ROJoson PEP Talk: Does Biopsy Make Cancer Spread?

1. April 6, 2024
1400H - 1500H
Via Zoom
DOES BIOPSY
MAKE CANCER
SPREAD?
Empowerment
objective - for laypeople
to have an essential
understanding on
WHETHER BIOPSY
MAKE CANCER SPREAD
as part of their health
management.

2. April 6, 2024
1400H - 1500H
Via Zoom
DOES BIOPSY
MAKE CANCER
SPREAD?
Empowerment
objective - for laypeople
to have an essential
understanding on
WHETHER BIOPSY
MAKE CANCER SPREAD
as part of their health
management.
Welcome all!
MUTE yourself but always
show your video picture.
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the Chat Box! Include names
of companions attending.
Use the Chat Box to ask
questions and make
comments while the PEP TALK
is on.
There will be group pictures
at start and end of PEP TALK –
show your face in video.

3. Reminder after the PEP
Talk:
Take the Online Learning
cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.
Link is in Chat Box.

4. Reminder:
25 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.

5. DOES BIOPSY
MAKE CANCER
SPREAD?
Empowerment
objective - for laypeople
to have an essential
understanding on
WHETHER BIOPSY
MAKE CANCER SPREAD
as part of their health
management.
ROJOSON’S REQUEST:
FEEDBACK TO THIS
PEP TALK!
Pls. type in your
feedback in the chat
box during the open
forum and before we
adjourn!
Thank you!

6. DOES BIOPSY
MAKE CANCER
SPREAD?
Empowerment
objective - for laypeople
to have an essential
understanding on
WHETHER BIOPSY
MAKE CANCER SPREAD
as part of their health
management.
LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
START PEP TALK
PROPER IN 2
MINUTES!
Pls. turn on your
video!
Show your face!

7. DOES BIOPSY
MAKE CANCER
SPREAD?
Empowerment
objective - for laypeople
to have an essential
understanding on
WHETHER BIOPSY
MAKE CANCER SPREAD
as part of their health
management.
ROJoson PEP Talk
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.

8. I started the PEP Talk
on May 15, 2021
during the COVID19
Pandemic. There are
3 courses in the PEP
Talk. I completed the
Core Course on
October 9, 2021.

9. From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses.
This may take 3 years or
longer depending on our
enthusiasm, discipline
and perseverance.
We are now on our 3rd
year!

10. DOES BIOPSY
MAKE CANCER
SPREAD?
Empowerment
objective - for laypeople
to have an essential
understanding on
WHETHER BIOPSY
MAKE CANCER SPREAD
as part of their health
management.
My PEP TALK today is
entitled:
DOES BIOPSY
MAKE CANCER
SPREAD?

11. Contents
- What is a biopsy?
- What are the different types of biopsy?
- What are benefits of biopsy?
- Does biopsy make cancer spread?
- What is the origin of the fear of spread of
cancer in biopsy?
- What are ROJoson’s advice on the issue?
- What are ROJoson’s practices related to the
issue?
Disclaimer:
ROJoson PEP Talk
contains ROJoson’s
Thoughts,
Perceptions,
Opinions and
Recommendations
(TPORs) culled from
experiences of
ROJoson and other
professionals.
DOES BIOPSY
MAKE CANCER
SPREAD?

12. What is a biopsy?
DOES BIOPSY
MAKE CANCER
SPREAD?

13. What is a biopsy?
A biopsy is a procedure that usually removes a sample of tissues,
cells and fluid from the body and then this sample is examined by a
medical pathologist usually through a microscope.
The objective of the biopsy is to come out with a more definite
diagnosis of presenting medical disease or condition prior to
instituting definitive treatment. This is usually done after a clinical
diagnosis (based on symptoms and physical exam) and other
laboratory diagnosis (such as CT scan, ultrasound , etc.) in which
there is yet a need to be more certain of the pretreatment
diagnosis.
DOES BIOPSY
MAKE CANCER
SPREAD?

14. What is a biopsy?
A biopsy is a procedure that usually removes a
sample of tissues, cells and fluid from the body
and then this sample is examined by a medical
pathologist usually through a microscope.
The objective of the biopsy is to come out with a
more definite diagnosis of the presenting medical
disease or condition prior to instituting definitive
treatment.
DOES BIOPSY
MAKE CANCER
SPREAD?
Clarification of
phrases in definition:
“Usually removes a
sample”
Usually, a SAMPLE
only NOT the whole
or all tissues, cells
and fluid

15. Gat
What is a biopsy? What are the different types?
A biopsy is a procedure that usually removes a
sample of tissues, cells and fluid from the body
and then this sample is examined by a medical
pathologist usually through a microscope.
The objective of the biopsy is to come out with a
more definite diagnosis of the presenting medical
disease or condition prior to instituting definitive
treatment.
DOES BIOPSY
MAKE CANCER
SPREAD?
Several types of
biopsy of masses:
• Needle aspiration
biopsy (sample)
• Cutting needle
biopsy (sample)
• Incisional biopsy
(sample)
• Punch biopsy
(sample)
• Excisional biopsy
(whole mass)

16. What is a biopsy? What are the different types?
A biopsy is a procedure that usually removes a
sample of tissues, cells and fluid from the body
and then this sample is examined by a medical
pathologist usually through a microscope.
The objective of the biopsy is to come out with a
more definite diagnosis of presenting medical
disease or condition prior to instituting definitive
treatment.
DOES BIOPSY
MAKE CANCER
SPREAD?
• Sample from
tissues of masses /
organs with a
medical condition
• Sample of cells
• Sample of fluid

17. What is a biopsy?
A biopsy is a
procedure that
usually removes a
sample of tissues,
cells and fluid from
the body ……
DOES BIOPSY
MAKE CANCER
SPREAD?
• Sample from organs with a medical condition
- kidney biopsy

18. What is a biopsy?
A biopsy is a
procedure that
usually removes a
sample of tissues,
cells and fluid from
the body ……
DOES BIOPSY
MAKE CANCER
SPREAD?
• Sample of cells – needle aspiration biopsy –
cells obtained
https://www.quora.com/W
hat-is-Fine-needle-aspiration

19. What is a biopsy?
A biopsy is a
procedure that
usually removes a
sample of tissues,
cells and fluid from
the body ……
DOES BIOPSY
MAKE CANCER
SPREAD?
• Sample of cells – needle aspiration biopsy –
cells obtained

20. What is a biopsy?
A biopsy is a
procedure that
usually removes a
sample of tissues,
cells and fluid from
the body ……
DOES BIOPSY
MAKE CANCER
SPREAD?
• Sample from tissues of masses - punch biopsy
– tissues obtained

21. What is a biopsy?
A biopsy is a
procedure that
usually removes a
sample of tissues,
cells and fluid from
the body ……
DOES BIOPSY
MAKE CANCER
SPREAD?
• Sample from tissues of masses - punch biopsy
– tissues obtained

22. What is a biopsy?
A biopsy is a
procedure that
usually removes a
sample of tissues,
cells and fluid from
the body ……
DOES BIOPSY
MAKE CANCER
SPREAD?
• Sample from tissues of masses - cutting / core
needle biopsy – tissues obtained
https://www.orthobullets.com/pathol
ogy/8082/biopsy-principles

23. What is a biopsy?
A biopsy is a
procedure that
usually removes a
sample of tissues,
cells and fluid from
the body ……
DOES BIOPSY
MAKE CANCER
SPREAD?
• Sample from tissues of masses - needle
aspiration vs core needle biopsy

24. What is a biopsy?
A biopsy is a
procedure that
usually removes a
sample of tissues,
cells and fluid from
the body ……
DOES BIOPSY
MAKE CANCER
SPREAD?
• Sample from tissues of masses – incisional
biopsy – excisional biopsy – tissues obtained
https://quizlet.com/gb/835794
596/biopsy-techniques-flash-
cards/

25. What is a biopsy?
A biopsy is a
procedure that
usually removes a
sample of tissues,
cells and fluid from
the body ……
DOES BIOPSY
MAKE CANCER
SPREAD?
• Sample from tissues of masses – incisional
biopsy – excisional biopsy – tissues obtained

26. DOES BIOPSY
MAKE CANCER
SPREAD?
• Sample of fluid (biopsy) – fluid in the chest

27. DOES BIOPSY
MAKE CANCER
SPREAD?
• Sample of fluid (biopsy) – fluid in the
abdomen

28. What is a biopsy?
A biopsy can be done on organs and tissues with
or without masses.
In those without masses, it is done to determine
the non-tumor disease present.
In those with masses, it is done to determine if
cancer is present or not.
DOES BIOPSY
MAKE CANCER
SPREAD?
In this PEP Talk, we
will focus on biopsy
for masses and
answer the question:
does biopsy make
cancer spread, if the
mass being biopsied
turns out to be
cancer?

29. Before discussing the issue,
let’s look at the benefits of biopsy first.
DOES BIOPSY
MAKE CANCER
SPREAD?

30. psy
What are benefits of biopsy?
DOES BIOPSY
MAKE CANCER
SPREAD?

31. What are benefits of biopsy?
Benefits:
To know exactly what kind of a mass is there. Is it
cancerous or not? If cancer, what is the specific
type?
A biopsy may be resorted to if clinical
examination (based on symptoms and physical
examination) and other laboratory examinations
cannot give a definite diagnosis.
The biopsy result will guide the treatment plans.
DOES BIOPSY
MAKE CANCER
SPREAD?

32. Does biopsy make cancer spread?
DOES BIOPSY
MAKE CANCER
SPREAD?

33. For a long time and up to now,
there have been rumblings about the possible
dangers of cancer spread when having biopsies,
for example, in breast cancer or prostate cancer.
People afraid of having a biopsy of a tumor which
can be cancer because of fear of spread of cancer.
Is this
A myth or a fact? A reality? Rare or often?
DOES BIOPSY
MAKE CANCER
SPREAD?

34. The fear issues are two-fold:
• CANCER SEEDING
• CANCER SPREAD
with biopsy
DOES BIOPSY
MAKE CANCER
SPREAD?

35. SEEDING OF CANCER in Biopsy
Cancer seeding or needle seeding (in needle
biopsy of cancer tumor) refers to occurrences
when the needle inserted into a tumor during a
biopsy dislodges and spreads cancer cells. It is
sometimes called needle track or tract seeding
because the cancer cells grow along the needle’s
track.
DOES BIOPSY
MAKE CANCER
SPREAD?

36. SEEDING OF CANCER in Biopsy
Aside from needle biopsy, the other
situation where there is a potential cancer
seeding or contamination is in patient
undergoing incision biopsy as one cuts
through cancer tissues to get a sample.
Cancer cells may spill over (seed or
contaminate) to the adjacent normal
tissues and instruments used to close the
skin overlying the cancer where incision
biopsy was done may also cause seeding
and contamination.
DOES BIOPSY
MAKE CANCER
SPREAD?

37. SEEDING OF CANCER in Biopsy
It is TRUE that biopsies, such as those using
needle inserted through the skin and the incision
biopsy that needs prior skin opening to reach a
cancer tumor, can cause seeding or
contamination of cancer cells in the needle track
and on the skin incision.
The question is how frequent does this seeding or
contamination cause ill-consequences
(particularly LOCAL RECURRENCES)?
DOES BIOPSY
MAKE CANCER
SPREAD?

38. SEEDING OF CANCER in Biopsy
What does the research say about biopsies
causing and spreading cancer?
Several studies and reports confirm that tumor
seeding and contamination with needle and
incisional biopsies can occur but rarely do they
cause ill-consequences such as local recurrence
and spread to distant sites.
DOES BIOPSY
MAKE CANCER
SPREAD?

39. SEEDING OF CANCER in Biopsy
What does the research say about biopsies
seeding and spreading cancer?
A 2008 review in the journal Gut showed that
needle track seeding occurred in 2.7% of liver
cancer biopsies.
In a 2015 BJU report, researchers found that the
incidence of needle track seeding was low (less
than 1%) in prostate biopsies.
DOES BIOPSY
MAKE CANCER
SPREAD?
https://www.cancer.net/blog/2021-03/can-biopsy-make-
my-cancer-spread

40. SEEDING OF CANCER in Biopsy
What does the research say about biopsies
spreading cancer?
In a 2013 study in Endoscopy, researchers found
no difference in cancer recurrence in 256 patients
with pancreatic cancer who did and did not
receive biopsies.
In a later 2015 study in Gut, the same researchers
found that biopsies were not associated with an
increased risk of dying in a database of 2,034
Medicare patients with pancreatic cancer.
DOES BIOPSY
MAKE CANCER
SPREAD?
https://www.cancer.net/blog/2021-03/can-biopsy-make-
my-cancer-spread

41. SEEDING OF CANCER in Biopsy
What does the research say about biopsies
spreading cancer?
In a 2019 study in Urology, researchers found that
the core needle biopsy technique was safe and
effective in 42 patients with bladder cancer and
that seeding did not occur after 28 months of
follow-up.
CONCLUSION: Overall, while it is NOT impossible
for needle seeding and contamination in
incisional biopsy to occur, it is RARE.
DOES BIOPSY
MAKE CANCER
SPREAD?
https://www.cancer.net/blog/2021-03/can-
biopsy-make-my-cancer-spread

42. SPREAD OF CANCER in Biopsy
A common patient concern is that biopsies may
cause microscopic cells from cancers to
metastasize (or SPREAD) to other parts of the
body.
In other words, the concern is: do biopsies cause
SPREAD OF CANCER to distant organs or tissues
such as breast cancer to bones and prostate
cancer to lungs and eventually cause death?
There are reports on this phenomenon. Again,
the incidence is said to be RARE.
DOES BIOPSY
MAKE CANCER
SPREAD?

43. SPREAD OF CANCER in Biopsy
In the Jan. 9, 2015 online issue of Gut, pancreatic cancer patients
who received a biopsy had a better outcome and longer survival
than patients who did not have a biopsy.
In a 2013 study published in Endoscopy, the researchers
examined outcomes in 256 pancreatic cancer patients treated at
Mayo Clinic in Jacksonville, Florida. They found no difference in
cancer recurrence between 208 patients who had ultrasound-
guided fine needle aspiration (EUS-FNA) and the 48 patients who
did not have a biopsy.
DOES BIOPSY
MAKE CANCER
SPREAD?
https://newsnetwork.mayoclinic.org/discussion/mayo-
researchers-find-cancer-biopsies-do-not-promote-cancer-
spread/

44. SPREAD OF CANCER in Biopsy
There are reports showing concerns of spread of cancer caused
by biopsy.
Examples:
For fear of spread, a needle biopsy usually isn't used in
diagnosing testicular cancer. Instead, if a surgeon suspects
testicular cancer, the testicle is removed.
Same reasons (fear of spread) are being given by specialists in
biopsying ovarian cancers, thymus tumors, and soft tissue
sarcomas.
DOES BIOPSY
MAKE CANCER
SPREAD?

45. SPREAD OF CANCER in Biopsy
The National Cancer Institute has also addressed this concern in
a statement on Common Cancer Myths and Misconceptions.
It also admits that there are cases but EXTREMELY LOW.
“The chance that surgery will cause cancer to spread to other
parts of the body is EXTREMELY LOW. Following standard
procedures, surgeons use special methods and take many steps
to prevent cancer cells from spreading during biopsies or surgery
to remove tumors. For example, if they must remove tissue from
more than one area of the body, they use different surgical tools
for each area.”
DOES BIOPSY
MAKE CANCER
SPREAD?
https://www.cancer.gov/about-cancer/causes-prevention/risk/myths

46. SEEDING and SPREAD of CANCER in Biopsy
Overall, based on the findings,
the likelihood of tumor recurrence and spread as consequences
of a biopsy procedure appears very low.
Nevertheless, VIGILANCE for this potential complication is still
advised.
Anxious patients, who may inquire about this potential
complication, can be reassured that, although it does occur, the
clinical effect appears negligible and biopsy as a cause of disease
recurrence and spread appears very rare.
DOES BIOPSY
MAKE CANCER
SPREAD?

47. What is the origin of the fear of spread of cancer
in biopsy?
DOES BIOPSY
MAKE CANCER
SPREAD?

48. What is the origin of the fear of spread of cancer
in biopsy?
“A few months or years after a biopsy procedure,
the patient dies of the disseminated cancer.”
The reality is that at the very start or at the time
of the biopsy procedure, the cancer is already
disseminated or far advanced, leading to early
death. Relatives cannot accept this reality and
relate, associate, and blame the death to the
biopsy procedure.
DOES BIOPSY
MAKE CANCER
SPREAD?
However, as
mentioned above,
there are reported
cases in which biopsy
procedure causes
spread to distant
organs, disseminated
diseases and cause
death. BUT these
are RARE.

49. What are ROJoson’s advice on the issue?
DOES BIOPSY
MAKE CANCER
SPREAD?

50. ROJoson’s Advice on SEEDING and SPREAD of CANCER
in Biopsy
• Take note of the POSSIBILITY but also take note of
RARITY.
• Weigh and balance the benefits and risks of biopsy
and then decide.
• Ask the physician for advice on the indication and
benefit-risk weighing of biopsy.
• Consider other options aside from biopsy or other
types of biopsy in getting to a more definitive
diagnosis prior to the definitive treatment.
DOES BIOPSY
MAKE CANCER
SPREAD?

51. ROJoson’s Advice on SEEDING and SPREAD of
CANCER in Biopsy
Take note of the usefulness of benefit of biopsy
in cancer treatment. It can prove the existence
of cancer and help plan treatment.
Under certain circumstances, however take note
that treatment can be instituted even without
biopsy confirmation of cancer.
DOES BIOPSY
MAKE CANCER
SPREAD?

52. Situations in which biopsy may be skipped
• Physicians quite certain of cancer diagnosis based on clinical
examination and imaging studies and other tests that biopsy may
not have to be done
• Deeply located tumors which may be extremely difficult to biopsy
• Tumors with track record of high chance of seeding and spread
such as ovarian cancers and thymus tumors
• When biopsy will not alter treatment – an excision or wide
excision has to be done regardless of whether cancer or not
• Tumor-associated emergencies – no time to do biopsy, such as
acute intestinal obstruction secondary to a tumor
DOES BIOPSY
MAKE CANCER
SPREAD?

53. What are ROJoson’s practices related to the
issue?
DOES BIOPSY
MAKE CANCER
SPREAD?

54. ROJoson’s Practices on Biopsy
ROJoson does biopsy only when strongly
indicated and after considering other options for
a more definite diagnosis and also after weighing
the benefits and risks of biopsy.
Indications for biopsy:
Need to come out with a more definite diagnosis
of the presenting medical disease or condition
prior to instituting definitive treatment.
Need to be more definite in diagnosis after
clinical exam and other diagnostic tests
DOES BIOPSY
MAKE CANCER
SPREAD?
ROJoson chooses a
biopsy options that
will avoid the risks of
seeding and
spreading as much
as possible.
Example: doing
excision biopsy
without cutting
through the cancer
tumor and with a
good margin.

55. Situations in which biopsy may be skipped
• Physicians quite certain of cancer diagnosis based on clinical
examination and imaging studies and other tests that biopsy may
not have to be done
• Deeply located tumors which may be extremely difficult to biopsy
• Tumors with track record of high chance of seeding and spread
such as ovarian cancers and thymus tumors
• When biopsy will not alter treatment – an excision or wide
excision has to be done regardless of whether cancer or not
• Tumor-associated emergencies – no time to do biopsy, such as
acute intestinal obstruction secondary to a tumor
DOES BIOPSY
MAKE CANCER
SPREAD?
ROJ follow these guidelines:

56. Contents
- What is a biopsy?
- What are the different types of biopsy?
- What are benefits of biopsy?
- Does biopsy make cancer spread?
- What is the origin of the fear of spread of
cancer in biopsy?
- What are ROJoson’s advice on the issue?
- What are ROJoson’s practices related to the
issue?
DOES BIOPSY
MAKE CANCER
SPREAD?
Summary
Take Away

57. Take Away in
relation to
Patient
Empowerment
Be always in touch with reliable medical
information on WHETHER BIOPSY MAKE CANCER
SPREAD?
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan to gain greater control over
decisions / make better decisions on
WHETHER BIOPSY MAKE CANCER SPREAD
as part of your health management.
DOES BIOPSY
MAKE CANCER
SPREAD?

58. DOES BIOPSY
MAKE CANCER
SPREAD?
Empowerment
objective - for laypeople
to have an essential
understanding on
WHETHER BIOPSY
MAKE CANCER SPREAD
as part of their health
management.
This ends my PEP
TALK today on:
DOES BIOPSY MAKE
CANCER SPREAD?

59. Reminder after the PEP
Talk:
Take the Online Learning
cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.
Link is in Chat Box.

60. Reminder:
25 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.

61. DOES BIOPSY
MAKE CANCER
SPREAD?
Empowerment
objective - for laypeople
to have an essential
understanding on
WHETHER BIOPSY
MAKE CANCER SPREAD
as part of their health
management.
ROJOSON’S REQUEST:
FEEDBACK TO THIS
PEP TALK!
Pls. type in your
feedback in the chat
box during the open
forum and before we
adjourn!
Thank you!

62. DOES BIOPSY
MAKE CANCER
SPREAD?
Empowerment
objective - for laypeople
to have an essential
understanding on
WHETHER BIOPSY
MAKE CANCER SPREAD
as part of their health
management.
LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
START Q&A AND
INTERACTIONS!
Pls. turn on your
video!
Show your face!