Tests for Cancer

TESTS FOR CANCER

The ultimate test, indeed, the only test for cancer is to take a sample of the offending tissue and look at it under the microscope. Cancer is a pathological diagnosis – it always has to be suspected in every differential diagnosis. However, the appearance of many is so typical that this does not invariably have to be done.

The joy of the environmental approach to diagnosis is that every symptom has to have an explanation. If a symptom cannot be explained as a result of an allergy, deficiency, toxicity or whatever, then you keep looking.

Common things are common. The commonest cancers and the symptoms with which they usually present are:

Lung cancer
Usually a smoker, and common symptoms are pain, coughing blood and failure to clear chest infections efficiently. Early lung cancer can be diagnosed by bronchoscopy. However, this investigation is no fun at all, and if I had the money I would go for an MRI scan! Later on, when it is big enough, a cancer can be seen on a chest X ray. But by the time it is visible on chest X ray, it is usually too late to do anything about it.

Breast cancer
This usually presents with a painless lump, but breast cancer can certainly present with breast pain, nipple discharge, dimpling of the overlying skin, lump in the armpit etc. Breast screening with mammography will pick up tumours earlier, but inevitably the breast is irradiated. In the future, I believe MRI scanning will take over but this is too expensive at present. Cancer antigen CA 15-3 can be used to monitor response to treatment but is not recommended (I’m not quite sure why) for diagnosis. It may also be raised in other tumours.

Bowel cancer (oesophagus, stomach, colon)
Change of bowel habit, any unremitting progressive gut symptom such as pain, indigestion, bloating, discomfort. Can be screened for by doing faecal occult blood but this test is not perfect.

The diagnosis is usually made by endoscopy, either a flexible pipe up the bum (colonoscopy), or a swallowed pipe (gastroscopy). If you have this investigation you may want to insist on being "knocked out", it is no fun at all.
Colonoscopy picks up colon cancers, gastroscopy stomach and swallowing tube (oesophageal) cancers. Funnily enough, cancers between the two (duodenum and small intestine) are very rare.
MRI scans are not good for bowel cancers because the bowel may not stay still for long enough to see what is going on!
Cancer antigen CA 15-3 can be used to monitor response to treatment but is not recommended for diagnosis.
Carcinoembryonic antigen (CEA) can also be used to monitor response to treatment, it is relatively insensitive when used for early detection.

Prostate cancer Usually presents with a change in the male’s usual peeing habit. The prostate sits at the base of the bladder and presses on the peeing tube (urethra). Symptoms reflect this such as increased desire to pee, peeing more often, difficulty starting to pee, poor flow, poor cut off and dribbling at the end of peeing. The question is, is this benign prostatic growth or malignant?
The only safe answer is to biopsy the prostate gland. Another ouch! A blood test, namely a PSA (prostate specific antigen), is often raised in prostate cancer but a negative blood test does not mean for certain that you do not have prostate cancer. A finger up the bum (this is the doctor’s, not a do it yourself, job!) may feel a hard nodule but equally can miss anterior tumours. Usually it is one or a combination of symptoms and signs which prompts a biopsy and the diagnosis.

Cervical cancer
This disease has increased 2,000% since the advent of the Pill and promiscuity. Risk factors include the Pill, especially when young, multiple sexual partners, sexually transmitted disease especially herpes, unprotected sex (sperm may be carcinogenic), smoking, etc. Nowadays with cervical screening programmes cancer is usually picked up early. Early symptoms might include vaginal discharge and bleeding.

Ovarian cancer
This is another difficult diagnosis since the ovaries are buried deep in the abdomen and cause little problem until the tumour is well grown. Women at risk (bad family history) often undergo ultrasound screening. Ovarian cancers can sometimes be picked up by doing a carcinogenic embryonic antigen.

Uterine (womb) cancer
This usually presents with unusual vaginal bleeding: either bleeding between periods; or bleeding after the menopause. In either of these cases if there is no easily identifiable cause, biopsy (D and C) is essential.

Bladder and kidney cancer
Often presents with blood in the urine. May cause pain, desire to pee, peeing more often etc. A multistix test may pick up blood, protein, cells. To diagnose one needs to do an IVP (special X ray) and/or cystoscopy (look inside the bladder).

Pancreatic cancer
Another difficult diagnosis. Often presents with vague abdominal symptoms. A stool elastase test may well be positive. Cancer antigen CA 19-9 (pancreas gut cancer antigen) is often raised in pancreatic cancer as well as gastrointestinal and liver/gall bladder cancers.

Testicular cancer
There is no excuse other than embarrassment for this being picked up late. The testicles are the one organ in which every aspect can be completely felt! Any lump should be reported at once. Blood tests may show raised alpha fetoprotein and/or raised placental alkaline phosphase.

Cancers of the mouth and throat
These are nearly all smoking related. Persistent hoarse voice or voice change should always be taken seriously.

Leukaemia
This can be picked up by blood testing. Ask for haematology.

Lymphoma
This can present with a lump almost anywhere. This is a pathological diagnosis but sometimes there are raised paraproteins. Ask for protein electrophoresis.

Liver cancer
In UK liver cancer is nearly always secondary to cancer elsewhere. It may cause raised levels of alpha fetoprotein (AFP). AFP may also be raised in prostatic, testicular, ovarian and stomach cancer as well as liver cirrhosis from hepatitis.

There are many other cancers, but the above are the commonest.

Related Test[s]
Faecal Occult Blood
Prostate specific antigen (PSA)
Disease screening tests – these tests would pick up most serious diseases
Elastase – a new test for pancreatic disease

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