DIAGNOSIS OF CANCER
Diagnosis of Cancer
The Diagnosis of Cancer involves three sets of investigations
Confirmation of Diagnosis, by biopsy which we discussed in the last issue
Staging workup, to see the extent of disease locally, its spread and the operability
General Investigations, to assess the general fitness of the patient to undertake the treatment
The routine investigations to asses the general fitness of the patient include blood tests for hemoglobin, white cell count, sugar, liver function tests, kidney function tests, proteins and electrolyte(to detect nutritional deficiencies) and blood grouping
X Rays
X-ray chest to see the state of the lungs and any spread to the lungs
X-rays of the limbs, head, spine are done when cancers of the bone are suspected, or in cancers of muscles, to see the involvement of bones
Ultrasound
Ultrasound of the Abdomen -This is a simple OPD procedure, which is cheap, painless, fast and very informative. Besides giving details of the cancers of the abdominal organs (digestive system, kidneys, liver, gall bladder and female organs like uterus, ovary etc) it is helpful in showing the spread to the liver and the nodes.
Ultrasound of the neck is done to see the nodes in the neck and for glands like the thyroid
Ultrasound of the breast and other swellings on the limbs are done too to see if the swelling contains water or is solid
Scopy
Scopy is an investigation where the inside of a hollow organ is seen by an instrument which has fiber optic light. It not only shows the cancer or the disease but also can be used to take a biopsy, stop bleeding, and put stents to bypass blocks and perform other procedures
Usually done without anesthesia
Upper Gastrointestinal Scopy
This is for the stomach and the upper intestines. This is done through the mouth and can also be used to see the pancreatic duct and the bile duct. ERCP(Endoscopic Retrograde Cholangio Pancreatico graphy) is done by this too
Broncoscopy is done through the nose to see the air passage and the lungs
Nasopharyngoscopy is done to see the inside of the nose, through the nose
Laryngoscopy is done to see the Larynx (Voice Box) through the nose
Colonoscopy is done through the rectum to see the large intestines
Doppler
Doppler is done over blood vessels (artery and veins) to see the blood flow in them, and to find the involvement of the vessels or any compression on them by the tumor. This is like the ultrasound and done externally
Computerized Axial Tomography
Commonly called CAT scan or CT scan, this is a very common investigation done to see the extent of the cancer. It gives a very good picture of the cancer, the organs involved, and the local and distant spread. It is however a little expensive and not available in all the hospitals in our country. It is very helpful in cancers of the chest, abdomen and brain and is a great help in deciding the extent of surgery and the treatment for the patient
MRI (Magnetic Resonance Imaging)
Like Tuscan, MRI is a very helpful investigation to see the internal organs, specially the bones, spine, limbs and the head
Radioactive Scans
These are done by injecting radioactive dyes specific for particular organ and subsequently picking up the radio sensitivity by special cameras. They help to see the involvement of various organs and the functioning. Commonly done scans are for bone, liver, kidney and thyroid gland
Tumor Markers
These are tests done on blood. Tumor Markers are substances which are normally not found in the blood or found in very small quantities. The presence or rise of these in the blood is an indicator of cancer. It is very good investigation to see the response to treatment in which situation it will fall to normal and for follow-up of cancer patients, where rise in the levels after treatment indicates relapse. Following are some common tumor markers
CA-125 for cancer of ovary
PSA (Prostates Specific Antigen) for cancer prostate
CEA (Carcinoma Embryonic Antigen) for cancer of large intestines and rectum
AFP (Alpha Fetor Protein) for cancer of testis and liver
BHCG (Beta Human Chronic Gonadotropin) for cancer of testis and ovary
Calcitonin for Medullary carcinoma of thyroid
Thyroglobulin for cancer of thyroid
Col S Kapoor VSM
Adviser, Prof and Head,
Surgery & Surgical Oncology
Command Hospital Lucknow
skapoors@gmail.com