In a previous post, I have discussed the signs and symptoms of cancer (Understanding Cancer Series: Signs and Symptoms of Cancer). Different patients will have different manifestations. They will have different reasons for going to the doctor. What is important is that when the condition has been lingering for two weeks or more, the patient should see a doctor as soon as possible.
How are Diseases Diagnosed?
Once you see your doctor, he will first get a thorough history (ask you to tell the story of the problem that caused you to see him then ask additional questions). Once he is already satisfied with the initial information, he will proceed to perform a physical examination on the patient and often request for laboratory exams.
A patient’s problem may not be immediately obvious to the doctor even after laboratory tests. This is especially true if the problem lies deep inside the body and nothing is obvious on the surface or if the patient’s symptoms are not typical of the underlying disease. The initial tests can sometimes not reveal anything. This does not always mean that there is no problem. The doctor may ask for additional tests or tell you that there is nothing wrong. Just by seeing patients, we can sometimes already tell whether something is terribly wrong or the problem is only minor. So if we see that the patient is quite ok, we can just tell the patient to observe the problem because some problems go away even without treatment such as some types of diarrhea or the common cold.
Getting a Second Opinion
Whenever I tell my patients that there is no intervention necessary, I always tell them when I expect the problem to have completely resolved and that if the problem persists, it means that we need to do further investigation. I also inform them to come back even before scheduled follow up if the problem gets worse or if a new problem arises.
I ask them to let me know whatever happened to the problem, whether good or bad, to make sure that the problem does not blow out of proportion. However, if you are not a hypochondriac (one who interprets minor illness as serious and life-threatening conditions) and you feel that your condition should be looked into some more and it is being ignored, let your doctor know this. If he doesn’t want to listen to you, there is nothing wrong in getting a second opinion.
The initial tests requested by a doctor are often only to screen for problems that he suspects based on the information at hand. Quite often, we need to do additional tests such as ultrasound, CT scan, MRI, endoscopies to give more detailed and more accurate information.
Cancers, except leukemia, are always associated with a mass anywhere in the body, sometimes easily evident but sometimes hidden in the nooks and crannies of the body. Even when we see the mass, we can never definitively tell that it is cancer without performing a BIOPSY. A BIOPSY is a procedure wherein a portion of the mass is removed in order to further evaluate it through the microscope or additional tests. The doctor who does the biopsy is almost always a SURGEON or an INTERVENTIONAL RADIOLOGIST and the doctor who evaluates the specimen is a PATHOLOGIST.
Types of Biopsy
There are different ways of doing a biopsy. I will divide them according to where the tumor is located. Tumors that are located at or near the body surface are easily accessible and don’t need elaborate techniques to perform the procedure. The following are the biopsy procedures employed:
a. Fine needle aspiration biopsy
b. Core needle biopsy
c. Excision biopsy
d. Incision Biopsy
Tumors that are hidden inside the body need special procedures to carry out the biopsy. Again, the objective is to get a piece of the tumor for analysis. The procedures include:
a. CT scan-guided aspiration biopsy
b. Endoscopic-guided biopsy
c. Laparoscopic biopsy
d. Thoracoscopic biopsy