Cancer: Classification, diagnosis, and symptoms

As a general rule, the earlier doctors can confirm a diagnosis in a person with cancer, the more likely it is that treatment will have powerful effects.

In this article, we examine the process for diagnosing cancer and the symptoms that can indicate when to see a doctor.

Diagnosis

Doctors will often use a combination of tests to determine whether a person has cancer. These tests indicate the presence of cancerous cells in the body and the extent to which these cells have spread.

Some of these tests include:

Biopsy: This involves taking a sample of tissue from a potentially cancerous lesion and sending it to a laboratory. A pathologist who specializes in diagnostic techniques will then examine the cells for signs of cancer.

A biopsy sometimes involves using a needle to remove cells, but a doctor might use a surgical procedure in instances where a larger area requires examination.

Imaging scans: These help a doctor identify cancerous lesions in the body. Examples of imaging studies include a CT, ultrasound, or MRI scan. Imaging machines have different methods of creating images and may be more sensitive to certain types of cancer, such as cancers of the soft tissue or bones.

A doctor may order more than one imaging scan for this reason.

Laboratory testing: Cancerous cells release compounds into the blood. A doctor may take samples of blood, urine, sputum, or other body fluids to check for these compounds. Lab tests are rarely a primary method for diagnosing cancer. However, they can be important for ruling out other conditions and confirming a diagnosis.

A doctor will usually work with a team of specialists to diagnose cancer, including a radiologist and pathologist.

Cancer symptoms usually create changes in the body that do not relate to a specific or identifiable cause. A person might incorrectly dismiss these as age-related changes when they indicate an early symptom of cancer.

Examples include:

• blood in the urine or stool
• changes to skin texture on the surface of a breast, nipple size, or breast shape
• vocal changes, such as hoarseness
• a persistent cough that does not respond to soothing measures
• difficulties in chewing and eating
• excessive tiredness and weakness
• profuse sweating during sleep
• urination problems, such as incontinence
• skin changes, such as a new mole or skin injury that does not heal
• stomach pain
• unexplained weight loss or gain

While cancer can cause pain, it is not usually an early symptom of cancer.

Seek a medical opinion if experiencing any of these symptoms without knowing the cause.

An example of a tumor staging using this system could be T1N0MX. This means the primary tumor is identified, there is no cancer in the lymph nodes, and the doctor cannot measure the spread, or metastasis, of the cancer.

The TNM system can be very detailed. Another staging method a doctor might use for some cancers ranges from 0 to IV.

These stages mean:

• Stage 0: The doctor has found cancer cells or abnormal cells, but they have not spread to nearby tissue. Another name for stage 0 cancer is carcinoma in situ.
• Stages I, II, and III: A higher the number suggests a larger tumor or a wider spread to nearby tissues or lymph nodes.
• Stage IV: The cancer has spread to distant parts of the body. This is the most serious stage of cancer.

Additional staging systems exist, and a doctor may use them based on conventions in the location of their practice and the type of cancer.

Staging is an important part of defining the outlook for a person with cancer but does not provide the full picture of how likely that person is to survive.

A doctor will also consider other factors, including:

• a person’s overall health
• the type of cancer
• how long ago a person received the diagnosis

When a doctor discusses the outlook with the person who has cancer, they might explain survival rates in various terms. Examples of these terms may include:

• Overall survival: This number refers to the percentage of people with a specific cancer type that survived for a certain period after their diagnosis.
• Disease-free survival: The percentage of people in a study or treatment group who have not died from a specific cancer over a certain period.
• Relative survival: This measurement compares the survival of cancer patients with the survival of people of the same sex and age who did not have cancer over a certain period of time.

None of these are absolutes. Some people survive longer than their predicted outlook, while others do not.

Takeaway

Diagnosing cancer in the early stages is vital for improving the chances of survival.

A doctor might use a biopsy, imaging scan, or blood test to confirm cancer. If cancer is present, they will then decide on the categorization and stage of it to determine how severe it is and shape the course of treatment.

Receiving a cancer diagnosis can be devastating. Taking the time to talk with a doctor and fully understand treatment options and prognosis can help a person move forward and make decisions about treatment.

Never ignore potential cancer symptoms. A person should talk with their doctor if they have observed any worrisome symptoms that are unexplained or persistent.

Q:

I have just received a diagnosis of cancer with a very poor outlook. What next?

A:

Receiving a diagnosis of advanced cancer may be overwhelming and distressing. It’s important to talk with your doctor in detail about your specific diagnosis and treatment options to fully understand your prognosis.

You can also get a second opinion to help you decide how to move forward with treatment or palliative care. It’s important to reach out for support from family and friends, and it may help to bring someone to support you at doctor visits.

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