2. Diagnostic tests include: Physical examination Laboratory tests Imaging Endoscopic examination Biopsy Surgery Molecular testing How is cancer diagnosed? Cancer is an umbrella term for a broad group of diseases There is no single test that can diagnose all cancers 1 1.Stanford Cancer Institute, Cancer Diagnosis, 2012 If there are symptoms suggestive of cancer a broad range of tests allow HCPs to make an accurate and detailed diagnosis

3. Laboratory tests Assess the general health of the body and levels of certain compounds Typically, blood and/or urine samples Blood is assessed for its composition, and can give an indication of liver and renal function Blood, proteins and other compounds in the urine indicate there could be a problem Tumour markers detected in blood or urine are substances created by the body in response to cancer cells Currently, markers are used to monitor treatment efficacy and recurrence May become more important in diagnosis in the future 1.Stanford Cancer Institute, Cancer Diagnosis, 2012. CEA, carcinoembryonic antigen, several cancers can raise CEA levels; AFP, alpha-fetoprotein; HCG, human chorionic gonadotropin; CA 15-3 and CA 27-29 are most useful in assessing advanced breast cancer treatment Marker Cancer CA 125Ovarian CEAColorectal AFPLiver, ovarian, testicular HCG Testicular, ovarian, liver, stomach, pancreatic, lung CA 19-9Colon, stomach, bile duct CA 15-3Ovarian, lung, prostate CA 27-29 Colon, stomach, kidney, lung, ovarian, pancreatic, uterus, and liver

4. Imaging 1.Stanford Cancer Institute, Cancer Diagnosis, 2012. Produce images of the organs and structures Reveal location and extent of disease Three main types: Transmission imaging: high- energy photons beamed through body – the opacity of different structures/tissues varies > X-ray, CT scan, bone scan, mammogram, lymphangiogram Reflection imaging: high frequency sound reflected differentially depending on structures/tissues > Ultrasound Emission imaging: atoms excited to emit energy waves detected by a scanner > MRI, PET magnetic field direction Imaging Transmitted radio waves Emitted radio waves

5. Endoscopy 1.Stanford Cancer Institute, Cancer Diagnosis 2012. Bronchoscopy Used to examine the airways and obtain tissue samples from the lungs Colonoscopy and sigmoidoscopy Used to view the large intestine or just the sigmoid colon Endoscopic retrograde cholangiopancreatography (ERCP) Combined with X-ray to examine the liver, gallbladder, bile ducts, and pancreas Oesophagogastroduodenoscopy (upper endoscopy) Used to view the inside of the oesophagus, stomach, and duodenum Cystoscopy (cystourethroscopy) Device inserted through the urethra to examine the bladder and urinary tract Oesophagus Endoscope Stomach Light Interior of stomach Endoscope Light Stomach lining Biopsy sample An endoscope is a small, flexible tube with a light, lens and tools

6. Biopsy 1.Stanford Cancer Institute, Cancer Diagnosis, 2012. Biopsy type Description Endoscopic Tissue sample removed via an endoscopy Bone marrow Bone chip or cells aspirated from the sternum or hip Excisional or incisional Full thickness of skin even whole tumour removed Fine needle aspiration (FNA) Tiny pieces of tumour extracted via a thin needle Punch Short cylinder of tissue taken ShaveTop layer of skin removed SkinSmall sample of skin taken Tissue or cells from the body for examination under a microscope Performed in the doctors office or hospital, depending on the type of biopsy and location of the tumour

7. Pathology 1.National Cancer Institute, Understanding Cancer, 2009. Artwork originally created for the National Cancer Institute. Reprinted with permission of the artist, Jeanne Kelly. Copyright 2013. Tests on biopsies and samples of patient tissue or body fluids reveal a great deal about the cancer Microscopic examination can reveal the presence of cancer cells, the origin of the cancer cells (sub-type), and information on stage, etc. Biopsy Blood sample or tissue sample Pathology Proteomic profile Genomic profile