The journey begins:
You go to the doctor for a routine annual visit. She notices you’ve dropped 20 lbs since your last visit. You tell her you are more tired and have lost your “get up and go.” You quit smoking 5 years ago, but now you’re more short of breath, and when you hack up your morning phlegm, you bring up some blood with it.
She’s concerned about these symptoms. She sends you for a chest X ray. Then calls you that evening, and gives you the news that the xray showed a shadow and she’s setting you up for more tests.
The next steps involve the following, in some order, depending on the situation:
1)xrays
2)CT scans (or CAT scans), which involve drinking a white liquid and an intravenous dye injection: the dyes are necessary to tell the blood vessels and intestinal tract apart from other internal organs. You lie on an table, travel through a machine with a doughnut hole, while it takes cross sectional “xrays”, and all the images are put together to give an inside view of the body.
3)sometimes , a brain scan: either an MRI or CT scan, also with an injection of dye
4)biopsy of the appropriate organ. Nowadays, it is often a needle placed directly through the skin, into the tumor site, under X ray vision, either a mammogram, CT scan or MRI. A piece or several pieces are withdrawn and sent to the Pathologist. The specialist who does this kind of biopsy is called an interventional radiologist.
5)sometimes, biopsies are obtained by endoscopy, that is a specialist introduces a flexible tube with a light though an external opening: nose, mouth, rectum or bladder and looks for the tumor site and takes a biopsy. Sometimes the biopsy is obtained during an operation.
6)the next wait is the difficult one. The tissue is sent to the Pathologist, and takes several days to process. Special stains and antibody tests are performed on this tissue to identify the kind of cancer cell. The slides are usually, (and should be) examined by more than one pathologist to confirm the diagnosis. All of this takes time, and the wait can be very difficult. It’s important to get it right, everything depends on this reading.
7)Depending on the kind of cancer, the next step is referral to the specialist, either a breast surgeon/ thoracic surgeon/ colon surgeon/ ENT surgeon, etc.
8)Often, the new practice is to be seen by Oncologists prior to any surgery in a multidisciplinary session with Radiation and Medical Oncologists, to decide the best course of treatment. This is not always necessary, for straightforward situations, but that is a topic for another day.
9)then on to the next step of actual decisions regarding treatment.