D

diagnosing cancer The procedures and tests that
determine whether cancer is present. The diagnos-
tic journey often begins with an unusual finding on
a screening procedure, such as a MAMMOGRAMor
PROSTATE SPECIFIC ANTIGEN(PSA)BLOODtest, or diag-
nostic procedure done for another purpose such as
an X-RAY or a complete blood count (CBC).
Sometimes the person identifies symptoms, such as
the presence of a lump or rectal bleeding.
The initial doctor’s evaluation includes a thor-
ough ROUTINE MEDICAL EXAMINATION with specific
focus on the abnormal findings; comprehensive
PERSONAL HEALTH HISTORY; and appropriate diagnos-
tic tests, which may include any combination of
blood tests, X-rays, COMPUTED TOMOGRAPHY (CT)
SCAN, POSITRON EMISSION TOMOGRAPHY (PET) SCAN,
MAGNETIC RESONANCE IMAGING (MRI), ULTRASOUND,
and biopsy.
Biopsy provides the definitive diagnosis for can-
cer, giving the pathologist the opportunity to
examine tissue structure and cell composition.
Depending on the location, size, and characteris-
tics of a tumor, the doctor may remove a small
sample of tissue or remove the entire tumor. Com-
mon methods for sampling tumors include

• fine-needle aspiration, in which the doctor
  inserts a small needle into the tumor to with-
  draw a sample of fluid and cells


• core-needle biopsy, in which the doctor inserts
  a larger needle into the tumor to extract a core
  of solid tissue


• ENDOSCOPY, in which the doctor inserts an endo-
  scope into the body through a natural opening
  to examine suspicious tissues and remove sam-
  ples
  
  
  • incisional biopsy, in which the surgeon
    removes a portion of the tumor to obtain a rep-
    resentative tissue sample
  
  
  • excisional biopsy, in which the surgeon
    removes the entire tumor
  
  
  
  

The pathologist then determines, from the diag-

nostic tests, imaging procedures, and biopsy find-

ings, the cancer’s stage and grade—assessments of

how extensive the presence of the cancer in the

body and how aggressive the growth of the cancer

cells. Though most cancers fit within the standard

parameters of STAGING AND GRADING OF CANCER,

some do not. The doctor may then present the cir-

cumstances and diagnostic findings to a review

panel of physician specialists, often called the

“tumor board,” for additional input and assess-

ment. All of these evaluations then help guide the

CANCER TREATMENT OPTIONS AND DECISIONS.

See also CANCER PREVENTION; COLONOSCOPY; SUR-

GERY BENEFIT AND RISK ASSESSMENT; SURGERY FOR

CANCER.

diet and cancer The ways in which foods and

NUTRIENTS influence the risk for cancer, cancer

development, and the effectiveness of cancer

treatment. A number of foods have emerged that

appear to contain substances that have cancer-

fighting capabilities. Substances found in foods

that appear able to help the IMMUNE SYSTEMsup-

press the development and growth of cancer cells

include calcium, folate (folic acid), carotenoids,

vitamin C, flavonoids, lignans, lycopenes, cate-

chins, indoles, and SOY isoflavones. Numerous

foods provide these substances. Conversely, foods

that are high in saturated fat, highly salted foods,

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