1. Cancer 101: A Cancer Education and Training Program for [Target Population]
Date
Location
Presented by:
Presenter 1
Presenter 2 1

2. Cancer Diagnosis and Staging
Learning Module 6

3. Learning Objectives
At the completion of learning Module 6, you will be able to:
Describe what is meant by the term biopsy
Describe how tumors may behave differently from one another
Give at least two examples of the stages of cancer and their meaning
Give at least two reasons why staging is important

4. Case Study Martha is 55 years old.
She had a mammogram 4 months ago, which was normal.
When she was doing BSE this month, she felt a lump in her left breast.
She scheduled an appointment to see her doctor.
After CBE, the doctor recommended a biopsy.

5. Diagnosing Cancer
To diagnose the presence of cancer, a doctor must remove a piece of affected tissue (biopsy) to look at it under a microscope.
When preliminary symptoms, Pap test, mammogram, PSA test, FOBT, or colonoscopy indicate the possible existence of cancer, a doctor must then perform a biopsy.
For leukemias, a small blood sample serves the same purpose.

6. Photo credit: John Crawford | Source: NCI
Biopsy
A biopsy is the surgical removal of a small piece of tissue for microscopic examination.
Cancer tissue has a distinctive appearance under the microscope.
This microscopic examination will tell the doctor whether a tumor is actually present and, if so, whether it is malignant (i.e., cancer) or benign.
Photo credit: John Crawford | Source: NCI

7. Types of Biopsies Types of biopsies include: Endoscopy Needle biopsy
Surgical biopsy
Excisional
Incisional
A sample may be removed in several ways:
With an endoscope: The doctor uses a thin, lighted tube (an endoscope) to look at areas inside the body. The doctor can remove tissue or cells through the tube.
With a needle: The doctor uses a needle to withdraw tissue or fluid.
With surgery: There are two types of surgical biopsies:
In an excisional biopsy, the surgeon removes the entire tumor. Often some of the normal tissue around the tumor is also removed.
In an incisional biopsy, the surgeon removes just part of the tumor.

8. Case Study
On CBE, the doctor suspects Martha’s lump is a cyst, and tries to aspirate it with a needle biopsy.
The needle biopsy did not extract any fluid.
The doctor now suspects it is a solid mass and recommends a surgical biopsy.
The surgical biopsy is done at the end of the week.

9. Diagnosis of Cancer
Microscopic examination of the tissue also helps the doctor determine the “aggressiveness” or the behavior of the cancer.
Among the traits the doctor looks for are a large number of irregularly shaped dividing cells, variation in nuclear size and shape, variation in cell size and shape, loss of specialized cell features, loss of normal tissue organization, and a poorly defined tumor boundary.

10. Cell Differentiation
Well differentiated cancer cells look and function similarly to normal cells of the same type.
Poorly differentiated, or undifferentiated, cancer cells look abnormal and disorganized.

11. What do cells look like under the microscope?
Normal
Cancer
Images Source: National Cancer Institute

12. Case Study
Martha’s surgical pathology report comes back from the lab the following week.
The biopsy is positive for breast cancer.
The cells are well differentiated, and the mass was small (<2 cm), so the doctor suspects it is an early stage breast cancer.
To be certain, the doctor orders a sentinel lymph node biopsy, a chest x-ray, and a CT scan.

13. Diagnosing Cancer
Once the cancer diagnosis has been made, more testing may be necessary to determine the primary site (where the cancer started).
The primary site helps determine the type of treatment of the cancer.

14. Staging of Cancer
Staging is the process that tells the doctor how far the cancer has spread in the body.
Staging is important for the following reasons:
Determines the extent of the disease
Treatment is determined by the stage
Determines a patient’s prognosis

15. Stages The common stages of cancer are: In situ Localized Regional
Distant
Recurrent
Unknown
In situ: Early cancer present only in the layer of cells in which it began.
Localized: Cancer is found only in the organ where it started to grow.
Regional: Cancer has spread beyond the original (primary) site to nearby lymph nodes or tissues.
Distant: Cancer has spread from the primary site to distant organs or distant lymph nodes
Recurrent: Cancer that has come back after a period of time during which it could not be found.
Unknown: Cancer cases in which there is not enough information to indicate a stage.

16. Case Study Martha’s sentinel node biopsy was negative for cancer.
Martha’s x-ray and CT scan were negative for cancer.
Martha is diagnosed with a Stage I (local) breast cancer.

17. In Summary You now have an understanding of:
The way in which cancer is diagnosed
How the extent or stage of cancer is determined