1

ASSIGNMENT ON
INVESTIGATIONS-
ONCOLOGY

Submitted by,
Submitted to,
Ms. Axsa Alex
Prof.Mrs.Regi Philip
1st year M.Sc. nursing
HOD of MSN
SJCON, Anchal
SJCON,Anchal Submitted on;28/3/2020
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INTRODUCTION
If a patient has a symptom or a screening test result that suggests cancer, doctor must find
out whether it is due to cancer or some other cause. The doctor may start by asking about
personal and family medical history and do a physical exam. The doctor also may order lab
tests, imaging tests (scans), or other tests or procedures. Patient may also need a biopsy,
which is often the only way to tell for sure if he has cancer.
INVESTIGATIONS
LAB TESTS
High or low levels of certain substances in the body can be a sign of cancer. So, lab tests of
blood, urine, or other body fluids that measure these substances can help doctors make a
diagnosis. However, abnormal lab results are not a sure sign of cancer
Some lab tests involve testing blood or tissue samples for tumor markers. Tumor markers are
substances that are produced by cancer cells or by other cells of the body in response to
cancer. Most tumor markers are made by normal cells and cancer cells but are produced at
much higher levels by cancer cells..
What are laboratory tests?
A laboratory test is a procedure in which a sample of blood, urine, other bodily fluid, or tissue
is examined to get information about a person’s health. Some laboratory tests provide precise
and reliable information about specific health problems. Other tests provide more general
information that helps doctors identify or rule out possible health problems. Doctors often use
other types of tests, such as imaging tests, in addition to laboratory tests to learn more about a
person’s health.
How are laboratory tests used in cancer medicine?
Laboratory tests are used in cancer medicine in many ways:

 To screen for cancer or precancerous conditions before a person has any symptoms of
disease
 To help diagnose cancer
 To provide information about the stage of a cancer (that is, its severity); for malignant
tumors, this includes the size and/or extent (reach) of the original (primary) tumor and
whether or not the tumor has spread (metastasized) to other parts of the body
 To plan treatment
 To monitor a patient’s general health during treatment and to check for potential side
effects of the treatment
 To determine whether a cancer is responding to treatment
 To find out whether a cancer has recurred (come back)

Which laboratory tests are used in cancer medicine?

Categories of some common laboratory tests used in cancer medicine are listed below ;
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Blood chemistry test

What it measures: The amounts of certain substances that are released into the blood by the
organs and tissues of the body, such as metabolites, electrolytes, fats, and proteins, including
enzymes. Blood chemistry tests usually include tests for blood urea nitrogen (BUN) and
creatinine.
How it is used: Diagnosis and monitoring of patients during and after treatment. High or low
levels of some substances can be signs of disease or side effects of treatment.
Cancer gene mutation testing
What it measures: The presence or absence of specific inherited mutations in genes that are
known to play a role in cancer development. Examples include tests to look for BRCA1 and
BRCA2 gene mutations, which play a role in development of breast, ovarian, and other
cancers.
How it is used: Assessment of cancer risk
Complete blood count (CBC)
What it measures: Numbers of the different types of blood cells, including red blood cells,
white blood cells, and platelets, in a sample of blood. This test also measures the amount of
hemoglobin (the protein that carries oxygen) in the blood, the percentage of the total blood
volume that is taken up by red blood cells (hematocrit), the size of the red blood cells, and the
amount of hemoglobin in red blood cells.
How it is used: Diagnosis, particularly in leukemias, and monitoring during and after
treatment

Cytogenetic analysis
What it measures: Changes in the number and/or structure of chromosomes in a patient’s
white blood cells or bone marrow cells
How it is used: Diagnosis, deciding on appropriate treatment
Immunophenotyping
What it measures: Identifies cells based on the types of antigens present on the cell surface
How it is used: Diagnosis, staging, and monitoring of cancers of the blood system and other
hematologic disorders, including leukemias, lymphomas, myelodysplastic syndromes, and
myeloproliferative disorders. It is most often done on blood or bone marrow samples, but it
may also be done on other bodily fluids or biopsy tissue samples.
Sputum cytology (also called sputum culture)
What it measures: The presence of abnormal cells in sputum (mucus and other matter brought
up from the lungs by coughing)
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How it is used: Diagnosis of lung cancer

Tumor marker tests
What they measure: Some measure the presence, levels, or activity of specific proteins or
genes in tissue, blood, or other bodily fluids that may be signs of cancer or certain benign
(noncancerous) conditions. A tumor that has a greater than normal level of a tumor marker
may respond to treatment with a drug that targets that marker. For example, cancer cells that
have high levels of the HER2/neu gene or protein may respond to treatment with a drug that
targets the HER2/neu protein.
Some tumor marker tests analyze DNA to look for specific gene mutations that may be
present in cancers but not normal tissues. Examples include EGFR gene mutation analysis to
help determine treatment and assess prognosis in non-small cell lung cancer and BRAF gene
mutation analysis to predict response to targeted therapies in melanoma and colorectal
cancer.
Still other tumor marker tests, called multigene tests (or multiparameter gene expression
tests), analyze the expression of a specific group of genes in tumor samples. These tests are
used for prognosis and treatment planning. For example, the 21-gene signature can help
patients with lymph node–negative, estrogen receptor–positive breast cancer decide if there
may be benefit to treating with chemotherapy in addition to hormone therapy, or not.
How they are used: Diagnosis, deciding on appropriate treatment, assessing response to
treatment, and monitoring for cancer recurrence
Urinalysis
What it measures: The color of urine and its contents, such as sugar, protein, red blood cells,
and white blood cells.
How it is used: Detection and diagnosis of kidney cancer and urothelial cancers
Urine cytology
What it measures: The presence of abnormal cells shed from the urinary tract into urine to
detect disease.
How it is used: Detection and diagnosis of bladder cancer and other urothelial cancers,
monitoring patients for cancer recurrence
IMAGING TESTS
Imaging tests create pictures of areas inside your body that help the doctor see whether a
tumor is present. These pictures can be made in several ways:
CT SCAN
A CT scan uses an x-ray machine linked to a computer to take a series of pictures of organs
from different angles. These pictures are used to create detailed 3-D images of the inside of
the body..
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Sometimes, patient may receive a dye or other contrast material before having the scan.
Patient might swallow the dye, or it may be given by a needle into a vein. Contrast material
helps make the pictures easier to read by highlighting certain areas in the body.
During the CT scan, patient will lie still on a table that slides into a donut-shaped scanner.
The CT machine moves around , taking pictures.

What is computed tomography?

Computed tomography (CT) is an imaging procedure that uses special x-ray equipment to
create detailed pictures, or scans, of areas inside the body. It is sometimes called
computerized tomography or computerized axial tomography (CAT).
The term tomography comes from the Greek words tomos (a cut, a slice, or a section) and
graphein (to write or record). Each picture created during a CT procedure shows the organs,
bones, and other tissues in a thin “slice” of the body. The entire series of pictures produced in
CT is like a loaf of sliced bread—you can look at each slice individually (2-dimensional
pictures), or you can look at the whole loaf (a 3-dimensional picture). Computer programs are
used to create both types of pictures.
Modern CT machines take continuous pictures in a helical (or spiral) fashion rather than
taking a series of pictures of individual slices of the body, as the original CT machines did.
Helical CT (also called spiral CT) has several advantages over older CT techniques: it is
faster, produces better quality 3-D pictures of areas inside the body, and may detect small
abnormalities better.
In addition to its use in cancer, CT is widely used to help diagnose circulatory (blood) system
diseases and conditions, such as coronary artery disease (atherosclerosis), blood vessel
aneurysms, and blood clots; spinal conditions; kidney and bladder stones; abscesses;
inflammatory diseases, such as ulcerative colitis and sinusitis; and injuries to the head,
skeletal system, and internal organs. CT imaging is also used to detect abnormal brain
function or deposits in adult patients with cognitive impairment who are being evaluated for
Alzheimer’s disease and other causes of cognitive decline.
During CT procedure
During a CT procedure, the person lies very still on a table, and the table passes slowly
through the center of a large donut-shaped x-ray machine. With some types of CT scanners,
the table stays still and the machine moves around the person. The person might hear
whirring sounds during the procedure. At times during a CT procedure, the person may be
asked to hold their breath to prevent blurring of the images.
Sometimes, CT involves the use of a contrast (imaging) agent, or dye. The dye may be given
by mouth, injected into a vein, given by enema, or given in all three ways before the
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procedure. The contrast dye highlights specific areas inside the body, resulting in clearer
pictures. Iodine and barium are two dyes commonly used in CT.
In very rare cases, the contrast agents used in CT can cause allergic reactions. Some people
experience mild itching or hives (small bumps on the skin). Symptoms of a more serious
allergic reaction include shortness of breath and swelling of the throat or other parts of the
body. People should tell the technologist immediately if they experience any of these
symptoms, so they can be treated promptly. Very rarely, the contrast agents used in CT can
cause kidney problems for certain patients, such as those with impaired kidney function.
Patient kidney function can be checked with a simple blood test before the contrast agent is
injected.
CT is a noninvasive procedure and does not cause any pain. However, lying in one position
during the procedure may be slightly uncomfortable. The length of a CT procedure depends
on the size of the area being scanned, but it usually lasts only a few minutes to half an hour.
For most people, the CT is performed on an outpatient basis at a hospital or a radiology
center, without an overnight hospital stay.
Some people are concerned about experiencing claustrophobia during a CT procedure.
However, most CT scanners surround only portions of the body, not the whole body.
Therefore, people are not enclosed in a machine and are unlikely to feel claustrophobic.
Women should let their health care provider and the technologist know if there is any
possibility that they are pregnant. Depending on the part of the body to be scanned, the
provider may reduce the radiation dose or use an alternative imaging method. However, the
level of radiation exposure in a CT scan is believed to be too low to harm a growing fetus.
How is CT used in cancer?
CT is used in cancer in many different ways:

 To screen for cancer

 To help diagnose the presence of a tumor
 To provide information about the stage of a cancer
 To determine exactly where to perform (i.e., guide) a biopsy procedure
 To guide certain local treatments, such as cryotherapy, radiofrequency ablation, and
the implantation of radioactive seeds
 To help plan external-beam radiation therapy or surgery
 To determine whether a cancer is responding to treatment
 To detect recurrence of a tumor

How is CT used in cancer screening?

Studies have shown that CT can be effective in both colorectal cancer screening (including
screening for large polyps) and lung cancer screening.
Colorectal cancer
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CT colonography (also known as virtual colonoscopy) can be used to screen for both large
colorectal polyps and colorectal tumors. CT colonography uses the same dose of radiation
that is used in standard CT of the abdomen and pelvis, which is about 10 millisieverts (mSv)
(1). (By comparison, the estimated average annual dose received from natural sources of
radiation is about 3 mSv.) As with standard colonoscopy, a thorough cleansing of the colon is
performed before this test. During the examination, air or carbon dioxide is pumped into the
colon to expand it for better viewing.
The National CT Colonography Trial, an NCI-sponsored clinical trial, found that the
accuracy of CT colonography is similar to that of standard colonoscopy. CT colonography is
less invasive than standard colonoscopy and has a lower risk of complications. However, if
polyps or other abnormal growths are found on CT colonography, a standard colonoscopy is
usually performed to remove them.
Whether CT colonography can help reduce the death rate from colorectal cancer is not yet
known, and most insurance companies (and Medicare) do not currently reimburse the costs of
this procedure. Also, because CT colonography can produce images of organs and tissues
outside the colon, it is possible that non colorectal abnormalities may be found. Some of
these "extracolonic" findings will be serious, but many will not be, leading to unnecessary
additional tests and surgeries.
Lung cancer
The NCI-sponsored National Lung Screening Trial (NLST) showed that people aged 55 to 74
years with a history of heavy smoking are 20% less likely to die from lung cancer if they are
screened with low-dose helical CT than if they are screened with standard chest x-rays.
(Previous studies had shown that screening with standard chest x-rays does not reduce the
death rate from lung cancer.) The estimated amount of radiation in a low-dose helical CT
procedure is 1.5 mSv (1). Those who have never smoked tobacco products are considered to
be at too low a risk of lung cancer to benefit from lung cancer screening.
Despite the effectiveness of low-dose helical CT for lung cancer screening in heavy smokers,
the NLST identified risks as well as benefits. For example, people screened with low-dose
helical CT had a higher overall rate of false-positive results (that is, findings that appeared to
be abnormal even though no cancer was present) than those screened with standard x-rays.
NCI’s Patient and Physician Guide: National Lung Screening Trial provides more
information on the benefits and harms.
The benefits of helical CT in screening for lung cancer may vary, depending on how similar
someone is to the people who participated in the NLST. The benefits may also be greater for
those with a higher lung cancer risk, and the harms may be more pronounced for those who
have more medical problems (like heart or other lung disease), which could increase
problems arising from biopsies and other surgery. However, because low-dose lung CT can
produce images of organs and tissues outside the lung, it is possible that non pulmonary
abnormalities such as renal or thyroid masses may be found. As with extracolonic findings
from CT colonography, some such findings will be serious, but many will not.
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Under the Affordable Care Act, all Marketplace health plans, and many other health plans,
must cover lung cancer screening with low-dose CT as a preventive care benefit for adults
ages 55 to 80 years who have a 30 pack-year smoking history (e.g., smoked one pack of
cigarettes per day for 30 years or two packs of cigarettes per day for 15 years) and are either a
current smoker or a former smoker who quit within the last 15 years. People who think they
might qualify for screening with low-dose helical CT should discuss the appropriateness and
the benefits and risks of lung cancer screening with their doctors. They should also check
with their health insurance company to determine whether this screening is covered by their
insurance plan.
Medicare covers the costs of annual lung cancer screening with low-dose CT in beneficiaries
considered to be at increased risk based on their smoking history. Annual screening is
covered for Medicare beneficiaries who are between 55 and 77 years old; have no signs or
symptoms of lung cancer; are either a current smoker or have quit smoking within the last 15
years; have smoked an average of one pack a day for 30 years (i.e., 30 pack years); and
receive the screening and low-dose CT scan at a Medicare-approved radiology facility.
Medicare coverage includes a prescreening counseling visit with the health professional who
wrote the order to review the benefits and risks of lung cancer screening.
What is total, or whole-body, CT?
Total, or whole-body, CT creates pictures of nearly every area of the body—from the chin to
below the hips. This procedure, which is used routinely in patients who already have cancer,
can also be used in people who do not have any symptoms of disease. However, whole-body
CT has not been shown to be an effective screening method for healthy people. Most
abnormal findings from this procedure do not indicate a serious health problem, but the tests
that must be done to follow up and rule out a problem can be expensive, inconvenient, and
uncomfortable, and they may expose the patient to extra risks, such as from an invasive
procedure like a biopsy that may be needed to evaluate the findings. In addition, whole-body
CT can expose people to relatively large amounts of ionizing radiation—about 12 mSv, or
four times the estimated average annual dose received from natural sources of radiation. Most
doctors recommend against whole-body CT for people without any signs or symptoms of
disease.
What is combined PET/CT?
Combined PET/CT uses two imaging methods, CT and positron emission tomography (PET),
in one procedure. CT is done first to create anatomic pictures of the organs and structures in
the body, and then PET is done to create pictures that provide functional data about the
metabolic pathways (chemical reactions that take place in a cell to create and use energy) that
are active in tissues or cells. Cancer cells often use different metabolic pathways than normal
cells.
Patients undergoing a PET/CT procedure are administered a positron-emitting (radioactive)
substance, or radiopharmaceutical, that is designed to target cancer cells specifically.
Numerous radiopharmaceuticals have been developed. However, the most common PET
procedure uses an imaging agent called FDG (a radioactive form of the sugar glucose).
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Because cancerous tumors usually metabolize glucose more rapidly than normal tissues, they
take up more FDG and appear different from other tissues on a PET scan.

Other PET imaging agents can provide information about the level of oxygen in a particular
tissue, the formation of new blood vessels, the presence of bone growth, whether tumor cells
are actively dividing and growing, and whether cancer may have spread.
Combining CT and PET may provide a more complete picture of a tumor’s location and
growth or spread than either test alone. The combined procedure may improve the ability to
diagnose cancer, to determine how far a tumor has spread, to plan treatment, and to monitor
response to treatment. Combined PET/CT may also reduce the number of additional imaging
tests and other procedures a patient needs.
MRI
An MRI uses a powerful magnet and radio waves to take pictures of body in slices. These
slices are used to create detailed images of the inside of the body, which can show the
difference between healthy and unhealthy tissue.
When patient have an MRI, he lies still on a table that is pushed into a long, round chamber.
The MRI machine makes loud thumping noises and rhythmic beats.
Sometimes, patient might have a special dye injected into his vein before or during MRI
exam. This dye, called a contrast agent, can make tumours show up brighter in the pictures.
NUCLEAR SCAN
A nuclear scan uses radioactive material to take pictures of the inside of the body. This type
of scan may also be called radionuclide scan.
Before this scan, patient receive an injection of a small amount of radioactive material, which
is sometimes called a tracer. It flows through your bloodstream and collects in certain bones
or organs.
During the scan, patient lie still on a table while a machine called a scanner detects and
measures the radioactivity in the body, creating pictures of bones or organs on a computer
screen or on film.
After the scan, the radioactive material in body will lose its radioactivity over time. It may
also leave the body through urine or stool.

BONE SCAN
Bone scans are a type of nuclear scan that check for abnormal areas or damage in the bones.
They may be used to diagnose bone cancer or cancer that has spread to the bones (also called
metastatic bone tumours).
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Before this test, a very small amount of radioactive material is injected into vein. As it
travels through the blood, the material collects in abnormal areas in the bone. Areas where
the material collects show up on pictures taken by a special scanner. These areas are called
“hot spots.”
PET SCAN
A PET scan is a type of nuclear scan that makes detailed 3-D pictures of areas inside body
where glucose is taken up. Because cancer cells often take up more glucose than healthy
cells, the pictures can be used to find cancer in the body.
Before the scan, patient receive an injection of a tracer called radioactive glucose. During the
scan, patient will lie still on a table that moves back and forth through a scanner.
ULTRASOUND
An ultrasound exam uses high-energy sound waves that people cannot hear. The sound waves
echo off tissues inside body. A computer uses these echoes to create pictures of areas inside
body. This picture is called a sonogram.
During an ultrasound exam, patient will lie on a table while a tech slowly moves a device
called a transducer on the skin over the part of the body that is being examined. The
transducer is covered with a warm gel that makes it easier to glide over the skin.
X-RAYS
X-rays use low doses of radiation to create pictures inside body. An x-ray tech will put body
in position and direct the x-ray beam to the correct part of your body. While the images are
taken, patient must stay very still and may need to hold breath for a second or two.
BIOPSY
In most cases, doctors need to do a biopsy to diagnose cancer.

Definition:
A biopsy is a procedure in which the doctor removes a sample of tissue. A pathologist looks
at the tissue under a microscope and runs other tests to see if the tissue is cancer. The
pathologist describes the findings in a pathology report, which contains details about
diagnosis. Pathology reports play an important role in diagnosing cancer and helping decide
treatment options.
The biopsy sample may be obtained in several ways:
With a needle: The doctor uses a needle to withdraw tissue or fluid. This method is used for
bone marrow aspirations, spinal taps, and some breast, prostate, and liver biopsies.
With endoscopy: The doctor uses a thin, lighted tube called an endoscope to examine areas
inside the body. Endoscopes go into natural body openings, such as the mouth or anus. If the
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doctor sees abnormal tissue during the exam, he will remove the abnormal tissue along with
some of the surrounding normal tissue through the endoscope.
Examples of endoscopy exams include:
Colonoscopy, which is an exam of the colon and rectum. In this type of exam, an endoscope
goes through the anus, allowing the doctor to examine the rectum and colon. If the doctor
sees polyps, she will remove them and send them to a lab for testing.
Bronchoscopy, which is an exam of the trachea, bronchi, and lungs. In this type of exam, an
endoscope goes through the mouth or nose and down the throat.
With surgery: A surgeon removes an area of abnormal cells during an operation. Surgery
may be excisional or incisional.
In an excisional biopsy, the surgeon removes the entire area of abnormal cells. Often some of
the normal tissue around these cells is also removed.
In an incisional biopsy, the surgeon removes just part of the abnormal area.
Some biopsies may require a sedative or anaesthesia.
Sedatives are medicine that help you relax and stay very still or sleep during a
biopsy.Anaesthesia keeps you from feeling pain. It refers to drugs or other substances that
cause you to lose feeling or awareness.
There are three types of anaesthesia:

Local anaesthesia, which causes loss of feeling in one small area of the body
Regional anaesthesia, which causes loss of feeling in a part of the body, such as an arm or leg
General anaesthesia, which causes loss of feeling and a complete loss of awareness that
seems like a very deep sleep
AFTER CANCER IS DIAGNOSED
If the biopsy and other tests show that patient have cancer, he may undergo more tests to help
doctor plan treatment. For instance, doctor will need to figure out the stage of cancer. For
some cancers, knowing the grade of the tumour or risk group that patient fall into are
important for deciding on the best treatment. The tumour may also be tested further for other
tumour or genetic markers.
CONCLUSION
A plan for the diagnosis and treatment of cancer is a key component of any overall cancer
control plan. Its main goal is to cure cancer patients or prolong their life considerably,
ensuring a good quality of life. For a diagnosis and treatment programme to be effective, it
must never be developed in isolation. It needs to be linked to an early detection programme
so that cases are detected at an early stage, when treatment is more effective and there is a
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greater chance of cure. It also needs to be integrated with a palliative care programme, so that
patients with advanced cancers, who can no longer benefit from treatment, will get adequate
relief from their physical, psychosocial and spiritual suffering. Furthermore, programmes
should include an awareness-raising component, to educate patients, family and community
members about the cancer risk factors and the need for taking preventive measures to avoid
developing cancer.
BIBLIOGRAPHY
 S. Lewis, M. Heitkemper, S. Dirksen, P. Obrien and L. Bucher (2007) Medical
Surgical Nursing; Assessment and Management of Clinical problems (7th edition)St
Louis Mosby. Page no-978
 https://www.tandfonline.com/toc/icnv20/current#Cancer Investigations
 https://www.who.int/cancer
 https://www.ncbi.nlm.nih.gov/books/NBK179047/
 https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis