Tests to diagnose cancer

How Cancer Is Diagnosed

Imaging Tests

Imaging tests create pictures of areas inside your body that help the doctor see whether a tumor is present. These pictures can be made in several ways:

CT Scan

A CT scan uses an x-ray machine linked to a computer to take a series of pictures of your organs from different angles. These pictures are used to create detailed 3-D images of the inside of your body.

Sometimes, you may receive a dye or other contrast material before you have the scan. You might swallow the dye, or it may be given by a needle into a vein. Contrast material helps make the pictures easier to read by highlighting certain areas in the body.

During the CT scan, you will lie still on a table that slides into a donut-shaped scanner. The CT machine moves around you, taking pictures. Learn more about CT scans and how they are used to diagnose cancer.

MRI

An MRI uses a powerful magnet and radio waves to take pictures of your body in slices. These slices are used to create detailed images of the inside of your body, which can show the difference between healthy and unhealthy tissue.

When you have an MRI, you lie still on a table that is pushed into a long, round chamber. The MRI machine makes loud thumping noises and rhythmic beats.

Sometimes, you might have a special dye injected into your vein before or during your MRI exam. This dye, called a contrast agent, can make tumors show up brighter in the pictures.

Nuclear scan

A nuclear scan uses radioactive material to take pictures of the inside of the body. This type of scan may also be called radionuclide scan.

Before this scan, you receive an injection of a small amount of radioactive material, which is sometimes called a tracer. It flows through your bloodstream and collects in certain bones or organs.

During the scan, you lie still on a table while a machine called a scanner detects and measures the radioactivity in your body, creating pictures of bones or organs on a computer screen or on film.

After the scan, the radioactive material in your body will lose its radioactivity over time. It may also leave your body through your urine or stool.

Bone Scan

Bone scans are a type of nuclear scan that check for abnormal areas or damage in the bones. They may be used to diagnose bone cancer or cancer that has spread to the bones (also called metastatic bone tumors).

Before this test, a very small amount of radioactive material is injected into your vein. As it travels through the blood, the material collects in abnormal areas in the bone. Areas where the material collects show up on pictures taken by a special scanner. These areas are called “hot spots.”

PET scan

A PET scan is a type of nuclear scan that makes detailed 3-D pictures of areas inside your body where glucose is taken up. Because cancer cells often take up more glucose than healthy cells, the pictures can be used to find cancer in the body.

Before the scan, you receive an injection of a tracer called radioactive glucose. During the scan, you will lie still on a table that moves back and forth through a scanner.

Ultrasound

An ultrasound exam uses high-energy sound waves that people cannot hear. The sound waves echo off tissues inside your body. A computer uses these echoes to create pictures of areas inside your body. This picture is called a sonogram.

During an ultrasound exam, you will lie on a table while a tech slowly moves a device called a transducer on the skin over the part of the body that is being examined. The transducer is covered with a warm gel that makes it easier to glide over the skin.

X-rays

X-rays use low doses of radiation to create pictures inside your body. An x-ray tech will put you in position and direct the x-ray beam to the correct part of your body. While the images are taken, you will need to stay very still and may need to hold your breath for a second or two.

Getting ready for a biopsy

Preparation for a biopsy depends on the type of biopsy you will have. For example, there is little preparation for a fine needle biopsy performed in a doctor’s office. In some cases, you will need to remove your clothing and wear a gown.

Before your biopsy:

  • Ask your doctor or nurse whether you can eat or drink anything before the biopsy.

  • Also ask if you should take your regular medications that day. For certain biopsies, your doctor will want to know if you are taking blood thinners or aspirin. Tell your doctor about all medications and supplements you are taking.

  • Tell your doctor about any drug allergies or other medical conditions you may have.

  • A member of your health care team will explain the procedure to you.

  • You will be asked to sign a consent form that states you understand the benefits and risks of the biopsy and agree to have the test done.

  • Talk with your doctor about any concerns you have.

During the procedure

Depending on the part of your body the doctor will biopsy, you may lay on your stomach or back or sit up during the procedure. For some types of biopsies, you may need to hold your breath while the needle is inserted or stay still. Your health care team will let you know ahead of time what to expect during the procedure.

Before the procedure, you will usually receive a type of anesthesia to block the awareness of pain. The type of anesthesia the doctor uses depends on the type of procedure and where in the body the biopsy is needed. The following types may be used:

  • Local anesthesia is an injection that numbs the area where a procedure is being done. You may feel some stinging when the doctor injects a local anesthetic by needle.

  • Conscious sedation or monitored anesthesia care uses medication to relax you. It is usually given through an intravenous (IV) tube and is often combined with a local or regional anesthesia.

  • General anesthesia makes you unconscious during a major procedure, such as surgery. If you receive a general anesthetic, you will not be aware of the procedure.

After the procedure

Your recovery period depends on the type of biopsy:

  • The least invasive procedures require no recovery time. You may be able to go back to your normal activities immediately after the procedure.

  • More invasive procedures may require a longer recovery time.

  • If you receive sedation as part of the anesthesia, you will usually need someone to drive you home after the procedure.

After a biopsy, talk with your doctor or nurse about taking care of the biopsy area. Also, be aware of the potential complications from the procedure. Contact your doctor’s office if you experience:

  • Infection

  • Severe pain

  • Fever

  • Bleeding

The amount of time it will take for you to receive the results of the biopsy depends on how many tests are needed on the sample to make a diagnosis. Based on this analysis, a pathologist determines whether the tissue removed contains a tumor and what type it is.

A tumor can be benign or malignant:

  • A benign tumor is not cancerous.

  • A malignant tumor is cancerous and can possibly spread to other parts of the body.

A result can often be given within 2 to 3 days after the biopsy. A result that requires a more complicated analysis can take 7 to 10 days. Ask your doctor how you will receive the biopsy results and who will explain them to you.

Questions to ask your health care team

Before a biopsy, consider asking your doctor the following questions:

  • Why do you recommend I have a biopsy?

  • What are the risks of not having the test?

  • When will I learn the results of the biopsy? How will I receive the information? Who will explain the results to me?

  • What will happen during the biopsy?

  • Who will perform the biopsy?

  • How long will the procedure take?

  • Will I receive local or general anesthesia?

  • Will it be painful?

  • How do I need to prepare for the biopsy? Are there any restrictions on what I may eat or drink the day before?

  • What specific care, if any, is required for the biopsy site after the procedure?

  • Is there a risk of infection, bleeding, or other side effects after the biopsy?

  • Will the biopsy leave a scar on my body?

  • Will the biopsy be performed in the clinic or in the hospital? If in the hospital, will I need to stay in the hospital after the biopsy?

  • Will I need to avoid any activities after the biopsy? If yes, for how long?

  • Will I need to have someone drive me home afterward?

  • Will I need to undergo any additional tests or procedures?

Related Resources

After a Biopsy: Making the Diagnosis

Reading a Pathology Report

The Oncology Team

To Biopsy or Not to Biopsy

by Karalee Whiting

My mother, Karen Sargent, took deep breaths as she tried to calm her nerves while the nurses prepared everything for her guided needle biopsy. With her left breast clamped in an imaging machine, she wasn’t sure what this was going to feel like.

“It was all bigger and more mechanical than what I was expecting,” she said. “I was kind of thinking just a simple needle, you know? As if you were to get an injection. But it was machinery.”

The radiologist gradually positioned the instruments, then came a startling snap as the machine snatched a small sample of tissue from the area in question.

The day before, my mother’s doctor explained that a routine mammogram had revealed a highly suspicious dot of tissue that required a closer look. An appointment for a biopsy, a procedure to look for signs of cancer in the abnormal tissue, had already been scheduled for the next morning. But this gave Karen pause. Biopsies never made logical sense to her – if you poke into a tumor, doesn’t this mean that those cancerous cell can leak out to other parts of the body?

Just a year after my mother successfully finished her cancer treatments, my brother, Jeremiah, was diagnosed with testicular cancer. After visiting his doctor because of some discomfort, he was immediately sent for a blood test and an ultrasound. Before he even got into the ultrasound room, he was told an urologist was waiting to see him.

The urologist confirmed that Jeremiah had malignant testicular cancer. Medical procedures have never phased my brother (in fact, he had elective wisdom tooth surgery while in the U.S. Navy in order to get a few days off duty), but a cancer diagnosis was, as he put it, “highly distressing.” Jeremiah’s doctor warned against a biopsy for reasons that confirmed my mother’s initial wariness about taking cancerous tissue samples: the risk of spreading my brother’s testicular cancer was too great to bother testing the tissue.

“Surgery was scheduled within 24 hours of going to my primary care physician,” said Jeremiah. “In about five hours, I went from thinking I would live my whole life with two balls to learning that I would be losing one.”

So which doctor was right? Are biopsies a perfectly safe procedure, or do they add a significant risk of spreading cancer? Was my mother’s radiologist being too cavalier, or my brother’s urologist being too conservative?

The idea that puncturing a tumor for biopsy could dislodge cancerous cells into the system has been an area of debate among doctors for decades, however physicians are quick to dismiss the risk in most cases. In fact, the National Institute of Health even has this very issue listed on its “Common Cancer Myths and Misconceptions” webpage, explaining that “surgeons use special methods and take many steps to prevent cancer cells from spreading during biopsies or surgery to remove tumors.”

“Most of the patients don’t ask that question, but occasionally I do get asked, ‘Will this spread the cancer cells?’” said Dr. David Euhus, Director of Breast Surgery and Professor of Surgery at Johns Hopkins Hospital. “With breast , I can tell them with certainty that it’s not going to spread the cancer cells and that it’s a lot better to know if you’re dealing with a cancer or not before you plan treatment.”

Researchers have found that in general, it is extremely rare for most cancers to seed, or spread due to mechanical interference, during today’s modern biopsy procedures. The NIH explains that stray cells from tumors usually die if they wander away from the primary tumor and into the bloodstream or lymphatic system. For example, if a couple cancerous breast cells are jostled loose from a lump during a needle biopsy, those cells usually perish right away and never pose a risk to the patient. This is because cancers tend to be rather choosy when it comes to real estate. According to the NIH, cancers prefer to metastasis, or infest other areas of the body, in a fairly predictable pattern. For example, colon cancer, if left to its own devices, usually spreads directly to the liver or lungs. Ovarian cancer customarily invades the liver or abdominal lining. Lung cancer typically likes to hop over to the other lung, or seep into the brain, bones or adrenal system. So, in most cases, if cancer cells are bumped loose into a location they didn’t choose themselves, they’ll simply conk out, harmless and unnoticed.

There is some research that casts doubt onto this rule of thumb, however. In a 2014 study from Dalhousie University in Canada, researchers found that core needle biopsies (which use an intimidatingly thick needle to remove tissue samples) can increase the chances of breast cancer metastases in mice because the procedure reduces the immune response in the tumor area. The study itself was rather small (only 84 mice were included) and what is true for mice is not necessarily true for humans, so the research team recommended further study to “better understand the biologic pathways associated with surgically induced metastases.”

Also in 2014, researchers from Rajarajeswari Dental College and Hospital in India evaluated a collection of case studies regarding cancer cell seeding related to biopsies. Their research found that the risk of spreading cancer depends on a couple factors. First, seeding is more likely in some very specific types of cancers, and second, the risk of seeding depends on the type of biopsy procedure being performed. From these case studies, the researchers collated general best practices for medical professionals during biopsies or surgery, and recommended follow up treatments to kill off any free-range cancer cells that may have evaded excision.

Today, doctors are well versed in the best methods to wrangle cancer by removing a certain amount of healthy tissue surrounding a tumor, called a margin, as well as the area’s associated lymph nodes. This eliminates the areas where seeding would most likely occur. In addition, surgeries to remove tumors are often followed by radiation or chemotherapy to knock out any stray malignant cells that might implant themselves in otherwise healthy tissue. But despite these safety precautions, there are limited situations where biopsies still present too great a risk.

“With the vast majority of cancers, biopsies do not cause any type of seeding or spreading,” said Dr. Jonathan Epstein, Professor of Pathology, Urology and Oncology and Director of Surgical Pathology at Johns Hopkins Hospital. “One of the exceptions happens to be the testes, where these tumors are very friable and if you biopsy some of these tumors, they can seed into the scrotum.”

This means when it comes to testicular tumors, most surgeons opt to swiftly remove the offending gonad without biopsy to mitigate any risk of spreading cancers cells, which explains my brother’s experience.

Despite the minimal risks and ongoing studies about cancer seeding during biopsy, collecting tissue samples has been one of the most useful tools in battling cancer. These samples give medical teams a lot of information that helps tailor treatments to give patients the best chance of recovery.

“You glean from a biopsy the type of tumor it is, whether it is malignant or benign, and how aggressive it is,” said Dr. Epstein. “You can also do special studies sometimes for certain markers… which can help determine therapy and which types of tumors would respond to different types of therapy.”

My mother’s biopsy laid the path for her diagnosis and treatment. The results confirmed that she had ductal carcinoma in situ, a very common and imminently treatable form of non-invasive cancer. Because of her biopsy, she knew surgery was necessary and that radiation therapy would likely follow in order to bring the chances of recurrence to around 15 percent. After my brother’s orchiectomy, pathologists examined his tumor to then inform the next step of his treatment, which consisted of a round of chemotherapy to bring his chances of recurrence down to just 10 percent. It turns out that both doctors recommended the right approach for my family members, and they are both cancer-free now.

Aside from informing immediate treatment options for patients, biopsies also provide life-saving data on the research side.

Dr. Catherine Pickworth, science information officer at Cancer Research UK, said, “Our researchers can look at proteins that are expressed on cancer cells, and they can develop targets against those molecules to develop treatments. And they are also looking at better ways for monitoring cancer patients – there’s a lot of talk about liquid biopsies.”

In the cancer world, liquid biopsies are causing quite a stir. Rather than jabbing a tumor with a needle or cutting a portion off for closer inspection, liquid biopsies may one day identify wandering tumor cells or cancer DNA present in a patient’s blood before their primary cancer has actually spread. Rather than an invasive biopsy procedure, patients would instead have a simple blood draw.

“ not right on the horizon, where it’s going to be useful in the next five years or ten years,” said Dr. Euhus. “I think we got a ways to go. Hopefully the doctor is someone that is evidence-based and been into the literature and knows, factually, whether the biopsy is safe or not.”

There is some method to the madness of cancer metastasis. The most common cancers spread to other areas of a body in a somewhat predictable pattern. This map shows where cancers are most likely to metastasis as the disease progresses.

  • Blood tests. Routine blood tests measure the number of different types of cells in a person’s blood. Levels of certain cells that are too high or too low can indicate the presence of certain types of cancer.

  • Biopsy. 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 except for certain types of brain tumors, only a biopsy can make a definite diagnosis. A biopsy can be guided by imaging tests (such as a CT or MRI scan; see below) to make the procedure accurate and precise. The type of biopsy performed depends on the location of the cancer. The sample removed during the biopsy is analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

  • Bone marrow aspiration and biopsy. These 2 procedures are similar and often done at the same time to examine the bone marrow, the spongy, fatty tissue found inside larger bones. 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.

    A pathologist then studies the samples. A common site for a bone marrow aspiration and biopsy is the pelvic bone, which is located by the hip. Doctors generally give a type of medication called “anesthesia” beforehand to numb the area. Anesthesia is medication that blocks the awareness of pain.

  • Lumbar puncture (spinal tap). A lumbar puncture is a procedure in which a needle is used to take a sample of cerebral spinal fluid (CSF) to look for cancer cells, or tumor markers. Tumor markers are substances found in higher than normal amounts in the blood, urine, or body tissues of people with certain kinds of cancer. CSF is the fluid that flows around the brain and the spinal cord.

    Patients are often given an anesthetic to numb the lower back before the procedure or other medications to calm or relax your child (sedation).

  • Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs.

  • Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer then combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow. When possible, it is best to have this test done in a pediatric specialty center where it can be supervised by pediatric radiologists. These centers are aware of the potential risks of radiation exposure from a CT scan.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

  • Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

  • Scans or radioisotope studies. In these procedures, a material with a small amount of radioactive substance (called a tracer) is injected into the body and then followed with a special camera or x-ray to see where the material goes. These studies can find abnormalities in the liver, brain, bones, kidneys, and other organs.

Many of these tests may be repeated during and after the child’s treatment period to find out how well the treatment is working. In addition, review tips and guidance on how to prepare your child for medical procedures.

After diagnostic tests are done, your child’s doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor categorize or describe the cancer; this is called staging.

Information about the cancer from diagnostic testing will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatments. Use the menu to choose a different section to read in this guide.

How Is Lung Cancer Diagnosed?

How lung cancer is diagnosed differs from person to person. Your medical team chooses tests based on a number of factors:

  • Your medical history
  • Your symptoms
  • Findings from your physical exam

Imaging Tests

Your doctor might order imaging tests that may help find lung cancer. Imaging tests make pictures of the inside of your body. These pictures help doctors to find lung cancer, to see if it has spread, to see if treatment is working or to find a cancer that has come back after treatment. These tests include:

  • Computed tomography (CT) scan
  • Positron emission tomography (PET) scan
  • Bone scan

Procedures

To see if something suspicious is actually lung cancer, the doctor must study tissue or fluid from or around the lung. Many different procedures allow doctors to remove cells from the body and look at them under a microscope to determine if they are cancer. These tests include:

  • Bronchoscopy biopsy
  • Endobronchial ultrasound (EBUS)
  • Endoscopic esophageal ultrasound (EUS)
  • Mediastinoscopy and mediastinotomy
  • Thoracentesis
  • Thoracoscopy or video-assisted thoracoscopic surgery (VATS) biopsy
  • Sputum cytology
  • Fine needle aspiration (FNA) biopsy
  • Open biopsy

Many researchers are working to develop tests that can make a difference in early lung cancer screening and survival.

If you think you are at risk for lung cancer or if you have any symptoms, talk to your doctor about tests to see if you have lung cancer.

Screening for Lung Cancer

Screening is looking for cancer before you have any symptoms, which can help find cancer at an early stage when it may be easier to treat. Screening may provide new hope for early detection and treatment of lung cancer. Learn more about lung cancer screening and take our quiz to see if you are eligible for screening.

Staging means finding out if and how much the lung cancer has spread and helps shape your recommended treatment plan. Staging. This is important because your treatment plan and the general outlook for your recovery depend upon the stage of your lung cancer. Learn more about lung cancer staging.

Tumor Testing

Ask your doctor if your lung cancer tumor should be tested for certain DNA changes. These tests—sometimes referred to as molecular, biomarker or genomic testing—look for changes (mutations) in the tumor’s DNA and evaluate levels of specific proteins present in the tumor. When doctors have this information, they may suggest treatment that targets the mutation in the cells. Learn more about tumor testing.

Diagnostic Tests

We often hear about lymph nodes when we talk about how cancer spreads. That’s because when cancer starts to spread, it often goes to the lymph nodes first.

When treating breast cancer and melanoma, and – increasingly — head and neck cancers and gynecologic cancers, physicians use a diagnostic method called sentinel lymph node biopsy, which looks at a patient’s lymph nodes to determine whether the cancer has spread and what type of cancer treatment is needed. At MD Anderson, our doctors often use sentinel lymph node biopsies because, in many cases, they help better detect cancer. In fact, about 20-30% of “node-negative” patients have disease present in their lymph nodes even though CT scans and/or ultrasound studies suggest that the lymph nodes are negative or do not contain disease.

We spoke with head and neck surgeon Stephen Lai, M.D., Ph.D., to learn more.

What is a sentinel lymph node biopsy?

Sentinel lymph nodes are an important part of the immune system, and they contain the cells that monitor foreign substances, like bacteria, viruses and cancer. Sentinel lymph node mapping helps to identify the lymph nodes that are at highest risk for containing cancer.

A sentinel lymph node biopsy (SLNB) is a surgical approach to identify and remove the sentinel lymph node to determine if the cancer has spread, and if so, how far.

In most cases, a negative sentinel lymph node biopsy means the cancer has not spread. A positive biopsy means cancer was found in the lymph node. It could be in other lymph nodes and even other organs.

What happens during a sentinel lymph node biopsy?

A surgeon injects a marker called a radiotracer around the site of the tumor. The radiotracer flows through the lymphatic system – a path or network of lymph channels and nodes. This allows the surgeon to see what lymph nodes are draining from the tumor first and identify a sentinel lymph node.

Then, the surgeon makes a small incision in the skin and identifies the lymph node for removal. A pathologist studies the lymph node to determine if it contains cancer.

What are the benefits of sentinel lymph node biopsy?

This technique uses a smaller incision and can prevent patients from needing a more invasive surgery. It can shorten postoperative recovery times and lower the risk of side effects like lymphedema, swelling caused by the removal of more lymph nodes.

A sentinel lymph node biopsy is often performed as an outpatient procedure, and patients are typically able to leave the hospital that day, unless they’re having additional surgery.

What are the risks of a sentinel lymph node biopsy?

The risks are very low risk, aside from the very low chance — 2 to 4% — that a sentinel lymph node would not be able to be identified.

Some patients have concerns about the radiotracer used to find the sentinel lymph node. While it is radioactive, the tracer has a very low-energy emission particle. No severe adverse reactions have been reported, and the only negative reaction reported has been rare episodes of brief pain during the injection.

Patients who have a sentinel lymph node biopsy may also experience lymphedema, but they’re less likely to than those who have an open surgery.

Tell me about advances in using sentinel lymph node biopsies to help more cancer patients.

Sentinel lymph node biopsy has been very well established for melanoma and breast cancer treatment. It’s also more commonly used in Europe for early-stage oral cavity cancer, and is being increasingly used in the U.S. I completed a Phase III clinical trial that led to the Food and Drug Administration approval of a new radiotracer for use in patients with oral cavity cancer. Now, I am leading an effort to start a Phase III clinical trial comparing sentinel lymph node biopsy to a more traditional technique called an elective neck dissection for early-stage oral cavity cancer patients. In addition, Michael Frumovitz, M.D., recently completed a Phase III clinical trial using a new type of dye in sentinel lymph node detection in patients with cervical and uterine cancers. These advances help us learn more about the cancer itself, while lessening side effects for patients.

Sentinel lymph node biopsy is personalized surgery. The surgery is tailored to the individual patient to target the lymph nodes most likely to harbor cancer. It helps patients get back to their everyday lives more quickly. It’s all about detecting the cancer effective and accurately in a way that helps the patients maintain their quality of life.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Your doctor may order blood tests for cancer/tumor markers to detect cancer activity in the body. Proteins and circulating tumor cells are two types of markers that can be measured. A cancer tumor often produces a specific protein in the blood that serves as a marker for the cancer. Circulating tumor cells are cells that break off from the cancer and move into the blood stream. Protein markers and circulating tumor cells can be measured with simple blood tests.

Blood marker tests may be done before treatment, to help diagnose the breast cancer and determine whether it’s moved to other parts of the body; during treatment, to assess whether the cancer is responding; and after treatment, to see if the cancer has come back (recurrence).

Examples of markers your doctor may test for include:

  • CA 15.3: used to find breast and ovarian cancers
  • TRU-QUANT and CA 27.29: may mean that breast cancer is present
  • CA125: may signal ovarian cancer, ovarian cancer recurrence, and breast cancer recurrence
  • CEA (carcinoembryonic antigen): a marker for the presence of colon, lung, and liver cancers. This marker may be used to determine if the breast cancer has traveled to other areas of the body.
  • Circulating tumor cells: cells that break off from the cancer and move into the blood stream. High circulating tumor cell counts may indicate that the cancer is growing. The CellSearch test has been approved by the U.S. Food and Drug Administration to monitor circulating tumor cells in women diagnosed with metastatic breast cancer.

Some doctors use marker test results as early indicators of breast cancer progression (the cancer getting worse) or recurrence. They may use this information to make decisions about when to change therapies — if current treatment does not appear to be working — or to start treatment for recurrence. If you have an elevated marker, your doctor may check that marker periodically to assess your response to chemotherapy or other treatments.

While breast cancer blood marker tests are promising, they’re not absolutely conclusive. When a breast cancer blood marker test comes back negative, it doesn’t necessarily mean you’re free and clear of breast cancer. And a positive result doesn’t always mean that the cancer is growing. These tests may help with diagnosis, but using cancer marker tests to find metastatic breast cancer hasn’t helped improve survival yet.

When deciding if you should get tested for breast cancer blood markers, there are some things you may want to consider:

  • cost: the tests can be expensive
  • anxiety: not just from an elevated blood marker, but by all the tests you may need to find out what’s causing the marker to go up

Talk to your doctor about the possible benefits and risks of blood marker testing in your unique situation.

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Last modified on October 24, 2019 at 8:18 AM

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General cancer information

They put a tight band (tourniquet) around your arm above the area where they take the sample. You may need to clench your fist to make it easier to find a vein.

They clean your skin and then put a small needle into your vein. Next, they attach a small bottle or syringe to the needle to draw out some blood. They might fill several small bottles.

Once they have all the samples, they release the band around your arm. They then take the needle out and put pressure on the area with a cotton wool ball or small piece of gauze for a few minutes. This helps to stop bleeding and bruising.

Look away when they’re taking the blood if you prefer. Tell your doctor, nurse or phlebotomist if you feel unwell.

Types of blood tests

Full blood count

A full blood count (FBC) measures the number of red cells, white cells and platelets in your blood.

  • Red cells carry oxygen around our bodies. Haemoglobin is the part of the cell that carries oxygen. If you have a low red cell count, your doctor might say you’re anaemic (pronounced a-nee-mic). This can make you feel tired, short of breath and dizzy.
  • White cells fight infections. There are several different types of white cells, including neutrophils and lymphocytes.
  • Platelets help clot the blood. Symptoms of a low platelet count include abnormal bleeding, such as bleeding gums and nosebleeds.

There isn’t an exact range of normal for blood counts. The range of figures quoted as normal varies slightly between laboratories and also differs between men and women.

Urea and electrolytes

These blood tests show how well your kidneys are working. Waste chemicals called urea and creatinine are produced by the body. Our kidneys remove them from our blood and get rid of them in our urine.

Electrolytes are substances such as sodium, potassium, chloride and bicarbonate.

Liver function tests (LFTs)

Liver function tests (LFTs) check how well your liver is working. LFTs look for levels of enzymes and proteins made by the liver or which are cleared by the liver. They include:

  • alanine aminotransferase (ALT)
  • aspartate aminotransferase (AST)
  • alkaline phosphatase (ALP)
  • gamma-glutamyl transferase (Gamma GT)

They might be raised if you have a blockage in your liver or bile duct, or if you drink a lot of alcohol.

LFTs also look at the amount of bilirubin in the blood. This is a chemical in bile.

Bilirubin can be raised if you have a problem with your liver or gallbladder. Bilirubin can cause yellowing of your skin and eyes (jaundice).

LFTs also measure albumin. This is a protein in the blood that can be low in some types of cancer. You can also have low albumin if you’ve been eating small amounts and are malnourished.

Tumour markers blood test

Tumour markers are substances that might be raised if there is a cancer. They’re usually proteins. They can be found in the blood, urine or body tissues.

Some tumour markers are only produced by one type of cancer. Others can be made by several types. Some markers are found in non cancerous conditions as well as cancer.

Doctors might use tumour markers to help diagnose a cancer. And if you have cancer they can also help to monitor how well your cancer treatment is working or check if the cancer has come back.

Possible risks

Blood sampling (phlebotomy) is a safe test. There is a possibility of:

  • bleeding and bruising – pressing hard when the needle is removed can help to stop it
  • pain – this is normally mild and can last for a few minutes
  • swelling (oedema) – ask your nurse, doctor or phlebotomist to avoid an arm that is swollen or has a risk of swelling
  • feeling faint or fainting – tell the person doing your blood test if you’re feeling lightheaded or dizzy at any time
  • infection – this is very rare

Getting your results

Ask the phlebotomist, doctor or nurse when and how you will get your results. Some results might be available quickly, such as a full blood count. But some other tests might take several weeks.

More information

We have more information on tests, treatment and support if you have been diagnosed with cancer.

Eight cancers could be diagnosed with a single blood test

For many cancers, diagnosis is a long and challenging process. A new blood test, however, could offer a much-needed simpler and more effective diagnostic technique. Called CancerSEEK, it has the potential to identify eight cancer types from one blood sample.

Share on PinterestResearchers have created a blood test that could detect eight cancer types.

In the new study, researchers reveal how the blood test demonstrated high sensitivity and specificity for cancer detection in more than 1,000 people with the disease.

The team — from the Johns Hopkins University School of Medicine in Baltimore, MD — recently published their results in the journal Science.

Worldwide, cancer remains one of the leading causes of death. It is estimated that by 2030, the number of cancer deaths will have risen from 8 million to 13 million.

Early diagnosis is key to reducing cancer-related deaths; the earlier the disease is diagnosed, the higher the chances of treatment success. But sadly, many cancers are not caught until the later stages, and this is largely due to a lack of fast and effective diagnostic tools.

However, the Johns Hopkins researchers believe that CancerSEEK could bring us closer to a quick, simple way to detect cancer in its early stages.

Test produced high sensitivity and specificity

When cancerous tumors form, they release small fragments of mutated DNA and proteins into the bloodstream, and these can act as markers for cancer.

The new blood test works by identifying the markers for 16 gene mutations and eight proteins that are associated with eight different cancer types. These include breast, lung, and colorectal cancer, as well as five cancers — ovarian, liver, stomach, pancreatic, and esophageal — for which there are currently no routine screening tests for people at average risk.

“A novelty of our classification method is that it combines the probability of observing various DNA mutations together with the levels of several proteins in order to make the final call,” explains study co-author Cristian Tomasetti, Ph.D., an associate professor of oncology and biostatistics at Johns Hopkins University.

For their study, the researchers tested CancerSEEK on 1,005 individuals who had been diagnosed with non-metastatic forms of one of the eight cancers.

They found that the test was able to identify 70 percent of the cancers, with sensitivity ranging from 33 percent for breast cancer to 98 percent for ovarian cancer. Sensitivity ranged from 69 percent to 98 percent for the five cancers that currently have no routine screening tests, the researchers report.

In terms of specificity, the test yielded an overall result of more than 99 percent. On testing CancerSEEK on 812 healthy adults, it only produced seven false-positive results.

As study co-author Kenneth Kinzler, Ph.D. — co-director of the Ludwig Center for Cancer Genetics and Therapeutics at Johns Hopkins — notes, “Very high specificity was essential because false-positive results can subject patients to unnecessary invasive follow-up tests and procedures to confirm the presence of cancer.”

What is more, the researchers found that their test was able to pinpoint the location of tumors for 83 percent of patients.

Test could ‘substantially impact patients’

The researchers note that larger studies will now be needed to further determine the efficacy of CancerSEEK as a routine screening test for cancer, and such studies are in the pipeline.

However, the team believes that the results of its current research are encouraging.

“This has the potential to substantially impact patients. Earlier detection provides many ways to improve outcomes for patients,” says study co-author Dr. Anne Marie Lennon, Ph.D., who is an associate professor of medicine, surgery, and radiology at Johns Hopkins.

“Optimally, cancers would be detected early enough that they could be cured by surgery alone, but even cancers that are not curable by surgery alone will respond better to systemic therapies when there is less advanced disease,” she adds.

The team hopes that CancerSEEK will one day offer a simple, noninvasive, and fast strategy for diagnosing cancer in its early stages.

“This test represents the next step in changing the focus of cancer research from late stage disease to early disease, which I believe will be critical to reducing cancer deaths in the long-term.”

Study co-author Dr. Bert Vogelstein, Johns Hopkins University School of Medicine

How do I check for cancer?

Knowing what’s normal for your body means you’re more likely to recognise something different. Spotting cancer at an early stage can save lives.

What should I look for?

There are more than 200 different types of cancer that can cause many different symptoms, and it’s not possible to know all of them. But what you can know is your own body and what’s normal for you.

Some parts of our body we can see and touch – and knowing what they usually look and feel like is a good way of being able to know what’s normal for you. But there’s no need to regularly check yourself at a set time or in a set way.

What about the parts of my body I can’t see or touch?

Changes that happen in parts of our body that we can’t see might be more difficult to spot or describe. But being aware of how you usually feel can help you notice when something’s different – whether it’s a cough that hangs around for a few weeks, spotting blood in your poo, having persistent heartburn or any other change that isn’t normal for you. It’s important not to put a change down to just getting older – get it checked out by your doctor– even if you’re not concerned about it.

What about self-checks?

Lots of people talk about the importance of breast or testicle ‘self-checks’ (also known as self-examinations or self-exams) to try and spot cancer early. But regularly checking your breasts testicles or other parts of your body could actually do more harm than good. Self-checking is different to cancer screening, read more about screening for cancer.

Should I check my breasts?

It’s a good idea from time to time to look at and feel your breasts. But there’s no need to do this regularly at a set time or in a set way. Research has shown that women who regularly self-check their breasts aren’t any less likely to die from breast cancer. But they are almost twice as likely to have a biopsy of a lump that turns out not to be cancer.
So the evidence tells us that regularly checking your breasts doesn’t reduce the risk of dying from breast cancer, but might mean you have unnecessary investigations.

But it’s still a good idea to get to know your body generally (not just your breasts) and keep an eye out for any changes.

Should I check my testicles?

Scientists reviewed the evidence and found no studies of a good enough quality to tell if testicular self-exams are effective. But regular testicular self-exams may cause unnecessary investigations and anxiety if they pick up harmless lumps that are not cancerous. It’s still a good idea to look at and feel your testicles every now and then, but there’s no need to worry about doing it regularly in a set way at a set time.

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