When dealing with the possibility of cancer, a fast, accurate diagnosis is of paramount importance. Different cancers require different kinds of treatment. In addition, the earlier treatment is started, the better the chances of survival and recovery. The primary diagnostic options are the incisional biopsy and the fine needle aspiration, or FNA. The latter has some distinct advantages, especially for the patient.
The Process of Diagnosis
In order to determine if a suspicious lump is in fact cancer, a doctor trained in pathology must examine cells from the lump. This microscopic examination allows the doctor to see abnormal cells and – if cancerous – to determine exactly what kind of cancer it is. Tumors respond differently to treatment depending on what type they are and how far the disease has advanced. This is important because all treatments have side effects. While doctors want to ensure the treatment is effective, they don’t want to over-treat. Once the specific kind of cancer has been identified, the doctor will stage the cancer – identify how advanced it has become and whether it has spread.
An incisional biopsy, as you might guess from the name, involves a cut through the skin in order to reach the mass and removed all or part of it for examination. The size and location of the incision depend on the location of the mass to be biopsied. In some cases, the procedure can be performed under a local anesthetic, while in others a general anesthetic is required. This kind of procedure is not usually performed in a doctor’s office, but in an outpatient surgery center or hospital. Most patients must miss at least one day of work. The incision requires stitches and a week or more of healing time. As with all surgeries, there is a risk of bleeding, bruising and damage to adjacent structures. The specimen must then be sent to a lab for microscopic analysis and diagnosis.
Fine Needle Aspiration
The fine needle aspiration method is somewhat different from an incisional biopsy. First, it requires no anesthetic – however, a local anesthetic is usually used for the comfort of the patient. The needle used for this procedure is very small and thin, so tissue trauma, bleeding and bruising are minimal. Second, it is an office-based procedure. The actual procedure takes about 20 minutes. No stitches are required – a band-aid is all the dressing necessary. Down time is minimal and recovery takes only a day or two. Many patients go back to work the same day. If the fine needle aspiration specialist is a cytopathologist, she can examine the tissue on-site, at the patient bedside, and usually is able to make a diagnosis within 24 hours.
Using FNA for Cancer Diagnosis
A skilled FNA doctor can obtain specimens from many areas of the body; however, only a cytopathologist is able to evaluate and diagnose the material obtained from these sites.
Among these are:
The Head and Neck
Cancers of the head and neck commonly begin in the cells that line the mouth, nose and throat (oropharynx). A common head and neck cancer is squamous cell carcinoma (SCC), as those are the cells which line the oropharynx. Many of these areas are readily accessible for biopsy, while others are less so. More common among men and those over age 50, they are linked to tobacco use or occupational exposure to wood dust and chemicals. Recently there is an emergence of HPV related SCC, which are seen in younger, non-smoking patients. FNA biopsy is usually the first way to diagnose these cancers.
The Salivary Glands
Salivary gland cancers are uncommon. Located in the cheek, near the jawbone, floor of the mouth and below the tongue, the salivary glands contain many different kinds of cells, any of which can become cancerous. The most common tumors arise in the parotid glands, located just in front of the ears. Most, but not all tumors of the salivary glands are benign (non-cancerous). A cytopathologist can perform an FNA biopsy on any of these glands.
The incidence of thyroid nodules is increasing in the US and Europe. Thyroid cancer affects more women than men. Although not common in the United States, there are some indications that it may be increasing. Those people with a family history or a history of radiation exposure are at an increased risk of thyroid cancer. Located just under the skin in the neck, the thyroid gland is considered the standard of care and is easily accessed for an FNA biopsy under ultrasound guidance.
Breast cancer is the most common cancer among women in the United States, although it can also occur in men. Genetics, family history, hormone therapy and radiation exposure can all increase the risk of breast cancer. Early age of onset of menses, pregnancy after the age of 30, late menopause or never becoming pregnant are also factors that can increase the chance of developing breast cancer, probably because these all result in longer exposure to female sex hormones. Fine needle aspiration biopsy is a less invasive method of obtaining a breast specimen.
The lymph nodes help remove waste and store white blood cells throughout the body. Although cancers can begin in the lymph nodes, it’s more common for them to spread (metastasize) to these glands from other parts of the body. Confirming the presence or absence of cancer cells in the lymph nodes is important to stage tumors – determine how much they have developed and how far they have spread. In addition, lymph node cancers, lymphoma, can also be diagnosed through a FNA biopsy of the lymph node.
The soft tissues of the body and trunk can develop tumors. One of the more common tumors are lipomas. These are benign fatty tumors that develop under the skin. However, rarely, there are malignant forms, called liposarcomas. In addition, metastatic tumors from the skin can appear in the soft tissue, such as melanoma, which can result from excessive sun exposure. These cancers often appear initially as a mole or thickened area of skin.
As with the trunk, sarcomas can develop in the extremities. In addition, tumors can develop in the bones. Cancer in the extremities can have a genetic component, although there may be other unknown risk factors.
Making a Diagnosis
Early diagnosis is vital, so treatment can begin immediately. While a biopsy is a critical component of this process, other kinds of diagnostic tools are also important. For less accessible areas, the doctor may use imaging technology such as ultrasound or stereoscopy (X-ray) to guide him/her. X-ray, MRI or CT scan can help identify the location of tumors deep in the body. Lab tests are useful to assess certain aspects of tumors. Choosing a highly-qualified Los Angeles biopsy doctor, experienced not only in the technique of fine needle aspiration, but also in the practice of cytopathology and microscopic analysis, will make use of all of these tools to make a more accurate diagnosis.