CANCER BIOLOGY ASSIGNMENT

CONVENTIONAL METHODS OF CANCER DIAGNOSIS

SUBMITTED TO: DR. SUDEEP BOSE

SUBMITTED BY:REETU LOHRA
ROLL NO:BSB/13/133
COURSE:BSc(H) BIOTECHNOLOGY
SEMESTER:6

CONVENTIONAL
DIAGNOSIS:

METHODS

OF

CANCER

Breast MRI
Biopsy
Colonoscopy
Pap test
Tumor marker tests

BREAST MRI:
MRI of the breast is not a replacement for mammography or ultrasound
imaging but rather a supplemental tool that has many important uses,
including:

Screening

in

women

at

high

risk

for

breast

cancer

For women at high risk for breast cancer, typically because of a strong
family history, MRI may be an appropriate tool to screen for breast
cancer. A strong family history is usually a mother or sister who has
had breast cancer before age 50. It can also be aunts or cousins,
including those on your fathers side. Relatives who have had ovarian
cancer also increase your risk. Your radiologist or primary care doctor
can look at your family history and determine if screening MRI may be
appropriate for you. Depending on your family history, genetic
counseling

may

also

be

recommended.

Determining the extent of cancer after a new diagnosis of breast

cancer
After being diagnosed with breast cancer, a breast MRI may be
performed to determine:

o how large the cancer is and whether it involves the underlying

muscle.
o if there are other cancers in the same breast and whether there
is an unsuspected cancer in the opposite breast.
o if there are any abnormally large lymph nodes in the armpit,
which can be a sign the cancer has spread to that site.

Further

evaluating

hard-to-assess

abnormalities

seen

on

mammography
Sometimes an abnormality seen on a mammogram cannot be
adequately evaluated by additional mammography and ultrasound
alone. In these rare cases, MRI can be used to definitively determine if
the

abnormality

needs biopsy or

can

safely

be

left

alone.

Evaluating lumpectomy sites in the years following breast cancer

treatment
Scarring and recurrent cancer can look identical on mammography and
ultrasound. If there is a change in a lumpectomy scar by either
mammography or on a physical exam, MRI can help determine
whether the change is normal maturation of the scar or a recurrence of
the

cancer.

Following chemotherapy treatment

in

patients

getting Neoadjuvant

Chemotherapy
In some cases, breast cancer will be treated with chemotherapy before
it

has

been

removed

by

surgery.

This

is

called

neoadjuvant

chemotherapy. In these cases, MRI is often used to monitor how well

the

chemotherapy

is

working

and

to

reevaluate

the

amount

of tumor still

Evaluating

present

before

the

surgery

is

breast

performed.

implants

MRI is the best test for determining whether silicone implants have
ruptured.

How does the procedure work?

Unlike conventional x-ray examinations and computed tomography (CT)
scans, MRI does not utilize on ionizing radiation. Instead, radio waves
redirect alignment of hydrogen atoms that naturally exist within the body
while you are in the scanner without causing any chemical changes in the
tissues. As the hydrogen atoms return to their usual alignment, they emit
energy that varies according to the type of body tissue from which they
come. The MR scanner captures this energy and creates a picture of the
tissues scanned based on this information.
The magnetic field is produced by passing an electric current through wire
coils in most MRI units. Other coils, located in the machine and in some
cases, placed around the part of the body being imaged, send and receive
radio waves, producing signals that are detected by the coils.
A computer then processes the signals and generates a series of images,
each of which shows a thin slice of the body. The images can then be studied
from different angles by the interpreting radiologist.
Frequently, the differentiation of abnormal (diseased) tissue from normal
tissues is better with MRI than with other imaging modalities such as x-ray,
CT and ultrasound.

How is the procedure performed?

MRI examinations may be performed on outpatients or inpatients.
You will be positioned on the moveable examination table. Straps and
bolsters may be used to help you stay still and maintain the correct position
during imaging.
For an MRI of the breast, you will lie face down on a platform specially
designed for the procedure. The platform has openings to accommodate your
breasts and allow them to be imaged without compression. The electronics
needed to capture the MRI image are actually built into the platform. It is
important

to

remain

very

still

throughout

the

exam.

This

is

best

accomplished by making sure you are comfortable and can relax rather than
trying to actively hold still tensing your muscles. Be sure to let the
technologist know if something is uncomfortable, since discomfort increases
the chance that you will feel the need to move during the exam.
If MRI of the breast is being performed for the sole purpose of determining if
you have a ruptured breast implant, you will not be given contrast material.
If the exam is being performed for any other reason, you will need to have a
contrast material injected intravenously. MRI of the breast without contrast
material is inadequate for identifying breast cancers.
If a contrast material will be used in the MRI exam, a physician, nurse
or technologist will insert an intravenous catheter, also known as an IV line,
into a vein in your hand or arm. A saline solution may be used to inject the
contrast material. The solution will drip through the IV to prevent blockage of
the IV catheter until the contrast material is injected.
You will be placed into the magnet of the MRI unit and the radiologist and
technologist will perform the examination while working at a computer
outside of the room.

If a contrast material is used during the examination, it will be injected into

the intravenous line (IV) after an initial series of scans. Additional series of
images will be taken during or following the injection.
When the examination is complete, you may be asked to wait until the
technologist or radiologist checks the images in case additional images are
needed.
Your intravenous line will be removed.
MRI exams generally include multiple runs (sequences), some of which may
last several minutes.
The imaging session lasts between 30 minutes and one hour and the total
examination is usually completed within an hour and a half.

BIOPSY:

For most types of cancer, a biopsy is the main way doctors diagnose cancer.
A biopsy is the removal of a small amount of tissue for examination under a
microscope. Other tests can suggest that cancer is present, but only a biopsy

can

make

definite

diagnosis.

Your doctor may recommend a biopsy if something suspicious is found during

a physical exam or other tests. You may have the biopsy in your doctor's
office. Sometimes, a biopsy may be performed with the help of an imaging
test, such as an ultrasound, CT scan, or MRI (see below). Occasionally,
surgery may be needed to get a tissue sample. The type of biopsy you
receive depends on where the possible tumor is located. An explanation of
the different types of biopsies is below.
Types of biopsies:
The types of biopsies include:

Fine needle aspiration biopsy. For this type of biopsy, the doctor
uses a very thin, hollow needle attached to a syringe. A small amount
of tissue is collected from the suspicious area for examination and
further testing. This biopsy may be used for a mass that can be felt
through the skin or used with image-guided biopsy (see further below).

Core needle biopsy. Similar to a fine needle biopsy, a core needle

biopsy uses a larger needle to remove a larger sample of tissue.

Vacuum-assisted biopsy. This type of biopsy uses suction to

collect a tissue sample through a specially designed needle. This

means the doctor does not have to insert the needle more than one
time. The doctor can collect multiple or larger samples from the same
biopsy site with this method.

Image-guided biopsy. This biopsy may be used when a tumor

cannot be felt by the doctor or when the area is deeper inside the
body, but appears on an imaging scan. During this procedure, a needle
is guided to the location with the help of an imaging technique. An
image-guided biopsy can be done using a fine needle, core, or vacuumassisted biopsy, depending on the amount of tissue needed. The type
of scan used depends on the location and other factors. One of the
following imaging scans may be used.

Ultrasound

Fluoroscopy

Computed Tomography (CT) scan

X-ray

Magnetic Resonance Imaging (MRI) scan

Excisional biopsy. An excisional biopsy is the removal of the entire

suspicious area. This type of biopsy is common for suspicious changes
on the skin. It is also sometimes used for a small lump under the skin
when it is able to be easily removed. However, fine needle aspiration
or a core biopsy are more common for lumps that cannot be seen or
felt through the skin.

Shave biopsy. For this type of biopsy, the doctor uses a sharp tool
to scrape tissue from the surface of the skin.

Punch biopsy. During a punch biopsy, the doctor uses a sharp,

circular tool that is inserted into the skin to take a sample from below
the surface of the skin.

Endoscopic biopsy. An endoscope is a thin, lighted, flexible tube

with a camera. Doctors use endoscopes to view the inside of the body,
including the bladder, abdomen, joints, or gastrointestinal (GI) tract.
Endoscopes are inserted into the body through the mouth or through a
tiny surgical incision. The attached camera helps the doctor see any
abnormal areas. It can also be used to take tiny samples of the tissue
using forceps. The forceps are also a part of the endoscope. Find out
more about the different endoscopic techniques.

Bone marrow aspiration and biopsy. These two procedures are

similar and often done at the same time to examine the bone marrow.
Bone marrow has both a solid and a liquid part. A bone marrow
aspiration removes a sample of the fluid with a needle. A bone marrow
biopsy is the removal of a small amount of solid tissue using a needle.
These procedures are used to find out if a person has a blood disorder
or blood cancer. Blood cancers include leukemia, lymphoma, or
multiple myeloma.
A common site for a bone marrow aspiration and biopsy is the pelvic
bone, which is located in the lower back by the hip. The skin in that
area is usually numbed with medication beforehand. Other types of
anesthesia (medication to block the awareness of pain) may be used.

Depending on the part of your body that will be biopsied, you may lay on
your stomach or back or sit up during the procedure. In addition, for some
types of biopsies, you may need to hold your breath while a biopsy needle is
inserted or remain still. Your health care team will let you know ahead of time
what to expect during the procedure.
Before the procedure, you will receive a type of anesthesia. Anesthesia is
medication to block the awareness of pain. The type of anesthesia used
depends on the type of procedure and where in the body the biopsy is
needed. The following types of anesthesia may be used:

Local, which is an injection that numbs the area where a procedure

is being done. You may feel some slight, stinging pain when a local
anesthetic is injected by needle to numb the area.

Conscious sedation or monitored anesthesia care, which uses

medication to relax you in combination with a local or regional
anesthesia.

General anesthesia, which makes a person unconscious during a

major procedure, such as surgery. If you receive a general anesthetic,
you will not be aware of the procedure.

COLONOSCOPY:
Colonoscopy is a procedure that enables an examiner (usually a
gastroenterologist) to evaluate the inside of the colon (large
intestine or large bowel). Thecolonoscope is a four foot long, flexible
tube about the thickness of a finger with a camera and a source of light
at its tip. The tip of the colonoscope is inserted into the anus and then
is advanced slowly, under visual control, into the rectum and through
the colon usually as far as the cecum, which is the first part of the
colon.
Colonoscopy may be done for a variety of reasons. Most often it is
done to investigate the cause of blood in the stool, abdominal
pain, diarrhea, a change in bowel habit, or an abnormality found on
colonic X-rays or a computerized axial tomography (CT) scan.
Individuals with a previous history of polyps or colon cancer and
certain individuals with a family history of some types of non-colonic
cancers or colonic problems that may be associated with
colon cancer (such asulcerative colitis and colonic polyps) may be
advised to have periodic colonoscopies because their risks are greater
for polyps or colon cancer. How often should one undergo colonoscopy
depends on the degree of the risk and the abnormalities found at
previous colonoscopies. One widely accepted recommendation has

been that even healthy people at normal risk for coloncancer should
undergo colonoscopy at age 50 and every 10 years thereafter, for the
purpose of removing colonic polyps before they become cancerous.

PAP TEST:
The Pap test is done during a pelvic exam. A doctor uses a device
called a speculum to widen the opening of the vagina so that the
cervix and vagina can be examined. A plastic spatula and small brush
are used to collect cells from the cervix. After the cells are taken, they
are placed into a solution. The solution is sent to a lab for testing.

Tumor markers TEST:

High tumor markers levels can be a sign of cancer. Along with other tests,
tumor markers tests can help doctors diagnose cancer and plan treatment.
Tumor markers are most commonly used to do the following:

Guide treatment decisions. Some tumor markers help doctors

decide whether to add chemotherapy or immunotherapy after surgery
and/or radiation therapy. Other tumor markers help doctors choose
which drug(s) or combinations of drugs will work best.

Monitor treatment. Doctors may use changes in tumor markers to

assess how well treatment is working.

Predict the chance of recovery. Tumor markers can help the

doctor predict the cancer's behavior and response to treatment. They
can also predict a persons chance of recovery.

Predict or watch for recurrence. Tumor markers may be used to

predict how likely it is that the cancer will come back after treatment.
Looking for changes in the amount of a tumor marker may be part of
some patients follow-up care plan. It may also help detect a
recurrence sooner than other tests.

Tumor markers may also be used to screen for cancer in people with a high
risk of the disease. In addition, some may be done to learn more about the
cancer when it is first diagnosed. However, the presence or amount of a
tumor marker alone is not enough to diagnose cancer.
Limitations of tumor markers
Tumor markers are not foolproof. Other tests are usually needed to learn
more about a possible cancer or recurrence. Some of the limitations of tumor
markers are listed below.

A condition or disease other than cancer can elevate tumor marker

levels.

Some tumor marker levels may be high in people without cancer.

Tumor marker levels may vary over time, making it hard to get
consistent results.

The level of a tumor marker may not rise until a person's cancer
worsens. This is not helpful for early detection, screening, or watching
for recurrence.

Some cancers do not make tumor markers that are found in the
blood. This includes cancers with no known tumor markers. Also, some
patients do not have higher tumor maker levels even if the type of
cancer they have usually makes tumor markers.

Testing for tumor markers

The doctor will take a sample of blood or urine to test for tumor markers. The
sample is sent it to a laboratory for analysis. Some tests must be repeated
because the levels of tumor markers can change from month to month. This
is serial testing.
As with other laboratory tests, a reliable tumor marker test must be both
specific and sensitive.

Specificity. There is a chance that the testing could result in a false

positive. This is what the tumor marker itself or the test used to detect
or measure it is not specific enough. If the testing is not specific
enough, the results could suggest a tumor is present, or growing
despite treatment. In this case, a healthy person may go through
unnecessary tests and anxiety.

Sensitivity. If the tumor marker or the test is not sensitive enough,

the results may suggest a false negative. This is when testing shows
that a person does not have a tumor when they actually do. Or, tumor
markers levels can suggest cancer treatment is working when it is not.
This means that a person who may benefit from additional testing and
treatment may not receive it if only tumor marker testing is used.