How Is Cancer Diagnosed? Cancer is diagnosed by physically removing a sample (tissue, cells, or fluid) of a suspected tumor and examining this material under a microscope. This procedure is called a biopsy. Microscopic examination of biopsy samples is the ONLY way that a positive diagnosis of cancer can be made. A specialist physician called a pathologist performs this examination. After careful evaluation, a benign (non-cancerous) or malignant (cancerous) diagnosis can usually be established. The pathologist then prepares a written report that is sent to your doctor, and upon which treatment is based. Note: Certain biopsy techniques, especially cytology procedures, needle biopsies, and core biopsies, sometimes remove such small quantities of cells or tissue that they can be inadequate to make a positive cancer diagnosis. While these techniques are generally accurate and reliable, situations where the needle misses the tumor can cause the biopsy to appear benign when in fact a cancerous tumor really does exist ('false negative'). In this situation, it may be necessary to repeat the biopsy procedure. This possibility should be discussed with your doctor.

BONE MARROW BIOPSY Bone marrow is located in the center of many bones, and is responsible for producing blood cells. This test is used for the diagnosis and staging of cancers involving the blood cells. These include the various forms of lymphoma and leukemia. Bone marrow biopsies are also used to look for metastatic disease (i.e. invasion of the bone marrow by tumor cells originating elsewhere in the body). CONE BIOPSY In this specialized technique, a small cone-shaped sample of tissue is removed from the inner surface of the cervix (opening of uterus). Cone biopsies are used to diagnose cervical cancer in patients with either an abnormal PAP smear or an abnormal cervical punch biopsy. CT- or ULTRASOUND-DIRECTED NEEDLE BIOPSY If a suspected tumor is inaccessible or located deep within the body, it may be necessary to use special x-ray (CT scan) or ultrasound imaging in order to precisely position a needle through which a biopsy sample can be removed. CYTOLOGY SMEARS In a cytology smear individual cells are removed using either a very thin needle or by scraping a surface with an instrument. The cells obtained are carefully smeared onto a glass slide, colored with special stains, and then interpreted by a cytopathologist (a pathologist with special training in the study of cells). ENDOSCOPIC BIOPSY An endoscopic biopsy is a general term that refers to biopsy samples obtained by using a special fiber-optic instrument (with miniature forceps on the end) that can be passed into hard-to- reach areas of the body. Endoscopic biopsies are commonly used to take biopsy samples from the stomach ("gastroscopy"), the colon ("colonoscopy"), the bladder ("cystoscopy"), the lungs ("bronchoscopy") or the joints ("arthroscopy"). EXCISIONAL BIOPSY An excisional biopsy is a surgical procedure in which an entire tumor, along with a small rim (or margin) of normal tissue around it, is removed. This technique is commonly used to remove relatively small and easily accessible masses. [ Back to top ] FINE NEEDLE ASPIRATION (FNA) In this procedure, a very thin needle attached to a syringe is used to extract (aspirate) individual or small clusters of cells. This technique is used alone when the mass can be clearly felt (palpated) through the skin. For subtle or deep lesions that cannot be felt through the skin, this procedure is used along with x-ray or ultrasound guidance. Since FNA only removes individual cells or very small clusters of cells, it is usually performed by a cytopathologist (a pathologist with special training in the examination of very small quantities of cells). FROZEN SECTION During surgery, it may be necessary to determine whether a tumor is benign (non-cancerous) or malignant (cancerous). A frozen section is a rapid process that allows the pathologist to give the surgeon an on-the-spot diagnosis, while the patient is still in the operating room. In this procedure, the surgeon removes a sample of tissue and submits it to the pathologist. Microscopic slides are then prepared and examined by a pathologist. The entire procedure takes 10-12 minutes. The pathologist discusses his findings with the surgeon who can then determine the best surgical procedure to perform. INCISIONAL BIOPSY Refers to a surgical technique used to sample a large, sometimes inaccessible mass. The surgeon cuts into the mass and removes a small wedge or slice. This method is used to establish a definitive diagnosis of cancer, before doing major surgery to remove a large mass. LYMPH NODE BIOPSY The lymph nodes are small, round structures found throughout the body that drain and filter body fluids. They can become involved and enlarged in many types of disease. These include cancers such as lymphoma or leukemia, as well as metastatic cancer. Lymph node biopsy is also used to "stage" various types of cancer to determine how far the disease has spread. NEEDLE (CORE) BIOPSY In a needle biopsy, a large diameter (large-bore) needle is inserted into a mass to extract one or many "cores" of tissue. The procedure can be performed in a doctor's office or hospital and results are usually available in 24-48 hours. [ Back to top ] PAP SMEAR PAP smears are routinely used to examine cells from the surface of the cervix. In this procedure, the surface of the cervix is scraped with a spatula-shaped instrument to obtain a sample of cells. These cells are then stained and examined under a microscope by a cytopathologist who makes a diagnosis. PUNCH BIOPSY This technique is used to obtain a deep core of skin and underlying tissue. The instrument is a hollow tube that is rotated into the skin until a cylinder (core ) of tissue from the proper depth is obtained. This procedure is also used to examine the cervix following an abnormal PAP smear. SHAVE BIOPSY A shave biopsy is a method of obtaining a biopsy sample from a skin lesion. A scalpel is used to literally shave off the surface of a lesion. This method is commonly used to evaluate pigmented moles (suspected melanomas), or other tumors involving the skin. If the pathologist determines that the lesion is malignant (cancerous), another procedure will be necessary to remove the remaining portion of the tumor. STEREOTACTIC BIOPSY This is a specialized radiology technique used to evaluate masses that are either too small to be felt directly through the skin or located in an inaccessible part of the body. It is most frequently used to evaluate breast masses, but other parts of the body can also be sampled using this procedure. With sophisticated, three- dimensional computerized x-ray equipment, the suspicious mass is localized on coordinates and then a small incision is made directly above it. A radiologist or surgeon then uses a needle to extract the biopsy sample, which is sent to a pathologist for diagnosis. WIRE LOCALIZATION BIOPSY This is a specialized procedure used for small or non-palpable breast masses. Using x-ray or ultrasound guidance, the mass is located and, under anesthesia, a thin wire is carefully inserted into the suspicious area. The surgeon uses the tip of the wire as a guide to locate and remove a sample from the area in question. [ Back to top ] [ Home ]