For most cancers, abnormal tissue must be removed and examined to make a diagnosis. A pathologist in a laboratory looks at the sample under a microscope to check for cancer.
The biopsy may be done using a thin or hollow needle, which may be guided by an ultrasound. This isn’t called surgery. A surgical biopsy (open biopsy) is done by cutting the body to take out all or part of the tumour. Various surgical tools can be used, depending on the part of the body affected.
Part of the tumour is removed to make a diagnosis. Sometimes the tissue may be examined by a pathologist in the operating theatre – this is called a frozen section. The frozen section helps the surgeon decide how extensive the surgery should be.
The entire abnormal area is removed. A margin of healthy tissue is usually cut out at the same time. This could be the only treatment required.
A long, thin, flexible tube with a light and camera is inserted into the body through an existing opening (e.g. the mouth or rectum). The doctor can then view images of the body on a TV or computer screen and cut out tissue.
There are many types of endoscopy, named after the part of the body affected. Some examples include:
This is similar to an endoscopy, except the surgeon must make small incisions on the abdomen to operate, instead of using natural openings in the body. You may also need general anaesthesia.
Other examples include thoracoscopy or mediastinoscopy procedures, which affect the chest.
The surgeon makes a vertical cut in the abdomen to look at the abnormal area. When it’s done to view the chest, this is called a thoracotomy. This might be carried out if less invasive tests, like a needle biopsy or laparoscopic biopsy, don’t work.
The way skin is biopsied depends on the tumour. The doctor can use a needle or do an incisional or excisional biopsy to shave off tissue. Another type of skin biopsy uses an instrument called a punch to remove skin layers.
Sometimes a surgical biopsy can be done in the doctor’s rooms, but it can also be done in theatre (in hospital) as day surgery. The amount of anaesthesia you receive depends on the procedure. For more information, see skin cancer or melanoma.
The stage of the cancer describes how far it has spread in the body. Staging the cancer can help the doctor recommend the best treatment for you. This may be determined by what is found during surgery as well as the results of medical imaging scans.
There are different staging systems used, depending on the type of cancer. However, the most common international system is called TNM. The table below has a general overview of this system.
|The TNM system
|T (Tumour) 1-4
||Refers to the size of the primary tumour. The higher the number, the larger the cancer.|
|N (Nodes) 0-3
||Shows whether the cancer has spread to the regional lymph nodes of the neck. No nodes affected is 0; increasing node involvement is 1, 2 or 3.|
|M (Metastais) 0-1||Cancer has either spread (metastasised) to other organs (1) or it hasn’t (0).|
The letters in TNM may also be assigned numbers to describe how far the cancer has spread. Some cancers are also given a grade, which describes how abnormal the cancer cells are and how fast they are growing.
To diagnose and grade the cancer, a pathologist must examine the tissue under a microscope. Sometimes it’s possible to biopsy a small amount of tissue, but in other cases, the doctor must perform a surgical procedure to remove enough tissue.
For specific information about staging a certain type of cancer, talk to your medical team or call Cancer Council 13 11 20.
Sometimes staging or diagnostic surgery removes the whole cancer, and you don’t need further surgery or other treatment.
"I had my testicle removed to cut out the cancer, then I didn’t need further treatment. The doctor put me on surveillance, which is just like having frequent check-ups with the specialist." – Michael
Reviewed by: Dr Bronwyn Avard, Deputy Director, Intensive Care Unit, The Canberra Hospital and Senior Lecturer, ANU Medical School, ACT; Kylie Foley, Registered Nurse, Urological, Gynaecological and Vascular Surgery, Royal North Shore Hospital, and Practice Nurse, Hills Family General Practice, NSW; Di Holt, Consumer; Shelly Hunter, Physiotherapist, Brisbane Private Hospital Rehabilitation Unit, QLD; Lorraine Kealley, Registered Nurse, Medical Oncology Ward, Royal Perth Hospital, WA; Shomik Sengupta, Urologist, Sengupta Urology, VIC; Dr BP Wheatley, Retired Generalist Obstetrician and Gynaecologist, SA; Carmen Heathcote, Yvonne Howlett and Amy Parker, Helpline Operators, Cancer Council Queensland.