Diagnosing cancer is a meticulous process. When it is suspected that a person may have cancer, the first step is to confirm or rule out the diagnosis. And, if confirmed, the origin of the disease, its stage or extent, and the type of cells affected are determined. It is normal for cancer diagnostic tests to be accompanied by anxiety or uncertainty.
First diagnostic cancer tests
It is usually a symptom, or a set of symptoms, that causes a person to visit a doctor in order to diagnosticate its origin. It can be fever, pain, a persistent cough, weight loss, etc. However, having these symptoms does not mean you have cancer.
This first appointment is, by itself, a test: doctor will take your medical history (an interview about symptoms or discomfort): when they started, how they show up, etc. You will likely be asked if you have a family history of certain diseases.
The doctor will also make a physical examination to you. It consists of observing the body area where these discomforts occur: the stomach, the throat, … These tests are non-invasive. This means that they do not involve any additional discomfort. Vision or movement tests can also be performed.
If the doctor is not sure what is behind the symptoms, he or she may order blood and urine tests, which will allow the evaluation of the different components of the blood (white blood cells, red blood cells, platelets, etc.) and the functioning of the liver, kidneys and hormones.
It is essential to remember that the results of some of these tests may be normal in people with cancer, or may be altered in healthy people. All the tests must be combined to reach a conclusion, which is why a doctor’s assessment is key.
Cancer diagnostic tests when cancer is suspected
Let’s say that the results of the first tests make the doctor suspect that you may have an oncological disease. In this case, he may decide to do more studies. Among the tests that we will describe below, only some of them, not all, will be ordered depending on the type of cancer that the doctor thinks you may have.
Tumor markers analysis
If the initial blood test was only basic and not complete, the doctor can order another one to detect tumor markers. Tumor markers are substances that normally exist in the body of any person, even if they are healthy. But they are found in abnormal amounts in the case of cancer. The most common are these:
- CEA (Carcino-Embrionary Antigen): present at high levels in many types of cancer, especially colorectal cancer.
- PSA (Prostate-Specific Antigen): Its moderately high amount may indicate benign prostatic hyperplasia (a mild disease); if its level is very high it is an indicator of prostate cancer.
- AFP (Alpha Fetoprotein).
- CA15-3, CA19.9, CA125, CA27.29 (cancer antigens): present in many kinds of cancer.
- CD19, CD20, CD22, CD25 (clusters of differentiation): present in hemato-oncological diseases: leukemias and lymphomas.
Imaging tests
Imaging tests allow us to see the structure and functioning of internal organs. They can be done both to confirm or rule out the presence of a tumor, and to study it in detail once it has been confirmed.
En ultrasound or sonography uses ultrasound to view an organ in the body (for example, an ovary) through a screen. It is done by passing a device over the skin of the area to be examined. A gel is first applied to your skin to help the scanner glide more easily. It is a painless test.
X-Rays use mild radiation to see inside the body. It lasts a few seconds and does not cause any discomfort. On the X-ray, the hardest parts of the body appear white (which is why bones look very shiny). The doctor can see if there is any area that is whiter than it should be.
CT (Computed Tomography) is a set of X-rays that, when put together, provides a three-dimensional image of the organs and bones. This test is not painful: you just have to lie on a stretcher and stay still. A ring-shaped machine runs around your body, without touching it. You may have to drink a contrast liquid to improve the quality of the images. This liquid is then eliminated in your urine without any discomfort.
In a MRI (Magnetic Resonance Imaging) magnets and radio waves are used to obtain a three-dimensional image of the organs. It is also not a painful test, but it can be more annoying because the machine is a closed tube and makes loud noises. The test does not use radiation, lasts about 35-45 minutes and requires the patient to remain still. Sometimes it is also necessary to ingest – or inject – a contrast agent.
PET (Positron Emission Tomography) helps locate the tumor. All cells in the body consume glucose, but cancer cells do so more quickly: in this test, you are injected with slightly radioactive glucose and it is observed which region of the body absorbs it the fastest. That is where the tumor is. The radioactivity is eliminated slowly and does not pose any danger.
Surely, one of the best-known cancer diagnostic tests is PET-TC scan. PET-CT is the combination of a positron emission tomography and a computed tomography. In other words, a PET and a CT scans performed together.
Colonoscopy helps diagnose colorectal cancer. After sedating the patient so that they don’t feel anything, the large intestine is observed through a camera that is inserted into the anus. The patient must follow a special diet in the previous days to ensure that the colon is clean.
Similar tests are gastroscopy (inserting a tube through the mouth to view the esophagus and stomach) or bronchoscopy, to observe the lungs through a camera that is inserted through the mouth or nose. These tests are also done under sedation to reduce discomfort.
Tests to establish the stage of cancer
Once the presence of a cancer or tumor has been confirmed, it is necessary to establish its stage. Staging a tumor means classifying it according to its size, the degree to which it has invaded surrounding tissues, whether it has affected lymph nodes, and whether it has spread to more distant parts of the body (metastasized). The decision on the treatment to be followed is made, in large part, based on the stage of the disease.
The tests that are performed in this situation are:
- Bone Gammagraphy: It helps to see if there are bone metastases, that is, if cancer that has started anywhere in the body has spread to the bones. The test is not painful, but it requires injecting a radioactive liquid to see how it is distributed. This liquid is later eliminated through the urine.
- Biopsy: A needle with forceps is used to obtain a small sample of tumor cells for analysis in the laboratory. This will help the medical team know what type of cells are affected, information that will be key to establishing treatment. The biopsy can be moderately painful because the needle must reach the tumor and pinch it to obtain a sample.
- Genetic testing: Through tumor samples obtained in the biopsy, or with blood tests, genetic mutations can be searched for that help to understand the origin of the tumor and to decide its most effective treatment. Some of the most studied mutations are those of the HER2, BRCA1 or BRCA2 genes. For example, if a breast cancer is detected to be triple negative, it means that neither hormonal treatment nor that which targets the HER2 protein will be effective.
The feedback interview
The results feedback interview is the visit during which the diagnosis will be explained to you. They will also explain the general lines of treatment.
It may be a good idea to have someone accompanying you: it will reduce your feeling of loneliness and help you understand the information as well as ask the necessary questions.
Many hospitals allow patients to access their own clinical information through apps or websites. This means you can see your diagnostic results before you even speak to your doctor. It’s understandable that you can’t wait to read them, and that you are scared when you do.
Whatever these results are, remember that your doctor can help you understand them realistically. If you go online to check what they mean, always do so on websites by recognized institutions:
- Catalan Institute of Oncology (Catalonia)
- Spaniard Society of Medical Oncology (Spain)
- National Cancer Institute (United States of America)
- American Cancer Society (United States of America)
Emotional management during cancer diagnostic tests
The main challenge during cancer diagnostic tests, in terms of emotional management, are the waiting times. The results of some of the tests may take a few days, during which you may experience anxiety or uncertainty. This is normal.
Your family and friends will probably tell you that there’s no point in worrying until something is confirmed. But to a certain extent, this worry is hard to avoid. It’s a mechanism your mind uses to help you prepare for what might come.
What works best is to maintain your normal life as much as you can, even with anxiety. That is, don’t let fear become a reason to stop you from doing things. Occupying your time is what allows you to keep distracted, at least for a few moments.
If you need specialized psychological care to manage this moment, contact me.
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