Diagnostic of Cancer

• cancer is an invading disease that makes itself difficult to be discovered

easily.

• There is no single specific test that can discover or diagnose cancer.

• complete evaluation of a patient usually requires a thorough history and

physical examination along with diagnostic testing.

• Radiological and endoscopic diagnostic assessment are used to discover

cancer presence.
Roadmap
Cancer
diagnosis

Lab
Radiological Endoscopic chemistry,
biopsy
Diagnostics Procedures genetic study

MRI &
Mammogram Ultrasound
X-Ray Nuclear
& CT Scan
Medicine
 Selecting the Appropriate Diagnostic
• Type of tumor.
Procedure
• Location of tumor.
• Risk and benefits of procedure.
• Cost of procedure.
• Urgency.
• Patient condition.
 Histopathology
Refers to the microscopic examination of tissue in order to study
the manifestations of disease.

Specifically, in clinical medicine, histopathology refers to the

examination of a biopsy or surgical specimen by a pathologist.
 What is Biopsy?
- Biopsy is a sample of tissue taken from the body in order to
examine it more closely. A doctor should recommend a biopsy
when an initial test suggests an area of tissue in the body isn't
normal.
- Doctors may call an area of abnormal tissue a lesion, a tumour,
or a mass. These are general words used to emphasize the
unknown nature of the tissue. The suspicious area may be noticed
during a physical examination or internally on an imaging test.
 Types of Biopsy
• Needle biopsy.
• CT-guided biopsy.
• Ultrasound-guided biopsy.
• Bone biopsy.
• Bone marrow biopsy: A large needle is used to enter the pelvis bone
to collect bone marrow.
• Surgical biopsy: Either open or laparoscopic surgery may be
necessary to obtain a biopsy of hard-to-reach tissue. Either a piece of
tissue or the whole lump of tissue may be removed.
• Aspiration biopsy. A needle withdraws material out of a mass. This
simple procedure is also called fine-needle aspiration.
 Nursing Role
• Help clients achieve their optimal level of function and
wellness after the biopsy.
• Simple gauze compression.
• The patient can eat and drink as normal.
• Advise to avoid hard physical activity for
24 hours after the biopsy.
 The Need for Medical Imaging
o Determine the presence of tumor mass. Contrast
• IV
o localize the mass for biopsy. • Oral
• Rectal
o Provide tissue characterization. • Intrathecal

o Assess or stage the anatomical extent of disease.

o Tumor treatment (either benign or malignant).
Positron Emission Tomography
(PET) Scan X-ray
MRI
Computerized Tomography (CT) Ultrasound (US)
Preparation for CT Scan and MRI
• If the patient has a history of allergy to contrast material
(such as iodine), the requesting physician and radiology staff
should be notified.
• If case patient has plain for CT scan with contrast, do not eat
anything (NPO) three hours prior to CT scan
• Large iv access.
• Kidney function test.
• Patient with Metal materials contraindicated for MRI
 Mammogram
• A mammogram is an x-ray
examination of the breast.
It is used to detect and
diagnose breast disease in
women who either have
breast problems such as a
lump, pain, or nipple
discharge, as well as for
women who have no
breast complaints.
 Mammogram
• The goal of mammography is the early detection of breast
cancer, typically through detection of characteristic of
masses.
• The National Cancer Institute recommends that women age
40 or older have screening mammograms every 1 to 2 years.
Women with family history of breast cancer should consider
yearly mammograms at young age.
• A normal mammogram does not exclude the presence of
cancer.
 Before Mammogram
• Do not use deodorant, perfume, powders, or ointments under
the arms or on the breasts on the day of the mammogram.
These substances may hide the images.
• Remove all jewellery from the neck and chest area.
• Asked the patient if she is pregnant or breastfeeding.
Positron Emission Tomography (PET)
• Diagnostic
procedure assess the Scan
metabolic activity
levels of tissues in
an attempt to
pinpoint the location
of cancerous tissues,
so this type of scan
can show how body
tissues are working,
as well as what they
look like.
 How Does it Work?
• Inject patient by radioactive drug (tracer) one hour Before,
tracer known as (fluorodeoxy glucose), (FDG-18) This is a
radioactive version of glucose.
• FDG-18 travels to places where glucose is used for energy. It
shows up cancers because they use glucose in a different way
from normal tissue, in order to satisfy the energy required for
their rapid growth.
• Tracer create “hot” or “cold” spots on the computer image
depending on whether more or less of the tracer is taken up by
the tissue.
 Preparation for PET Scan
• Refrain from consuming caffeine for at least 24 hours prior to
the PET scan.
• A small quantity of radiotracer will either be injected into the
patient's arm or breathed in as a gas .
• Consume any food for at least four to six hours before the scan,
but to drink plenty of water.
• Some patients may be given some medication, such as
diazepam, to relax.
 PET Scan Findings
• Show whether a lump is cancer or not.
• Show whether a cancer has spread to other parts of the body.
• Show the difference between scar tissue and active cancer
tissue.
• Find out the stage of a cancer.
• Show how well cancer drug treatment is working.
Radiological Diagnostics Advantages Disadvantages

Plain X-ray Quick, non-invasive and painless.

Can help diagnose various diseases and
Very small increased risk of cancer in future
from exposure to ionising radiation (X-rays).
injuries, including broken bones, some cancers Risk is greater for children
and infections.

Ultrasound Usually non-invasive, safe and relatively

painless.
Quality and interpretation of the image highly
depends on the skill of the person doing the
Uses no ionising radiation. scan
Does not usually require injection of a contrast Other factors can affect image quality,
medium (dye). including the presence of air and calcified areas
Can be used to check on the health of a baby in the body (e.g. bones, plaques and hardened
during pregnancy. arteries), and a person's body size

Computed tomography Quick and painless

Can help diagnose and guide treatment for a
Uses higher doses of radiation than plain
X-ray, so the risks (while still small) are
(CT scans) wider range of conditions than plain X-ray generally greater than for other imaging
Can detect or exclude the presence of more types.
serious problems Injection of a contrast medium (dye) can
Can be used to check if a previously treated cause kidney problems or result in allergic
disease has recurred or injection-site reactions in some people.
Some procedures require anaesthesia.
Magnetic resonance imaging Usually non-invasive and painless
Uses no ionising radiation.
Can be a lengthy and noisy procedure
Slight movement can ruin the image,
(MRI) Can help diagnose and guide treatment for requiring retesting.
a wide range of conditions. Can make some people feel claustrophobic
Can provide similar information to CT in Sedation or anaesthesia may be required
some types of investigations. for young children or others who can't
remain still.
Can't be undertaken in some situations
(e.g. when a heart pacemaker is present).

Screening mammograms are the most they are not 100% accurate. There is a
effective test for finding breast cancer small chance that a screening
Mammogram early. mammogram will look normal even if a
breast cancer is present.
Routine screening mammography is not
done during pregnancy or while
.breastfeeding

Nuclear medicine imaging Can help diagnose, treat, or predict the outcome
for a wide range of conditions.
Involves exposure to ionising radiation(gamma-
rays)
including positron-emission Unlike most other imaging types, can show how Radioactive material may cause allergic or
different parts of the body are working and can injection-site reactions in some people.
tomography (PET) detect problems much earlier. PET scanners cause some people to feel
Can check how far a cancer has spread and how claustrophobic, which may mean sedation is
well treatment is working. required.
Endoscopies
• Endoscopy: is a procedure that allows to view the inside of a person's
body.
• During an endoscopy, inserts a tool into a person’s body.
Most endoscopes are thin tubes with a powerful light and tiny camera
at the end.
• There are several different
types of endoscopes.
 Endoscopies Equipment

• An endoscope also often has a channel so the physician can insert

tools to collect tissue or provide treatment. Some of the tools a
doctor may use during an endoscopy include:
1. Flexible forceps, a tool that looks like tongs, for taking a tissue
sample
2. Biopsy forceps for removing a tissue sample or a suspicious
growth
3. Cytology brush for taking cell samples
4. Suture removal forceps for removing stitches inside the body
Reason for Endoscopies
• Endoscopy recommended to the patient for several different reasons.
• To screen for and prevent cancer. the use of a colonoscopy to screen for
colorectal cancer. During a colonoscopy, the doctor can remove growths
called polyps that could develop into cancer.
• To diagnose a disease or find out the cause of symptoms. The type of
endoscopy it will recommend depends on the part of the body that needs
to be seen.
• To give treatment. Doctors can provide different treatments using
endoscopy
The Most Common Types of Endoscopy
Laparoscopy: Laparoscope Stomach, liver, or other abdominal organ,
including female reproductive organs (uterus, ovaries, fallopian tubes)
Inserted through a small, surgical opening in the abdomen

Colonoscopy: Colonoscopy Entire length of the colon and large

intestine Inserted through the anus.

Bronchoscopy: Bronchoscope Trachea (windpipe) and bronchi

of the lungs
Inserted through the mouth
The Most Common Types of Endoscopy
• Cystoscopy: used for bladder
• Arthroscopy: use to joint.
• Esophagoscopy: Inserted to show Esophagus
• Laryngoscopy: Laryngoscope Larynx (voice box) Inserted through the
mouth
• Sigmoidoscopy: Sigmoid colon (bottom part of the colon) Inserted
through the anus.
• Thoracoscopy: Pleura covering the lungs and structures covering the
heart Inserted through a small surgical opening in chest.
• Gastroscopy: Stomach and duodenum (beginning of the small intestine)
Inserted through the mouth
Instructions Before During the Procedure After the Procedure
Endoscopy
• NPO for several hours • If anesthesia or sedative • the patient will rest in
before the procedure. received depending on the a recovery area. may
• Stop anticoagulation type of endoscopy. have mild side effects
drug several days Checked patient alert, afterwards. This
drowsy, or asleep during depends on the type
before the procedure
the procedure. of endoscopy but can
to reduce the risk of
• monitor vital sign include a sore, dry
bleeding.
• collecting tissue sample throat or bloating and
• Take a laxative to gas.
for testing.
clean bowels,
depending on the type
of endoscopy.
Nursing Responsibilities in Diagnostic
Measures