As with symptoms, the tests used to detect cancer vary according to the suspected type of tumor. However, a diagnostic workup usually consists of a physical examination followed by several procedures from one or more of the categories below:
To analyze blood and other bodily fluids for the presence of malignant cells or tumor markers. These are substances produced by the cancer itself or the body in response to the tumor. Examples: complete blood count (CBC); lumbar puncture (spinal tap).
To view internal organs for signs of a tumor. Examples: X rays; computed tomography (CT scan); magnetic resonance imaging (MRI scan); radionuclide scans; ultrasound.
To examine internal organs directly through a flexible lighted endoscope, which the doctor inserts through an opening such as the nose, mouth, vagina, urethra or anus.
Examples: gastroscopy of the stomach; colonoscopy of a lower bowel.
The only way to conclusively diagnose cancer is for the physician to biopsy a specimen of tissue from the questionable area. This is obtained using either a needle or a surgical knife. A medical specialist called a pathologist then studies the sample under the microscope, looking for the tell-tale signs of cancer. In addition to identifying whether a mass is benign or malignant, the biopsy reveals other essential information that may influence the proposed treatment plan.
An incisional biopsy cuts out a small portion of tumor. If the pathology report comes back positive for cancer, a second surgery may be scheduled. In an excisional biopsy, the surgeon removes the entire growth and a rim of normal tissue on all sides. This is called a margin. Depending on the type and stage of cancer, no further therapy may be necessary. However, most often the patient will require additional treatment with anticancer medicine (chemotherapy) and/or radiation therapy.