Role of Investigations in Cancer Treatment –
Cancer treatment can’t be decided by seeing Investigations of patient only (without examining the patient). Sometimes attendants come to Oncologist for second opinion without the patient and they expect you to tell the treatment plan for the patient which is not advisable.
Cancer treatment can’t be decided by examining patient only (without any investigations). Sometimes, patient and attendants expect you to decide treatment plan for the patient on first visit while no investigations have been done. This is also not advisable.
Clinical examination and Investigations are complimentary to each other in deciding cancer treatment.
Investigations to confirm Cancer – Pathological confirmation is must before starting cancer treatment. Cancer treatment can’t be started without pathological evidence (as expected by some patients). There are different types of histopathology diagnosis at same organ with different treatment options for each, so a biopsy is must. Various pathological tests available to confirm cancer are FNAC, Fluid cytology, PAP smear, Biopsy – Incisional, Excisional, Punch biopsy, Core biopsy, IHC.
Investigations to assess extent of Cancer – These imaging modalities are required to assess the spread of cancer locally as well as in distant organs. These imaging studies may convert a simple looking localised disease into a metastatic disease and hence change the treatment plan. Various radiological tests available are Chest X-ray, CECT Scan, MRI, Mammography, PET-CT Scan, Bone scan, Thyroid scan etc.
Endoscopies to assess extent of Cancer – Endoscopies are done in hollow organs with lumen where an endoscope can be passed and visual impression of surface growth can be done. Growth extent can then be used to decide treatment plan for that particular organ.
Various endoscopies available are Upper GI Endoscopy, Colonoscopy, Bronchoscopy, Direct Laryngoscopy, Fibre-optic Laryngoscopy, Cystoscopy, Endo-bronchial Ultrasound, Endoscopic Ultrasound etc.
Tumour Markers to assess extent of Cancer – Tumour markers help in diagnosis and sometimes prognostication of cancer. Tumour markers level is helpful in follow up of cancer patients after completion of treatment. Increase in their level after treatment suggests recurrence.
Various Tumour Markers tests available are CA 125- Ca ovary, CEA – GI malignancies, CA 19-9 – Hepatobiliary malignancies, PSA – Ca Prostate, AFP, B-HCG etc.
Routine Investigations required to assess fitness of Patient – Some tests are required not to assess extent of cancer but to assess fitness of patient to tolerate treatment e.g. Blood tests (CBC, LFT, RFT), ECG, 2D Echocardiography etc.
Not all investigations are required in every patient. Let your Oncologist decide which investigations are needed for you. PET-CT Scan is not required in every patient (as demanded by some patients).
Once cancer is confirmed and extent of cancer defined, your oncologist will make a treatment plan best suited for you.