In the previous Mini Med School blog post we covered (1) Anatomy and Physiology and (2) Disease and Pathophysiology of Cancer. Today we will turn to Cancer (3) Diagnosis. In an effort to keep these blog posts concise and readable. I will address (4) Treatment and (5) Outcomes in a separate blog post.
Cancer typically presents itself in one of two ways: (1) Some abnormal symptom causes a person to seek medical care—at a PCP’s office, ER, Ob/Gyn, etc—because something is wrong. It could be a persistent cough (possibly Lung Cancer), weight loss and night sweats (possibly Lymphoma), an abnormal lump or mass (possibly Breast Cancer) or abdominal pain (possibly colon cancer). These are just some examples and not an exhaustive list. (2) A screening test in an asymptomatic person comes back abnormal (e.g. abnormal mammogram, pap smear, colonoscopy, etc.).
Next, that particular physician will typically order some tests as part of the Work Up. Work Up is medical jargon for the series of diagnostic tests that are typically ‘grouped’ together to determine the diagnosis for a symptom or constellation of symptoms. Typically that Work Up involves a CT scan or MRI and/or basic blood tests like a Complete Blood Count with Differential (CBC with Diff). As you can imagine, the vast majority of coughs are not caused by Lung Cancer and the vast majority of abdominal pain is not caused by Colon Cancer. So the Work Up is important to identify those other causes of the symptoms or determine if cancer may truly be the cause.
Note: A diagnosis of Cancer CANNOT be made off of the result of a scan or a simple blood test. The definitive diagnosis of Cancer is made only when a tissue biopsy or blood is taken and sent to a Pathologist for examination. Pathologists are doctors that don’t see any patients—they only see the tissue and blood/fluid of patients and they are experts in determining if the tissue is cancerous or not. The Pathologist does this by examining the tissue under a microscope and often applying special ‘stains’ to the tissue. The slang term in medicine for this process of sending suspicious tissue to a pathologist is ‘Tissue is the Issue.’ In other words, without tissue, the Cancer diagnosis cannot be made.
Typically, After and only After the diagnosis of Cancer is made by a Pathologist will a person then be referred to a Cancer doctor for treatment. Many Cancer doctors will not even accept patients until that biopsy result is back. There are different types of Cancer doctors and we will go over them in the section on Treatment.
One of the first steps the cancer doctor will perform is to Stage the cancer. Staging means to determine the extent of the Cancer’s growth and spread. Staging will often determine the next step in treatment. Different stage Cancers call for different treatments. Staging is typically performed by additional CT scans, MRIs or PET scans. A PET scan involves the use of injecting a radioactive ‘dye’ to help better localize the cancerous tissue.
There are 4 Stages in Cancer:
Stage 1: Cancer that is confined to its original organ. For example, colon cancer that is still only in the colon.
Stage 2: Cancer that has locally extended beyond the original organ, but not much. The ‘not much’ differs by different cancers, but typically is defined as less than about 2 cm.
Stage 3: Cancer that has locally extended beyond the original organ, but more. The ‘more’ also differs by different cancer, but typically is defined as a Large Tumor that has not spread to other distant parts of the body.
Stage 4: Cancer that has metastasized. Metastasis means that cancerous cells have entered the blood stream or lymphatic vessels, traveled throughout the body, landed in a different organ and begun to grow there. For example, Prostate Cancer can metastasize to the spine. Breast Cancer can metastasize to the liver. Lung Cancer can metastasize to the brain.
We will end there for Cancer Diagnosis. Next, we will move on to Treatment and Outcomes. Again, great job as always. You are absorbing this content with great skill. I really appreciate your attention.
To learn how Compass helps its 2 million members across 2,000+ employer clients navigate the complex world of cancer care, visit compassphs.com