The initial evaluation of a person presenting with symptoms suggestive of cancer begins with an assessment of the presenting symptoms, personal and family medical history, risk factors for cancer and a thorough physical examination.
This history and physical examination might suggest an initial diagnosis. However, most often, laboratory tests are performed to confirm the clinician's initial working diagnosis and assist in the evaluation of the impact of a cancer on major organ function. Laboratory studies may include analysis for tumour markers which are helpful in the diagnosis and evaluation of the progress of some cancer types.
The next stage in the diagnostic process generally involves the use of diagnostic imaging techniques to locate the primary tumour and, if indicated, determine the extent of any metastatic disease. Following the localisation of the primary and/or secondary disease sites, the definitive step in establishing a diagnosis is the collection of a tumour tissue sample for pathological analysis. Tissue biopsy for pathological analysis is essential in determining the characteristics of a tumour that will guide decisions about how it should best be treated.37, 38, 42
Access a current text or relevant literature. For the following tumour markers, summarise the associated malignancies, normal ranges, and implications of the marker for cancer detection and monitoring:
- prostate-specific antigen (PSA)
- alpha-fetoprotein (AFP).
Access a current text and summarise the indications, adverse effects and nursing implications for the following methods of obtaining biopsy tissue samples for the purpose of making a cancer diagnosis:
- fine-needle aspiration
- core needle biopsy
- excisional biopsy
- incisional biopsy
- endoscopic biopsy.
For the following imaging techniques, discuss the indications and their role in cancer diagnosis and preparation required for the procedure:
- magnetic resonance imaging (MRI)
- positron emission tomography (PET)
- bone scan
Select one cancer type and describe the likely pathway for a person who may have a suspected diagnosis of this cancer type, from symptom presentation to commencement of treatment.