is present
  • Invasive: the cancer has spread to surrounding tissues
  • In Situ: abnormal cells have not spread; the abnormal cells are only where they started
  • Lymph node: lymph nodes filter lymphatic fluid and store white blood cells.
  • Malignant: cancerous
  • Metastasis: cancer that has spread to other parts of the body
  • Pathologist: a doctor who identifies diseases by studying cells and tissues under a microscope
  • Positive margins: the outer edge of the tissue sample does contain cancer cells
  • Stage: how advanced the cancer is
  • Stains: used to color the tissues and cells so the pathologist can see them better
  • Tissue Block: the sample of tissue removed during a biopsy or surgery
  • Vascular invasion: cancer cells are in the blood vessels