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|How Is Cancer Diagnosed?
The diagnostic process for cancer can be divided into three distinct phases. These are:
Step One: Detection, Initial Discovery
This is where a woman or her doctor notices a physical cancer symptom such as a lump on the breast. The doctor will then gather some further information and decide if it is necessary to proceed further. Alternatively a potential problem may be discovered through a routine screening like a mammogram or Pap Test.
Step Two: Diagnosis: Medical Tests
A sample of cells (biopsy) from the suspected tissue area is examined under a microscope to see what those changes mean.
Step Three: Determining Progression Of Cancer
If the diagnosis is cancer, doctors will need to learn as much about the cancer involved so that they can treat it effectively. This will include how advanced it is (staging) and how aggressive it is (grading).
As cancer grows it eventually becomes large enough to physically show itself in some way - whether that is a lump, a sore or some other indication. Where symptoms have not yet shown themselves, they may be discovered through a routine screening test. If a change is detected, most doctors assess a patient first by taking a medical history and performing a physical examination. Additional information can then be gathered with imaging techniques such as X-rays and mammogram's, as well as lab tests such as a blood count. This is known as clinical staging.
Imaging procedures provide pictures of the inside of the body without having to cut the skin open. They are used for detecting changes rather than diagnosing cancer. Most commonly they are used for (1) screening in women at risk of developing cancer (2) detecting changes where cancer is suspected (3) checking after treatment, is a tumor reducing? (4) following up years after treatment to ensure no changes have re-occurred.
Tips: Cancer Prevention Tips - Learn how to lower your risks.
X-rays are the most commonly used imaging technique and they can highlight both bone and certain tissues. A chest X-ray can show changes which occur with lung cancer for example. By injecting (or swallowing) a contrast medium other organs may also be outlined such as the digestive tract which can help detect signs of colon or rectum cancer. Unfortunately X-rays are not sophisticated enough to detect early changes for people without symptoms. They may however be used for those who have been diagnosed with cancer and to check if that cancer has spread to other organs.
Mammograms are special X-rays of the breast. Mammograms can be carried out diagnostically, where a lump or nipple discharge is present. They are also routinely carried out in postmenopausal women over 50 as an early detection measure. Research dating as far back as the 1960s confirms that mammography is the only proven method for finding cancer before anyone suspects it is there. The particular advantage of mammogram's is that they can detect calcifications, which are tiny white specs of calcified tissue. Although calcifications can be present in normal breast changes, those which indicate early invasive cancer will be found in a certain shape. A more recent invention is digital mammography which captures images with an electronic X-ray machine. However it appears that the digital version is still not as good at capturing microcalcifications as a standard mammography.
A sonography use sound waves to generate computer images of the internal organs. An ultrasound may be used for seeing if a breast or ovarian lump is solid or full of fluid. It is considered safe to use during pregnancy. However it does not show microcalcifications or changes in breast structure, so it is not generally used for screening.
CAT & MRI Scans
MRI (magnetic resonance imaging) and CAT (computerized tomography) have revolutionized cancer diagnosis and treatment. They can show cross-sections of the body which would not show up in a standard X ray but which would only normally be seen by surgery.
After a change has been detected by a doctor, a diagnosis is the next important step. This involves taking a specimen of cells and examining them under a microscope to determine if cancer is present. A surgeon, doctor or gynecologist may collect the sample but it is examined by a pathologist. Even if a doctor is almost 100 percent certain that after taking a medical history, carrying out a physical examination, imaging procedure or lab works, that cancer is present - a diagnosis is still not possible without a pathologist. This is known as pathologic staging. In some instances the pathologist discovers that the cancer is more advanced than indicated by the clinical stage. Pathological staging gives doctors more accurate information which they can use for determining treatment and a patient’s prognosis (outcome). The least invasive way of gathering information is a biopsy, although more invasive cancer surgeries are sometimes performed. The patient will be advised about cancer surgery recovery timelines if necessary.
How Is a Specimen Obtained?
If cells can be gathered from an external or internal examination, they may be gathered by a doctor. For example if worrying spots are found in or around the vagina he may carry out a biopsy, snipping or scrapping a small piece of the tissue. If the area or organ is not accessible, a needle may be used to withdraw cells. Alternatively a biopsy may require some sort of scope such as a laparoscopy, colonoscopy or sigmoidoscopy. An open biopsy, surgically cutting through the skin to reach the affected area is also a consideration. On occasion no biopsy is performed: for example, when a hysterectomy operation is performed where a large tumor on the uterus needs to be removed because of symptoms. The pathologist will then examine the tumor once it's removed.
If diagnosis after a biopsy is cancer, then doctors will want to learn as much as possible about the cancer involved. Everyone (patient above all!) will want to know what stage the cancer is at (staging) and how aggressive it is likely to be (grading). This will help determine prognosis. That is to say, the most important question of all: What are my chances? Staging is also important for those considering joining a cancer clinical study, because only certain stages will be accepted into certain studies.
Staging Of Cancer
Staging is determined by (a) how large the tumor is (b) if it has spread to the lymph nodes and (c) if it has spread to other organs (metastasis). Each category is numbered according to a stage. So for example, a breast cancer diagnosed as T2 N1 M0 means that the tumor is 2-5cm large, more than one lymph node shows signs of cancer, but no metastasis has taken place. If cancer is not invasive, the best staging it could receive is T0 N0 M0.
Grading Of Cancer
The next important question is how a cancer is likely to behave. Under a microscope, the more 'normal' a cancer cell looks, the better. How fast it is dividing (mitosis) is also critical, the faster it is growing, the more aggressive the cancer. Other tests such as S-phase fraction (SPF), DNA Ploidy and Ki-67 can be carried out to determine speed of cell division. The idea behind these tests is to determine the kind of treatment that will help the woman live longer. More aggressive cancers will need stronger cancer treatments, while less aggressive can be more gently treated. See: Alternative treatments for cancer.
|Related Articles on Female Cancer
For more information on treating and diagnosing female cancers, see the following:
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