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8. Making a Diagnosis of Cancer

J. story illustrates many aspects of oncology, but the first is that cancer often gets diagnosed after it calls attention to itself either by causing a symptom (pain, bleeding, cough, headache, fatigue - virtually anything)or through an abnormal growth (“a lump”). If these are brought to a doctor’s attention, tests are ordered to investigate the reason for the symptom, and a biopsy (surgical sampling) of any abnormality is performed straightaway.

The material obtained from a biopsy is analyzed by a pathologist (a physician expert at making diagnoses from the appearance of tissue under the microscope), who may make the diagnosis of cancer. Under the microscope, cancer reveals itself as cells growing in a disorganized pattern, in contrast to the organized appearance of normal tissues. In addition to diagnosing the type of cancer, the pathologist will also assign it a “grade,” which relates to how aggressively it appears to be growing and how likely it is to spread. A cancer can be low, intermediate, or high grade, in order of least to most aggressive. A prominent example of how grade influences cure is in prostate cancer, in which each cancer is assigned a Gleason score between 2 and 10. The Gleason system divides prostate cancers into those that are low grade (2–4), intermediate grade (5–6), and high grade (8–10); a score of 7 can be intermediate or high grade depending on details of the pathology report. The higher the Gleason score, the lower the chances for cure after treatment with surgery or radiation.

As indicated in J. case, pathologists play a critical role in diagnosing and interpreting cancer. Because the pathologist’s impression is in part subjective and may be imprecise, it is sometimes necessary to obtain a second pathologic opinion on a biopsy sample to make certain of the diagnosis.

Cancer patients should ask their oncologists if there is any uncertainty in the diagnosis and whether it would be helpful (and worth the expense) to have another pathologist confirm the findings.

One of the most common ways for cancer to be detected today is during a screening test, such as a mammogram or examination of the inside of the colon by colonoscopy. Prostate cancer is screened for with palpation of the prostate gland (called a digital rectal exam) and measurement of the PSA (prostate specific antigen) in the blood; PSA is a protein shed by prostate cancer cells into the bloodstream. Routine screening for some cancers has been proven to save lives and is one reason that cancer death rates are declining. Screening offers the best opportunity to catch a cancer when it is at its earliest and smallest phase of growth.

Unfortunately, there are no effective screening tests as of yet for a number of cancers, and the disease is not often detected during a routine physical examination or blood testing. Most cancers are detected when they cause symptoms that lead a person to seek medical help.

 Current cancer screening guidelines can be found at the American Cancer Society web site: http://www.cancer.org/

 

 

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