Dr. Nadelman Community Contributor.
February is National Cancer Prevention Month, and a perfect time to learn about prevention, screenings, diagnosis and treatment options. When dealing with the possibility of cancer, a fast, accurate diagnosis is of paramount importance. Different cancers require a variety of treatments and the earlier treatment is started, the better the chances of survival and recovery.
According the National Cancer Institute, throughout 2018, an estimated 1,735,350 new cases of cancer will be diagnosed in the United States and 609,640 people will die from the disease. According to estimated new cases in 2018, the most common cancers are breast cancer, lung and bronchus cancer, prostate cancer, colon and rectum cancer, melanoma of the skin, bladder cancer, non-Hodgkin lymphoma, kidney and renal pelvis cancer, endometrial cancer, leukemia, pancreatic cancer, thyroid cancer, and liver cancer (listed in descending order). Now more than ever it is important to know about proper screening and diagnosis options.
The Process of Diagnosis
For abnormal findings in the head and neck, salivary glands, thyroid, breast, lymph nodes, trunk and extremities, the primary diagnostic options are an incisional biopsy or fine needle aspiration (FNA). 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, identifying how advanced it has become and whether it has spread.
Incisional Biopsy
An incisional biopsy, as you might guess from the name, involves a cut through the skin in order to reach the mass and remove 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 quite 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 also a cytopathologist, he or she can examine the tissue on-site, 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 include the head and neck, salivary glands, thyroid, breast, lymph nodes, the trunk and the extremities.
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 or her. X-ray, MRI or a 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 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 and quicker diagnosis.
Research has shown that more than 40 percent of all cancers diagnosed in the United States can be attributed to preventable causes, according to the American Association for Cancer Research. This February, take time to learn about cancer to see what you can do to reduce your risks, and make informed decisions on screenings, diagnosis and treatment options.
By Dr. Nadelman. Originally published 1/18/2019 on Buzzfeed. 
