Faq’s
Frequently Asked Question/s
Lymph Nodes And Cancer
What are lymph nodes?
Lymph nodes are small bean shaped structures that are a part of body’s immune system. There are hundreds of lymph nodes scattered in all areas of the body. These lymph nodes are connected by tubes called Lymphatic channels.
Where are the lymph nodes located?
Lymph nodes are grouped together in specific anatomical regions throughout the body. Common clusters are located in the neck (cervical), underarms (axillary), and groin (inguinal), as well as deeper within the chest cavity and abdomen.
What do lymph nodes do? What is the function of lymph nodes?
Their primary function is to filter lymphatic fluid. They trap bacteria, viruses, and abnormal cellular matter, and house specialized white blood cells (lymphocytes) that defend the body against infections and disease.
Why lymph nodes are important in cancer?
When cancer cells break free from a primary tumor, they often travel through lymphatic vessels and get filtered by nearby regional nodes. Assessing these nodes gives doctors crucial information regarding cancer staging, risk of recurrence, and overall treatment strategy.
How do I get to know if the cancer has spread to the nodes?
Spread is detected through diagnostic imaging (such as Ultrasound, CT, MRI, or PET scans), physical examination, fine-needle aspiration or core needle biopsy, and intraoperative sentinel lymph node mapping.
If the cancer has spread to nodes, what does it mean?
It means the cancer has advanced beyond the localized primary site into regional lymphatic filters. While this indicates a higher stage, it is still categorized as regional involvement rather than distant stage IV metastatic disease.
Does cancer surgery involve removal of these nodes also?
Yes. Surgical cancer procedures frequently incorporate regional lymph node dissection (lymphadenectomy) or targeted sentinel node removal to eliminate spread and ensure precise pathological analysis.
Does my cancer treatment change if the cancer has spread to the nodes?
Yes. Regional nodal involvement typically indicates a higher risk profile, leading oncologists to recommend systemic adjuvant treatments—such as chemotherapy, targeted therapies, immunotherapy, or targeted radiation therapy—alongside surgery.
Managing Surgical Stitches / Clips At Home, After Surgery
Is It Normal To Get Discharged With Stitches/Clips Still In Place?
Yes. Most patients get discharged from the hospital with clips or stitches still in place. It is not necessary to stay back in the hospital purely for stitch removal, as remaining admitted unnecessarily increases the cost of your hospital stay.
Can I travel in car, bike, plane and train?
Yes, gentle travel by car, train, or plane is generally permissible once you are discharged and feeling stable. However, avoid riding two-wheelers (bikes/scooters) or bumpy routes that could jar or place sudden strain on your surgical incision.
Do I Need To Take Pain Killers For My Wound?
Take prescribed pain medications only as advised at discharge. In general, severe wound pain subsides significantly after the first few days, and many patients require pain relief only as needed (SOS).
Do I Have To Apply Any Ointment Or Medications On My Stitches/Clips?
No topical creams, powders, or antiseptic ointments should be applied to the incision unless your surgical team has explicitly prescribed one. Keeping the site clean and dry is the best way to promote natural healing.
Can I Leave The Stitches Open?
Once the surgical incision is dry and healing well (usually 48 to 72 hours post-operation), your surgical team will often recommend leaving the incision open to air without regular dressings unless there is persistent discharge.
Can I Take Bath?
You may take a gentle shower or sponge bath once permitted by your surgeon. Avoid soaking in bathtubs, swimming pools, or directly scrubbing the incision line until the stitches or clips are removed.
How To Dry The Stitches After Bath?
Pat the incision area gently with a clean, dry, soft cotton towel. Never rub vigorously. You can also use a hairdryer on the cool (low heat) setting held at a safe distance to ensure the suture line is thoroughly dry.
Can I Do My Routine Work?
Light personal daily activities like walking and self-care are encouraged. Avoid heavy lifting (generally anything over 5 kg), strenuous workouts, and tasks involving intense bending or stretching across your operative area.
Can I Cough? Will Coughing Open Up My Stitches?
Normal coughing will not break properly closed surgical stitches. For abdominal or chest incisions, support the wound gently by pressing a small pillow against your abdomen while coughing or sneezing to minimize tension and discomfort.
Do I Have To Follow Any Specific Diet Plan? Do I Have To Avoid Any Particular Type Of Food?
Follow a balanced, nutrient-rich, high-protein diet with plenty of fluids and dietary fiber to prevent constipation and promote wound recovery. Avoid dietary restrictions unless specifically instructed for your condition.
When Do The Stitches Come Off?
Clips and non-absorbable sutures are typically removed between 7 and 14 days after surgery, depending on the anatomical location of the surgery and individual healing speed.
Is Removal Of The Stitches Painful?
No, removal is generally painless. Patients occasionally experience a mild pulling or pinching sensation, but it only lasts a few seconds and does not require local anesthesia.
Do I Have To Visit Your Clinic/Hospital For Stitch Removal?
Visiting your surgeon’s OPD is preferred so the doctor can evaluate your healing. However, if you reside far away, removal can often be carried out by a trained healthcare professional at a nearby clinic upon your surgeon's guidance.
What About The Wounds At Drain Tubes?
Drain tube sites are kept covered with a sterile absorbent dressing while the tube remains in place. Once the drain is removed, the small puncture wound closes naturally over several days with basic dry dressing changes.
I Have Been Advised To Get Regular Dressing Of Surgical Stitch Site. Why Is That?
Regular dressings are prescribed if there is ongoing serous oozing, minor gap formation, or if the wound requires barrier protection against external contamination in sensitive anatomical folds.
Can I Manage Such Wounds At Home?
Yes, simple dry dressings can be handled at home by a family member or home nurse using sterile gloves and gauze, strictly adhering to the aseptic techniques demonstrated by hospital staff.
How Do I Recognize If There Is Any Issue With My Stitches?
Contact your surgical team immediately if you notice spreading redness, increasing swelling, foul-smelling or purulent discharge, wound gaping, persistent fever, or rapidly worsening pain around the incision.
Chemotherapy In Cancer Treatment
What is chemotherapy?
Chemotherapy is a general term used to refer to administration of chemotherapeutic drugs to kill the cancer cells.
It’s a common misconception that chemotherapy means “a single drug that kills cancer”. In reality, there are several varieties of chemotherapy drugs. The choice of drug depends on the type of cancer being treated.
Why is chemotherapy given?
Chemotherapy is given to destroy cancer cells, shrink tumors before surgical removal (neoadjuvant), eliminate microscopic cancer cells that might remain after surgery (adjuvant), or control tumor growth and alleviate symptoms in advanced stages (palliative).
How chemotherapy is given?
Chemotherapy can be given intravenously (through a drip into a vein or via a chemoport), orally as tablets/capsules, or occasionally injected into specific body cavities (such as intraperitoneally or intrathecally).
Does chemotherapy mean only one drug/medicine?
No. Most chemotherapy regimens involve a combination of multiple drugs that work through different biological mechanisms to attack cancer cells at various stages of their growth cycle.
What does a “chemotherapy cycle” mean?
A cycle consists of the administration of chemotherapy followed by a defined rest and recovery period (often lasting 2 to 3 weeks). This rest period allows healthy cells and organs to regenerate before the next dose.
I am afraid of needle pricks!!!
For patients who require repeated intravenous cycles or have fragile veins, doctors often place an implantable device called a chemoport under the skin. This significantly reduces needle discomfort and avoids repeated vein punctures.
How long does my chemotherapy last?
The total duration depends on the cancer type, stage, and individual regimen. A standard course usually lasts between 3 to 6 months, divided across planned treatment cycles.
How do we come to know that my chemotherapy is working?
Response to treatment is assessed through periodic imaging scans (CT, MRI, or PET-CT), tumor marker blood tests, and physical clinical examinations to evaluate tumor shrinkage or symptom relief.
How can I make my chemotherapy more effective?
Maintaining adequate nutrition, drinking plenty of fluids, strictly following your medication schedule, and immediately reporting any side effects so they can be managed without treatment delays all help optimize treatment effectiveness.
What foods should be avoided during chemotherapy?
Avoid raw or undercooked meats, unpasteurized milk or cheeses, unpeeled raw street food, and unwashed raw fruits/salads to minimize the risk of foodborne infections when your immune system is temporarily suppressed.
Am I going to lose all my hair due to chemo?
Not all chemotherapy drugs cause hair loss. Some cause mild thinning, while others cause temporary loss. In almost all cases, hair begins regrowing within a few weeks to months after completing the treatment.
Is it possible to prevent hair loss?
Techniques such as scalp cooling caps (cold caps) can reduce blood flow to hair follicles during infusions, which helps minimize or prevent hair loss for certain chemotherapy regimens.
Why am I advised chemotherapy even before the surgery?
Preoperative (neoadjuvant) chemotherapy is given to downsize larger tumors, make them surgically resectable, reduce surgical morbidity, and address microscopic systemic spread as early as possible.
I have undergone successful removal of my tumor. Why am I still advised to undergo chemotherapy?
Even after complete tumor excision, microscopic cancer cells may remain in the bloodstream or regional tissues. Postoperative (adjuvant) chemotherapy destroys these stray cells and minimizes the chance of disease recurrence.
Are there any alternatives to chemotherapy?
Depending on cancer subtype and molecular profiling, alternatives or complementary therapies may include targeted therapy, immunotherapy, and hormone therapy.
Do I have to make changes in my diet?
Focus on a clean, hygienic, high-protein diet that helps support tissue recovery and maintain muscle mass. Small, frequent meals are often easier to tolerate if you experience nausea or reduced appetite.
Can I work while receiving chemotherapy?
Many patients continue working during treatment, especially on light duties or remote work setups. Energy levels tend to dip for a few days right after an infusion, so flexible scheduling is recommended.
Where can I receive chemotherapy?
Most chemotherapy is delivered in a daycare oncology unit without needing overnight hospitalization. In specialized or intensive infusion regimens, short hospital admission may be required.
Does chemotherapy have severe side effects?
Modern supportive medications (anti-nausea drugs, growth factors, and anti-allergy medicines) have significantly reduced severe side effects. Most side effects are manageable and resolve once treatment finishes.
What are the common side effects of chemotherapy?
Common side effects include fatigue, nausea, appetite changes, mouth ulcers, diarrhea or constipation, temporary drops in blood cell counts (increasing vulnerability to infection), and transient hair loss.
I am worried that I won’t tolerate chemotherapy.
Your medical oncologist tailors drug dosages to your age, weight, liver/kidney function, and overall performance status. Doses can be adapted or paused at any point to ensure safety and comfort.
Who will give my chemotherapy?
Chemotherapy is prescribed by a Medical Oncologist and administered by trained oncology nurses in an infusion day-care facility.
What if my chemotherapy does not work?
If a tumor shows resistance or lack of response to a first-line regimen, oncologists switch to second-line therapies, targeted agents, immunotherapy, or clinical trials.
Can I take my routine diabetic, blood pressure medicines? Vitamin supplements?
Routine prescription medicines for hypertension or diabetes should generally be continued. Always inform your oncologist about all ongoing medications and any over-the-counter supplements, as certain antioxidants or vitamins may interact with chemotherapeutic drugs.
Chemoport In Cancer Treatment
What is a Chemoport?
Chemoport is a medical device that is implanted into the patient’s body (just under the skin of the chest, most commonly), primarily for chemotherapy. It has a small chamber with a thin tube (catheter) attached to it. This tube enters the vein. The entire device is under your skin and no part of the port is outside.
Why am I advised to get it inserted?
Chemotherapy drugs can cause severe irritation, burning, and sclerosis in peripheral arm veins over multiple cycles. A chemoport provides direct, safe access to a large central vein where drugs quickly dilute, preventing chemical phlebitis, repeated needle pricks, and vein damage.
What are the advantages of Chemoport?
It eliminates recurrent, painful needle pricks, reduces the risk of drug extravasation (leakage into surrounding tissues), remains entirely concealed under the skin, allows patients to shower freely once healed, and can remain in place for months or years.
Besides receiving chemotherapy, are there any other advantages of having a Chemoport?
Yes. The port can also be used for taking blood samples, delivering intravenous fluids, administering antibiotics, giving blood transfusions, and injecting contrast dye for certain imaging scans (if a power-injectable port is used).
How chemotherapy is administered from Chemoport?
The skin over the port is cleaned with an antiseptic, and a specially designed, non-coring needle (Huber needle) is inserted through the skin into the self-sealing silicone septum of the port. Medications are then infused smoothly through this needle.
Will it be painful every time a needle is inserted into my port?
Most patients experience only a minor pinch. To minimize discomfort, a local anesthetic cream (such as EMLA) can be applied over the port area 45–60 minutes before the needle is inserted.
Where does the Chemoport go in my body?
The port chamber is placed in a small pocket created under the skin below the collarbone (clavicle) on the upper chest wall. The flexible catheter runs beneath the skin and enters one of the large central veins (typically the internal jugular or subclavian vein).
How is it inserted?
It is placed through a minor surgical procedure under sterile operating room conditions, using ultrasound guidance and fluoroscopy (real-time X-ray) to ensure exact positioning of the catheter tip near the heart.
How long does it take to put a chemoport?
The insertion procedure typically takes about 30 to 45 minutes under standard surgical conditions.
What preparations do I have to make before the insertion procedure?
You may be asked to fast (nothing to eat or drink) for 4 to 6 hours before the procedure, undergo basic blood tests (coagulation profile and complete blood count), and temporarily adjust any blood-thinning medications as advised by your doctor.
Do I need anesthesia for this procedure?
It is commonly performed under local anesthesia combined with mild intravenous sedation so that you remain relaxed, comfortable, and pain-free throughout the procedure.
How long do I have to stay in the hospital after the procedure?
It is done as a daycare procedure. After a short observation period of 2 to 4 hours post-insertion, you are usually discharged home the same day.
What are the risks of this procedure?
Risks are low when performed by trained surgeons, but can include minor bleeding, bruising, local infection, rare accidental puncture of adjacent structures, or catheter thrombosis. Proper sterile care keeps infection rates minimal.
Is an X ray taken after the procedure?
Yes. A post-procedure chest X-ray is routinely performed to verify the exact position of the catheter tip and confirm that the lung is completely unaffected.
Is the Chemoport clearly visible through the skin?
No, it usually appears only as a subtle, small bump under the skin and is not noticeable under normal clothing.
What care do I have to take after the discharge?
Keep the surgical dressing dry and clean for the first 5 to 7 days until the incision heals. Take prescribed mild analgesics if you experience soreness, and report any redness, swelling, or fever promptly.
How should I sleep after Chemoport insertion?
For the first few days, sleep on your back or on the opposite side to avoid putting direct pressure or weight on the newly placed port site.
Can I carry shoulder bags?
Avoid placing heavy strap bags, backpack straps, or seatbelt tension directly over the port site to prevent localized friction and discomfort.
What care do I have to take while bathing?
Keep the incision area dry until the sutures have healed completely and your doctor gives clearance. Once healed, you can bathe or shower normally because the entire port is beneath the skin.
Will there be any restrictions on my activities if I undergo Chemoport insertion?
Once healed, you can resume almost all normal activities, including walking and light exercise. However, avoid strenuous upper-body weightlifting, heavy direct-contact sports, or sudden excessive pulling around the shoulder on that side.
How long can I keep the Chemoport?
A chemoport can safely remain in place for the entire duration of your chemotherapy and subsequent monitoring period—often ranging from several months to a few years.
Who can use/access the Chemoport?
Only trained oncology nurses, doctors, or specialized healthcare professionals who are certified in sterile port-access technique using non-coring Huber needles should access the device.
What maintenance is required? How often does a port need to be flushed?
When in active use, the port is flushed after each infusion. If the port is not in active use, it needs a routine heparinized saline flush every 4 to 6 weeks to keep the catheter clear and prevent blockages.
When can I get the port removed?
Once your medical oncologist confirms that all courses of chemotherapy and related IV treatments are complete and the port is no longer required for treatment or surveillance, it can be scheduled for removal.
Is removal of Chemoport a major surgical procedure?
No. Removing a chemoport is an even simpler procedure than inserting it. It is done in daycare under local anesthesia, takes about 15 to 20 minutes, and allows you to return home shortly afterward.
How To Manage The Wounds At The Drain Tube Sites, At Home?
What Are These Drain Tubes?
These are tubes made of non-reactive plastic with varying pliability. These are kept in the surgical field to drain the fluid that is discharged from the raw surgical surfaces.
They prevent these fluids from getting collected inside the body; as such collections may hamper healing and may later get infected. They are also used to monitor the healing process, where surgery is performed on hollow tubes like intestines, ureters, bladder, and bile ducts.
Any leakage from these structures can be identified by the nature and volume of the fluid that is drained by these tubes.
When These Tubes Are Removed?
Drain tubes are removed when the daily drainage volume drops significantly (usually below 20–30 ml over 24 hours), the color of the output transitions to clear serous fluid, and your surgical team is confident that there are no internal fluid collections or anastomotic leaks.
The Tubes I Had In Place After Surgery Were Removed In The Hospital. Now I Am Getting Discharged. I Want To Know How I Can Take Care Of The Small Wounds At The Drain Tube Sites?
Care for the drain site primarily involves keeping it clean, dry, and protected with a sterile dressing. Avoid picking at scabs or probing the small puncture opening, and wash your hands thoroughly before touching or changing any dressings.
How Long These Wounds To Take To Heal?
Because the small puncture hole left behind heals from the inside out (by secondary intention), it typically takes about 5 to 10 days for the tract to close completely and skin over.
How Long Should I Keep Dressing These Wounds?
Continue keeping the site dressed until all fluid leakage and serous staining have stopped and a dry scab has formed over the puncture site—usually for 3 to 7 days following tube removal.
The Dressing Done In The Hospital Looks Perfectly Fine. Do I Have To Change It?
If the hospital dressing remains clean, completely dry, and well-adhered, you do not need to disturb it immediately. It should be changed if it becomes loose, soiled, or soaked with fluid drainage.
Do I Have To Change The Dressing Daily?
Daily dressing changes are only required if there is active fluid seepage soaking the gauze. Once drainage ceases and the site stays dry, daily changes are unnecessary and leaving it undisturbed promotes faster healing.
What Kind Of Dressing Is Required To Cover These Wounds?
A simple sterile gauze pad secured with medical micropore adhesive tape is usually all that is needed. Avoid using airtight or waterproof plastic tapes that trap sweat and moisture against the healing skin.
How Do I Clean These Wounds?
Clean around the puncture site gently using a sterile cotton swab or gauze moistened with sterile saline or a prescribed antiseptic solution (such as povidone-iodine), wiping gently from the center outward.
Do I Have To Apply Anything On These Wounds At Home?
No special creams, powders, or ointments should be applied unless directly prescribed by your surgeon. Keeping the puncture wound clean and dry is the safest approach to prevent bacterial colonization.
Should I Avoid Taking Bath Till These Wounds Heal?
You can take a sponge bath while ensuring the drain wound is kept completely dry. Avoid full showers, tub baths, or swimming pools until the tract has fully sealed and your surgeon confirms it is safe.
The Dressing At The Drain Site Gets Wet Frequently. Should I Be Worried?
A small to moderate amount of clear or pinkish serous fluid leakage is normal for the first 24–48 hours after removal. Simply replace the damp dressing with a dry sterile one. However, if copious amounts continue to soak through multiple pads rapidly, notify your surgical team.
When Should I Contact My Surgeon? How Do I Understand There Is Something Wrong With These Wounds?
Contact your surgical team immediately if you notice spreading redness, increasing localized heat or swelling, thick yellow/green foul-smelling pus, persistent high fever, or sudden large surges of fluid escaping from the site.
PET Scan
What is PET scan?
PET scan is the abbreviation for Positron Emission Tomography. It is an imaging procedure, similar to CT scan. However, in PET scan a special drug is used, that emits radiation (a radiotracer).
What is PET scan used for?
A PET scan is used to evaluate cellular metabolic activity and organ function. While primarily known for cancer detection and staging, it is also used in cardiology (to assess blood flow and heart tissue vitality) and neurology (to investigate brain disorders such as Alzheimer's, epilepsy, and Parkinson's disease).
How PET scan helps in Cancer?
In cancer management, PET scans help pinpoint primary tumor locations, detect regional lymph node spread, determine whether the cancer has metastasized to distant organs (staging), evaluate how well a tumor is responding to chemotherapy or radiotherapy, and monitor for recurrence after treatment.
How does PET scan identify the cancer and its spread?
Cancer cells divide rapidly and consume significantly higher amounts of glucose than normal healthy tissues. Patients are injected with a radiolabeled glucose compound (typically Fluorodeoxyglucose or 18F-FDG). The PET scanner detects areas of high glucose uptake, highlighting cancerous lesions as bright "hot spots" on the images.
Is PET scan 100% accurate?
No imaging modality is 100% accurate. Non-cancerous conditions such as active infections, inflammation, or healing wounds can also show high glucose uptake, producing false positives. Conversely, very tiny lesions (under a few millimeters) or slow-growing, low-metabolic tumors may not register clearly (false negatives).
How do I prepare for a PET scan?
Preparation typically requires fasting for 4 to 6 hours prior to the scan (plain water is usually permitted), avoiding strenuous physical exercise for 24 hours beforehand, and adhering to strict low-carbohydrate guidelines. Diabetic patients must follow specific instructions from the imaging center to ensure blood glucose levels remain in an acceptable range before radiotracer injection.
How the PET scan is done? What to expect? How much time does it take?
Upon arrival, your blood sugar is verified, and the radiotracer is administered through a small IV line. You then rest quietly in a designated room for about 45 to 60 minutes while the tracer distributes through your body tissues. The actual scan inside the machine takes around 20 to 30 minutes, making the total appointment duration approximately 2 to 3 hours.
What happens during the scan?
You lie flat on a cushioned motorized examination table that smoothly moves through the ring-like opening of the PET-CT scanner. You will be instructed to remain as still as possible so that images remain sharp and clear. The machine makes gentle humming noises, but the procedure is non-invasive and painless.
What precautions am I supposed to take after the PET scan?
Drink plenty of fluids (water and juices) throughout the remainder of the day to help flush the radiotracer from your system via urine. As a standard safety precaution, maintain physical distance from pregnant women, infants, and young children for roughly 6 to 12 hours after the scan.
I am advised biopsy and PET scan as well. What should I get done first?
In most situations, performing the PET scan before the biopsy is preferred. Biopsy procedures cause local inflammation and healing changes, which can take up glucose and create misleading "hot spots" on a subsequent PET scan. Your treating oncologist will guide the optimal sequence based on clinical urgency.
Is PET scan painful?
No. The scan itself is entirely painless. The only mild discomfort is the standard needle prick when the intravenous cannula is inserted to inject the radiotracer.
How do I get the results of the PET scan?
The cross-sectional images are analyzed and interpreted by a certified Nuclear Medicine specialist or Radiologist. A formal written report and digital image disc/access are typically available within 24 to 48 hours for your oncologist to review.
What are the risks of PET scan?
The amount of radiation received from the radiotracer and low-dose CT component is relatively small and carries very low risk compared to the clinical benefit of accurate cancer staging. Allergic reactions to the radiotracer are extremely rare.
Will PET scan tell if I have cancer elsewhere in body?
Yes. A whole-body PET-CT scan generally covers the region from the base of the skull down to mid-thigh (or head to toe when indicated), allowing clinicians to check whether the disease has spread to distant lymph nodes, bones, liver, lungs, or other organs.
Will I need any other scan?
Possibly. While PET scans provide functional and metabolic data, high-resolution anatomical imaging such as a contrast-enhanced MRI (often preferred for brain, liver, spine, or pelvic organs) or dedicated high-resolution CT may still be required to assess surgical resectability and microscopic anatomical details.
Cancer Diagnosis
Can Cancer Be Diagnosed Based On Symptoms Alone?
Unfortunately, cancer symptoms are not very specific. Many of the symptoms produced by cancer are shared by several other common ailments.
For example, pain in the upper abdomen, bloating, acidity, or epigastric burning could be due to gastritis, a stomach ulcer, gallstones, or stomach cancer. Similarly, difficulty in passing urine in an elderly individual is most commonly due to benign prostate enlargement, but prostate cancer can present in a very similar manner.
However, certain red-flag presentations carry very high suspicion—such as an ulcerative, non-healing growth in the mouth of an individual with a history of tobacco use, or a hard lump in the breast of an older woman—which must be considered cancerous unless proven otherwise.
Can Clinical Examination Diagnose A Cancer?
A physical examination by an experienced oncologist can strongly suggest the presence of cancer by evaluating a tumor's texture, mobility, borders, and associated lymph node swelling. However, a clinical exam alone cannot provide an absolute, conclusive diagnosis—it must be backed by pathology and diagnostic imaging.
What Is "A Must" For Cancer Diagnosis?
A microscopic tissue examination—namely a histopathological examination (biopsy)—is an absolute necessity ("a must") for confirming a cancer diagnosis. It identifies the exact cellular origin, histological type, grade, and malignant behavior of the tumor.
Is Biopsy Always Necessary For Cancer Diagnosis?
In almost all cases, yes. A biopsy is mandatory before starting systemic therapies like chemotherapy, radiotherapy, or targeted therapy. There are rare exceptions (such as classic radiological presentations of primary liver cancers like HCC in cirrhotic patients or certain testicular tumors) where upfront surgery is planned based on characteristic imaging and tumor markers, but the resected specimen is still confirmed by pathology afterward.
Is Diagnosis Of Cancer On Biopsy Enough To Start Treatment?
No. Confirming cancer under the microscope is only the first step. Before beginning treatment, doctors must establish the stage of the disease (extent of local and distant spread) through imaging, and often perform immunohistochemistry (IHC) or molecular genetic tests to determine which targeted therapies will be most effective.
Why So Many Tests Are Required Before Treatment Begins?
Cancer treatment is personalized and depends heavily on precise staging, tumor genetics, and patient fitness. Multiple scans (CT, MRI, PET-CT) determine if the tumor can be surgically removed, cardiac and pulmonary tests confirm whether the patient can safely undergo anesthesia or chemotherapy, and blood tests ensure vital organs are functioning properly.
Cancer Staging
Why Cancer Needs To Be Staged?
To treat a cancer, it’s imperative that we need to know how far it has spread. Based on the degree of its spread in the organ concerned, its surrounding area and to other distant parts of the body, the cancer is staged.
Each stage has a specific treatment method to achieve optimal results. Hence staging is a must before starting treatment.
How Many Cancer Stages Are There?
Most solid cancers are categorized into four numbered stages (Roman numerals I through IV), often preceded by Stage 0 (carcinoma in situ):
Stage 0: Abnormal cells are confined to their original layer without invasion into deeper tissues.
Stage I: The tumor is small and confined entirely to the primary organ (early stage).
Stage II & III: Larger tumor growth, deeper local tissue invasion, and involvement of nearby regional lymph nodes (locally advanced stage).
Stage IV: The cancer has spread to distant organs, such as the liver, lungs, bones, or peritoneum (metastatic or advanced stage).
How Do We Come To Know Which Stage The Cancer Is?
Cancer stage is determined through a comprehensive diagnostic workup, which includes:
• Imaging Scans: Contrast-enhanced CT scans, MRI, Ultrasound, and PET-CT scans to visualize local depth and distant spread.
• Biopsies & Endoscopy: Direct visualization (e.g., upper GI endoscopy, colonoscopy) and tissue sampling.
• Laboratory Tests: Specific tumor markers and organ function tests.
• Pathological Staging: Microscopic examination of surgical specimens (primary tumor and removed lymph nodes) after surgery.
Are All Cancers Staged The Same Way?
No. While most solid tumors (such as breast, stomach, colon, lung, and prostate) follow the anatomic TNM classification, certain malignancies have distinct staging systems. For instance, blood cancers like leukemias are not staged numerically like solid tumors, lymphomas utilize the Ann Arbor system, gynecological cancers frequently reference the FIGO system, and brain tumors are classified primarily by grade rather than nodal staging.
Is There A Standard Of Staging Cancer?
Yes. Globally, the primary benchmark is the TNM Staging System developed and maintained by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC):
• T (Tumor): Indicates the size and extent of the primary tumor.
• N (Nodes): Evaluates whether cancer cells have reached regional lymph nodes.
• M (Metastasis): Denotes whether the cancer has spread to distant body parts.
What Does Cancer Stage Indicate?
The cancer stage indicates three fundamental aspects: the anatomical extent of the disease, the recommended treatment blueprint (e.g., upfront surgery vs. neoadjuvant chemotherapy or radiation), and the expected prognosis or long-term survival probability.