This document discusses methods for diagnosing cancer. Cancer is initially suspected based on symptoms and screening tests and is then confirmed through diagnostic tests. The main diagnostic methods discussed are radiological tests like x-rays and CT scans, cytological tests like fine needle aspiration cytology, histological tests like biopsies, frozen section analysis, hematological tests, immunohistochemistry, molecular diagnosis, and tumor markers. These methods provide information about the presence, type, and stage of cancer. Obtaining an accurate diagnosis often requires using multiple diagnostic methods and getting a second opinion from an expert.

1. DIAGNOSIS OF CANCER
INTRODUCTION:- Cancer is suspected based on a person's symptoms, the results of
a physical examination, and sometimes the results of screening tests. Occasionally, x-rays
obtained for other reasons, such as an injury, show abnormalities that might be cancer.
Confirmation that cancer is present requires other tests (termed diagnostic tests).
After cancer is diagnosed, it is staged. Staging is a way of describing how advanced the cancer
has become, including such criteria as how big it is and whether it has spread to neighboring
tissues or more distantly to lymph nodes or other organs.
There are several methods of diagnosing cancer with advantages in technologies that understand
cancer better There are rises of number of diagnostic tools that can help detect. cancers
Diagnosis is usually made by pathologist and oncopathologist. Some type of cancers, particularly
lymph nodes, can be hard to classify even for an expert. Most cancer needs a second opinion
regarding diagnosis before being sure of diagnosis or stage & type.
MAIN METHODS OF CANCER DIAGNOSIS
1. Radiological diagnosis
2. Cytological diagnosis
3. Histological diagnosis
4. Frozen section
5. Heamatogical diagnosis
6. Immunohistochemistry
7. Molecular diagnosis
8. Tumour markers
1.RADIOLOGICAL DIAGNOSIS
These are one of the best early, non-invasive methods of cancer diagnosis.
• X-ray – it is a most common technique. These is used for detection of stomach & small
intestinal growths & cancer.
• Ultrasound- an exam in which the sound waves are bounced off tissue and echoes are
Converted into picture
• CT scan – (computerized tomography) It uses radiographic beams to create detail
Computerized picture. It is more preserise than a standered X-ray .

2.  MRI- (Magnetic resonance imaging) It uses powerful magnetic field to create Detail
computerized images of the body’s Soft tissue, large blood vessels & major organ.
2. CYTOLOGICAL DIAGNOSIS
• 1. Fine needle aspiration cytology (FNAC)
• Fine needle aspiration cytology is a popular method of tumor diagnosis particularly for
palpable tumors
• Lymph nodal tumors
• Breast tumors
• Salivary gland tumors
• Thyroid tumors
FNAC with aspiration
PROCEDURE:
EQUIPMENTS
1. Needles: Routinely 22-23 gauge needle used.
2. Syringes: 5-10 ml syringe
3. Pistol handle
FAILURE TO OBTAIN A REPRESENTATIVE SAMPLE
Needle has missed the target tangentially
Needle in central cystic/necrotic/hemorrhagic area
Devoid of diagnostic cells. Needle in dominant benign mass missing a small
Adjacent malignant lesions. Fibrotic/desmoplastic target tissue giving a scant cell yield.
PITFALLS OF FNAC
 Deviation of needle
 Poor aspiration technique
 Poor smearing technique
 Maintaining negative suction while with drawing the needle.
 Excessive suction
 Forgetting to remove the stilette from the needle
 Obtaining bloody aspirate.
FIXATIVES Fixatives commonly used 95% ethyl alcohol.
STAINS Smear stain by Papanicolaou stain.
ADVANTAGE OF FNAC
 Simple technique , no hospitalization is required
 Wide patient acceptance due to less trauma.
 Rapid diagnosis
 Economical
 Sampling from multiple sites in the same sitting
 High diagnostic accuracy
 Many techniques such as bacterial culture, immunocytochemistry, flow cytometry,
cytogenetics, polymerase chain reaction, etc. are possible from FNAC material.
DISADVANTAGE OF FNAC
A. Loss of tissue architecture
B. Capsular invasion and lymphovascular invasions cannot be detected
C. Difficult to differentiate in situ versus invasive carcinoma

3. D. Considerable training is needed for accurate interpretation. May produces
complications, e.g. Bleeding, infection.
FNAC COMPLICATIONS
FNA is considered one of the safest invasive diagnostic procedures though complications were
estimated at 0.03% of cases.
1)Hematomas
2)Infection
3)Pneumothorax
Contraindication Bleeding
1-Obstructive
2-Emphysema or pulmonary hypertention
3-Pancreatitis
4-Bacteraemia/septicemia
THE PRACTICE OF FNAC Success of FNAC depends on four fundamental requirement:
1. Samples must be representative of the lesion investigated.
2. Samples must be adequate in terms of cells & other tissue components
3. Samples must be correctly smeared and processed
4. FNAC must be accompanied by relevant and correct clinical/radiological information.
3.HISTOLOGICAL DIAGNOSIS :
For histological diagnosis the following methods of sampling is done:
1- Biopsy- biopsy is a surgical removal of small piece of tissue For microscopic
examination for the presence of cancer cell. There are three ways tissues can be removed .
a. Endoscopy- in this process , A thin, flexible tube with a tiny camera on the end is
inserted into the body cavity. This allows the doctor to view the abnormal area.
b. Needle biopsy - the doctor takes a small tissue sample by Inserting a needle into
abnormal area. Different types of needles are used, EX:Vim Silverman needle for
liver biopsy
c. Renal biopsy needle for renal tissue
d. True cut biopsy needle for prostatic Tissue or breast tissue
2- Surgical Biopsy-There are two types of surgical biopsies.
a. An excisional biopsy :it is performed when the doctor removes the entire tumor,
often with some surrounding normal tissue.
b. An incisional biopsy: it is performed when the doctor removes just a portion of
the tumor. If cancer is found to be present, the entire tumor may be removed
immediately or during another operation. The processing of tissue and its
diagnosis takes a two or three days.
4. FROZEN SECTION:-
I. Frozen section is quick diagnosis method. The tissue is quickly frozen at around -
20’ c in frozen section

4. II. cryostant which makes the tissue hard. -tissue is immediately sectioned & stained
-the whole process from receiving, staining to diagnosis can be completed within
10 to 15 days.
5. HAEMATOLOGICAL DIAGNOSIS:-
 Marrow is aspirated by bone marrow aspiration needle biopsied by trephine needle. It is useful in the
diagnosis of Leukemia
 Metastasis from lymphoma or solid tumors.
 This is needed for staging Leukemia
6.IMMUNOHISTOCHEMISTRY
Large number of monoclonal antibodies are available which are useful for
typing of a malignant tumour
Poorly differentiated tumours are difficult to morphologically type but if it shows positivity
for cytokeratin antibody then it can be typed as carcinoma.
T cell or B cell monoclonal antibody positivity in the T cell or B cell lymphoma.
7.MOLECULER DIAGNOSIS
• Molecular diagnosis is an ever emerging field.
• These are useful in detection of Minute translocations Minimal residual disease.
8. TUMOR MARKER
• Some tumors release substance is called tumor markers
• Blood test can be performed to detect the blood Cells as well as for specific tumor markers
• Tumor marker is biochemical indicators of Tumors .
these may be:
 Antigens
 Cytoplasmic proteins
 Enzymes
 Hormones
 Use in support diagnosis