Cancer diagnosis

Cancer is a disease which, unfortunately, especially in the initial stages, is devoid of symptoms; for this reason, diagnosis is often made late when the disease is widespread.

Making early diagnosis, when symptoms are not yet present or non-specific symptoms are present, is very important as it makes the disease more treatable and allows the patient to get better at healing.

There are four steps to diagnose cancer early:

1. Recognize signs and symptoms which alone are not diagnostic but serve to induce the doctor to investigate with more specific surveys. Recognize signs and symptoms which alone are not diagnostic but serve to induce the physician to investigate further with more specific investigations. For example, a dry and persistent cough can be the signal of a lung tumor, the variation in the shape and size of the moles can lead to the diagnosis of melanoma, the change in urinary or intestinal functions can reveal a tumor of the urinary tract or intestine , a persistent fever can be the symptom of a possible lymphoma and so on.


2. Learn more with a hematological laboratory examination. The parameters that are generally analyzed are the values of the blood count, liver function, electrolytes, protidogram, hormonal status, inflammatory indices and many others. Then there are more specific blood tests that are carried out when the suspicion of cancer is higher: the dosage of the tumor markers. Tumor markers are substances normally produced by the cells of our body but in the presence of a tumor their levels are much higher than normal. To give some examples:

        • CEA and CA 19-9 for the gastrointestinal tract
        • CEA, CA 125 and HE4 for ovarian and peritoneum lesions
        • CEA and CA 15-3 for breast lesions
        • PSA for the prostatic lesions
        • Alphafetoprotein for liver injury

Markers alone are not diagnostic but should be considered an alarm signal.


3. Confirm the presence of the disease with instrumental diagnostic imaging tests:

        • Ultrasound:

Ultrasound is a non-invasive diagnostic method which, thanks to ultrasounds emitted by an instrument placed on the patient, allows to visualize internal organs and structures such as glands, blood vessels, tendons, ligaments and muscles except for the skeleton and internal skull structures .

The instrument is able to highlight the presence of liquid, cysts, benign or malignant formations in the organs.

The ultrasound is absolutely harmless to the patient, it is quick to perform and with decidedly low costs. There are no contraindications, in fact the examination can also be performed during pregnancy. The only limitations to the use of this method are the characteristics of the patient: for example obesity and meteorism (presence of air in the intestine) are factors that hinder the spread of sound waves.

        • Radiography:

Radiography was one of the first imaging techniques that spread.

The method is based on the emission of X-rays that pass through the patient’s body. Images are created because the tissues of our organism absorb energy in a different way.

The radiographic techniques most used in oncology are chest radiography and mammography.

The X-rays emitted during the exam are harmful to the body therefore it is necessary to carry out the examination only when it is strictly necessary. It is contraindicated in pregnancy.

The exam is not painful.

        • Computed tomography (CT):

CT is a technique that uses X-rays to obtain very specific images of various parts of the body. The radiation dose is much higher than that of a normal radiograph. Sometimes, to obtain better images, the contrast medium can be used. It is an iodine-based liquid inserted in the vein and which absorbs the X-rays in a different way than the tissues which in this way are more emphasized.

It is a very important exam in oncology as it is able to detect even very small lesions (2-3 mm).

CT has no particular contraindications except that the radiation used, even if used at low doses, is harmful to the body, therefore better not to abuse it. It is to be avoided in pregnancy.

The contrast agent is contraindicated only to people allergic to this substance. As soon as it is injected it can give a strong sensation of heat which however quickly vanishes.

Overall, the exam is not painful.

        • Positron emission tomography (PET)

PET is an examination that involves the intravenous administration of substances, such as glucose, labeled with radioactive molecules. After being administered, the glucose-based radiopharmaceutical is distributed in the patient’s body so as to allow the instrument to detect its distribution. Since the tumors are particularly greedy for glucose, the injected radiopharmaceutical will be deposited especially where there is hyper consumption of sugar, highlighting and allowing the operator to identify the neoplastic lesion.

The examination is not painful and is not dangerous because the dose of radioactive substance is low. This does not mean that one should abuse.

It is contraindicated in pregnant and breastfeeding women and in some cases even in diabetic patients.

        • Nuclear magnetic resonance imaging:

Magnetic resonance imaging is an instrument that thanks to the emission of electromagnetic waves allows to obtain very detailed images of the body without administering dangerous radiation. It allows you to obtain images of the internal organs, especially the brain, spine, skeleton and joints.

The images obtained are much more precise than those obtained with CT with the exception of moving structures such as blood in the blood vessels.

The only limitation of the tool is the particularly high cost.

Due to the magnetic field generated by the device, people to whom internal metal devices such as pacemakers, metal implants or vascular clips have not been subjected to the examination.

Carry out the exam is often difficult due to the sense of claustrophobia that comes from the very narrow space in which one must remain immobile. To overcome this problem, semi-open magnetic resonances are increasingly spreading.

        • Scintigraphy:

Scintigraphy is an examination that is performed to evaluate the presence of metastases or tumor cells in tissues and organs distant from the place where the tumor was formed.

It is carried out by administering a radioactive substance into the vein which is deposited in the organs where there is a greater metabolic activity, for example where there are metastases.

The examination is not painful and is not dangerous because the dose of radioactive substance is low. This does not mean that you can abuse it.

It is contraindicated in pregnant women.


4. Know the nature of the lesion and its characteristics through direct examination of the tumor. Having this information on the tumor is used to establish the best therapeutic approach. The tumor examination can be of two types:

        • Cytological examination:

The analyzed sample is an aggregate of cells. Taking the cell sample is called  needle aspirate.

        • Hystological examination:

The analyzed sample is a tissue. Taking the tissue sample is called biopsy.

In both cases, after collection, the sample is prepared, colored and observed under a microscope. The microscopic observation of cells and tissues is able to provide important information on the physiology of cells and highlight the presence of inflammatory or tumor processes.