Tests and Procedures

Doctors use many different types of tests to diagnose cancer and to find out how far the disease has spread. Some tests can also determine which treatments will work best for a particular person. Diagnostic tests can involve simple laboratory tests, surgery, or radiologic imaging. The tests a doctor selects depends on the type of cancer that is suspected; the person's symptoms, age, and medical condition; and the results of other tests.

Biopsy

In many cases, a diagnosis of cancer is made with a biopsy. This test involves the doctor removing all or part of the tumor and then examining the sample under the microscope to determine if cancer cells are present. There are different types of biopsies.

Fine needle aspiration biopsy. A fine needle biopsy may be the first type of biopsy done on tumors that can be felt by the doctor. The doctor uses a very thin, hollow needle in a syringe to gather a small amount of fluid and cells from the suspicious area.

Core needle biopsy. The size of the syringe needle used in a core needle biopsy is larger than the one in a fine needle biopsy, so that a cylinder of tissue can be obtained. If a fine needle biopsy cannot provide a definitive diagnosis, the doctor may want to do a core needle biopsy. Core biopsies are often performed instead of fine needle aspiration biopsies because they provide more tissue to review.

Vacuum-assisted biopsy. Vacuum pressure (suction) is used to pull the sample tissue through a specially designed hollow needle in this biopsy method. This gives the doctor the ability to collect multiple or larger samples from the same biopsy site without having to insert the needle more than once.

Image-guided biopsy. An image-guided biopsy is a procedure in which the doctor uses imaging technology, such as ultrasound, fluoroscopy, CT scan, x-ray, or MRI scan, to determine the exact location from which the tissue sample will be removed for analysis. A needle is used to obtain a sample of the tissue from the site; the needle type used may be a fine needle, core needle, or vacuum-assisted needle. An image-guided biopsy may be used when a tumor appears on an imaging scan, such as an x-ray, but cannot be felt by the doctor, or when the area is located deeper inside the body. The type of imaging technology used depends on the location of the biopsy site and other factors.

Surgical biopsy. Unlike the needle methods described above, in a surgical biopsy, a surgeon makes an incision in the skin and removes some or all of the suspicious tissue. It is often used after a needle biopsy shows cancer cells, or it can be used as the first method to obtain tissue for diagnosis. There are two main categories of surgical biopsies:

Incisional biopsy removes a piece of the suspicious area for examination. An incisional biopsy may be used for soft tissue tumors, such as those arising from muscle or fat, to distinguish between benign lumps and cancerous tumors called sarcomas.

Excisional biopsy removes the entire lump. An excisional biopsy, which was more common prior to the development of fine needle aspiration, may be used for enlarged lymph nodes or breast lumps or in situations where the lump is small enough to be easily completely removed in one procedure.

Endoscopic biopsy. Endoscopes are tubes with cameras that doctors use to view the inside of body, including the bladder, abdomen, joints, or gastrointestinal (GI) tract. Endoscopes can be inserted through the mouth or a tiny surgical incision.

Using an endoscope, the doctor can see any abnormal areas and pinch off tiny samples of the tissue using forceps that are part of the endoscope. Many common medical procedures, such as a cystoscopy to examine the bladder and colonoscopy to examine the colon, use endoscopic techniques.

Bone marrow biopsy. The doctor uses a large, rigid needle to go through a bone, often the back of the hip bone, and into the marrow in order to gather a sample. A core biopsy of the bone may also be performed at the same time. A bone marrow biopsy is used to determine if a person has a blood disorder or a blood cancer, including leukemia and multiple myeloma. It can also be used to find out if a cancer that originated in another part of the body has spread to the bone marrow.

Read more about Biopsy—What to Expect and Specimen Processing.

Imaging tests

Doctors use imaging tests to determine whether the cancer has spread to other areas in the body, and to evaluate the size and location of the tumor. Imaging tests alone are generally not specific enough to diagnose cancer.

X-ray. X-rays use electromagnetic radiation to produce an image of the inside of the body. X-rays are not as sophisticated as newer procedures, but they are still useful for finding and monitoring some types of tumors.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body using a series of x-ray pictures that are taken from many different angles. A computer compiles these images into a detailed, cross-sectional view. Read more about CT scan.

Magnetic resonance imaging (MRI). An MRI uses electromagnetic waves to create computer-generated pictures of the inside of the body. Read more about MRI.

Ultrasound. Ultrasounds create pictures of the inside of body using high-frequency sound waves. Read more about the ultrasound.

Positron emission tomography (PET) scan. This is a procedure in which radioactive sugar molecules, called tracers, are injected into the body in a low dose, radioactive form. During the scan, the cancer cells "light up," because the cancer cells absorb sugar faster than normal cells. Read more about the PET scan.

Bone scan. This test is used to determine if the bone is damaged, either from cancer or from some other cause. A radioactive tracer is injected into a person's body. If the bone is damaged, the tracer will concentrate in the bone. Read more about the bone scan.

Integrated PET-CT Scan—What to Expect

Endoscopic tests

Any medical procedure performed with an endoscope is called an endoscopy. An endoscope is a thin, flexible, lighted tube that is used to look at the inside of the body. The exact type of endoscope varies depending on what part of the body needs to be viewed. The following are some common examples of endoscopic tests.

A bronchoscopy uses a bronchoscope to examine the lungs.
A colonoscopy uses a colonoscope to examine the colon and rectum.
A laparoscopy uses a laparoscope to examine the abdominal area.