April 6, 2024

1400H - 1500H
Via Zoom

Empowerment
objective - for laypeople
DOES BIOPSY to have an essential
MAKE CANCER understanding on
WHETHER BIOPSY
SPREAD?
MAKE CANCER SPREAD
as part of their health
management.
 April 6, 2024
1400H - 1500H
Via Zoom
Welcome all!

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DOES BIOPSY to have an essential the Chat Box! Include names
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 ROJOSON’S REQUEST:

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objective - for laypeople PEP TALK!
DOES BIOPSY to have an essential
understanding on Pls. type in your
MAKE CANCER feedback in the chat
WHETHER BIOPSY
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as part of their health forum and before we
management. adjourn!

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 LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
Empowerment START PEP TALK
objective - for laypeople PROPER IN 2
DOES BIOPSY to have an essential MINUTES!
MAKE CANCER understanding on
WHETHER BIOPSY Pls. turn on your
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 ROJoson PEP Talk
Empowerment
objective - for laypeople I have a Patient
DOES BIOPSY to have an essential Empowerment
understanding on Program in which I
MAKE CANCER
WHETHER BIOPSY like to empower the
SPREAD? lay people or
MAKE CANCER SPREAD
as part of their health patients to take
management. control in the
management of
their health.
I started the PEP Talk
on May 15, 2021
during the COVID19
Pandemic. There are
3 courses in the PEP
Talk. I completed the
Core Course on
October 9, 2021.
 From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses.
This may take 3 years or
longer depending on our
enthusiasm, discipline
and perseverance.
We are now on our 3rd
year!
 My PEP TALK today is
entitled:
Empowerment
objective - for laypeople DOES BIOPSY
DOES BIOPSY to have an essential MAKE CANCER
MAKE CANCER understanding on SPREAD?
WHETHER BIOPSY
SPREAD?
MAKE CANCER SPREAD
as part of their health
management.
 Contents Disclaimer:
DOES BIOPSY - What is a biopsy?
MAKE CANCER - What are the different types of biopsy? ROJoson PEP Talk
- What are benefits of biopsy? contains ROJoson’s
SPREAD? - Does biopsy make cancer spread? Thoughts,
- What is the origin of the fear of spread of Perceptions,
cancer in biopsy? Opinions and
- What are ROJoson’s advice on the issue? Recommendations
- What are ROJoson’s practices related to the (TPORs) culled from
issue? experiences of
ROJoson and other
professionals.
 What is a biopsy?
DOES BIOPSY
MAKE CANCER
SPREAD?
 What is a biopsy?
DOES BIOPSY
MAKE CANCER A biopsy is a procedure that usually removes a sample of tissues,
cells and fluid from the body and then this sample is examined by a
SPREAD?
medical pathologist usually through a microscope.

The objective of the biopsy is to come out with a more definite

diagnosis of presenting medical disease or condition prior to
instituting definitive treatment. This is usually done after a clinical
diagnosis (based on symptoms and physical exam) and other
laboratory diagnosis (such as CT scan, ultrasound , etc.) in which
there is yet a need to be more certain of the pretreatment
diagnosis.
 What is a biopsy? Clarification of
DOES BIOPSY phrases in definition:
MAKE CANCER A biopsy is a procedure that usually removes a “Usually removes a
sample of tissues, cells and fluid from the body sample”
SPREAD?
and then this sample is examined by a medical
pathologist usually through a microscope. Usually, a SAMPLE
only NOT the whole
The objective of the biopsy is to come out with a or all tissues, cells
more definite diagnosis of the presenting medical and fluid
disease or condition prior to instituting definitive
treatment.
 Gat
What is a biopsy? What are the different types? Several types of
DOES BIOPSY biopsy of masses:
MAKE CANCER A biopsy is a procedure that usually removes a • Needle aspiration
sample of tissues, cells and fluid from the body biopsy (sample)
SPREAD? • Cutting needle
and then this sample is examined by a medical
pathologist usually through a microscope. biopsy (sample)
• Incisional biopsy
The objective of the biopsy is to come out with a (sample)
more definite diagnosis of the presenting medical • Punch biopsy
disease or condition prior to instituting definitive (sample)
treatment. • Excisional biopsy
(whole mass)
 What is a biopsy? What are the different types? • Sample from
DOES BIOPSY tissues of masses /
MAKE CANCER A biopsy is a procedure that usually removes a organs with a
sample of tissues, cells and fluid from the body medical condition
SPREAD? • Sample of cells
and then this sample is examined by a medical
pathologist usually through a microscope. • Sample of fluid

The objective of the biopsy is to come out with a

more definite diagnosis of presenting medical
disease or condition prior to instituting definitive
treatment.
 • Sample from organs with a medical condition What is a biopsy?
DOES BIOPSY - kidney biopsy
A biopsy is a
MAKE CANCER procedure that
SPREAD? usually removes a
sample of tissues,
cells and fluid from
the body ……
 • Sample of cells – needle aspiration biopsy – What is a biopsy?
DOES BIOPSY cells obtained
A biopsy is a
MAKE CANCER procedure that
SPREAD? usually removes a
sample of tissues,
cells and fluid from
the body ……

https://www.quora.com/
What-is-Fine-needle-
aspiration
 • Sample of cells – needle aspiration biopsy – What is a biopsy?
DOES BIOPSY cells obtained
A biopsy is a
MAKE CANCER procedure that
SPREAD? usually removes a
sample of tissues,
cells and fluid from
the body ……
 • Sample from tissues of masses - punch biopsy What is a biopsy?
DOES BIOPSY – tissues obtained
A biopsy is a
MAKE CANCER procedure that
SPREAD? usually removes a
sample of tissues,
cells and fluid from
the body ……
 • Sample from tissues of masses - punch biopsy What is a biopsy?
DOES BIOPSY – tissues obtained
A biopsy is a
MAKE CANCER procedure that
SPREAD? usually removes a
sample of tissues,
cells and fluid from
the body ……
 • Sample from tissues of masses - cutting / core What is a biopsy?
DOES BIOPSY needle biopsy – tissues obtained
A biopsy is a
MAKE CANCER procedure that
SPREAD? usually removes a
sample of tissues,
cells and fluid from
the body ……

https://www.orthobullets.com/
pathology/8082/biopsy-principles
 • Sample from tissues of masses - needle What is a biopsy?
DOES BIOPSY aspiration vs core needle biopsy
A biopsy is a
MAKE CANCER procedure that
SPREAD? usually removes a
sample of tissues,
cells and fluid from
the body ……
 • Sample from tissues of masses – incisional What is a biopsy?
DOES BIOPSY biopsy – excisional biopsy – tissues obtained
A biopsy is a
MAKE CANCER procedure that
SPREAD? usually removes a
sample of tissues,
cells and fluid from
the body ……

https://quizlet.com/gb/
835794596/biopsy-techniques-
flash-cards/
 • Sample from tissues of masses – incisional What is a biopsy?
DOES BIOPSY biopsy – excisional biopsy – tissues obtained
A biopsy is a
MAKE CANCER procedure that
SPREAD? usually removes a
sample of tissues,
cells and fluid from
the body ……
 • Sample of fluid (biopsy) – fluid in the chest
DOES BIOPSY
MAKE CANCER
SPREAD?
 • Sample of fluid (biopsy) – fluid in the abdomen
DOES BIOPSY
MAKE CANCER
SPREAD?
 What is a biopsy? In this PEP Talk, we
DOES BIOPSY will focus on biopsy
MAKE CANCER A biopsy can be done on organs and tissues with for masses and
or without masses. answer the question:
SPREAD?
does biopsy make
In those without masses, it is done to determine cancer spread, if the
the non-tumor disease present. mass being biopsied
turns out to be
In those with masses, it is done to determine if cancer?
cancer is present or not.
 Before discussing the issue,
DOES BIOPSY
MAKE CANCER let’s look at the benefits of biopsy first.
SPREAD?
 psy
What are benefits of biopsy?
DOES BIOPSY
MAKE CANCER
SPREAD?
 What are benefits of biopsy?
DOES BIOPSY
MAKE CANCER Benefits:
To know exactly what kind of a mass is there. Is it
SPREAD?
cancerous or not? If cancer, what is the specific
type?

A biopsy may be resorted to if clinical

examination (based on symptoms and physical
examination) and other laboratory examinations
cannot give a definite diagnosis.

The biopsy result will guide the treatment plans.

 Does biopsy make cancer spread?
DOES BIOPSY
MAKE CANCER
SPREAD?
 For a long time and up to now,
DOES BIOPSY there have been rumblings about the possible
MAKE CANCER dangers of cancer spread when having biopsies,
SPREAD? for example, in breast cancer or prostate cancer.

People afraid of having a biopsy of a tumor which

can be cancer because of fear of spread of cancer.

Is this
A myth or a fact? A reality? Rare or often?
 The fear issues are two-fold:
DOES BIOPSY • CANCER SEEDING
MAKE CANCER •
CANCER SPREAD
SPREAD?
with biopsy
 SEEDING OF CANCER in Biopsy
DOES BIOPSY Cancer seeding or needle seeding (in needle
MAKE CANCER biopsy of cancer tumor) refers to occurrences
SPREAD? when the needle inserted into a tumor during a
biopsy dislodges and spreads cancer cells. It is
sometimes called needle track or tract seeding
because the cancer cells grow along the needle’s
track.
 SEEDING OF CANCER in Biopsy
DOES BIOPSY Aside from needle biopsy, the other
MAKE CANCER situation where there is a potential cancer
SPREAD? seeding or contamination is in patient
undergoing incision biopsy as one cuts
through cancer tissues to get a sample.
Cancer cells may spill over (seed or
contaminate) to the adjacent normal
tissues and instruments used to close the
skin overlying the cancer where incision
biopsy was done may also cause seeding
and contamination.
 SEEDING OF CANCER in Biopsy
DOES BIOPSY It is TRUE that biopsies, such as those using
MAKE CANCER needle inserted through the skin and the incision
SPREAD? biopsy that needs prior skin opening to reach a
cancer tumor, can cause seeding or
contamination of cancer cells in the needle track
and on the skin incision.

The question is how frequent does this seeding or

contamination cause ill-consequences
(particularly LOCAL RECURRENCES)?
 SEEDING OF CANCER in Biopsy
DOES BIOPSY What does the research say about biopsies
MAKE CANCER causing and spreading cancer?
SPREAD?
Several studies and reports confirm that tumor
seeding and contamination with needle and
incisional biopsies can occur but rarely do they
cause ill-consequences such as local recurrence
and spread to distant sites.
 SEEDING OF CANCER in Biopsy
DOES BIOPSY What does the research say about biopsies
MAKE CANCER seeding and spreading cancer?
SPREAD?
A 2008 review in the journal Gut showed that
needle track seeding occurred in 2.7% of liver
cancer biopsies.

In a 2015 BJU report, researchers found that the

incidence of needle track seeding was low (less
than 1%) in prostate biopsies.
https://www.cancer.net/blog/2021-03/can-biopsy-make-
my-cancer-spread
 SEEDING OF CANCER in Biopsy
DOES BIOPSY What does the research say about biopsies
MAKE CANCER spreading cancer?
SPREAD?
In a 2013 study in Endoscopy, researchers found
no difference in cancer recurrence in 256 patients
with pancreatic cancer who did and did not
receive biopsies.
In a later 2015 study in Gut, the same researchers
found that biopsies were not associated with an
increased risk of dying in a database of 2,034
Medicare patients with pancreatic cancer.
https://www.cancer.net/blog/2021-03/can-biopsy-make-
my-cancer-spread
 SEEDING OF CANCER in Biopsy
DOES BIOPSY What does the research say about biopsies
MAKE CANCER spreading cancer?
SPREAD?
In a 2019 study in Urology, researchers found that
the core needle biopsy technique was safe and
effective in 42 patients with bladder cancer and
that seeding did not occur after 28 months of
follow-up.
CONCLUSION: Overall, while it is NOT impossible
for needle seeding and contamination in
incisional biopsy to occur, it is RARE.
https://www.cancer.net/blog/2021-03/can-
biopsy-make-my-cancer-spread
 SPREAD OF CANCER in Biopsy
DOES BIOPSY A common patient concern is that biopsies may
MAKE CANCER cause microscopic cells from cancers to
SPREAD? metastasize (or SPREAD) to other parts of the
body.
In other words, the concern is: do biopsies cause
SPREAD OF CANCER to distant organs or tissues
such as breast cancer to bones and prostate
cancer to lungs and eventually cause death?
There are reports on this phenomenon. Again,
the incidence is said to be RARE.
 SPREAD OF CANCER in Biopsy
DOES BIOPSY In the Jan. 9, 2015 online issue of Gut, pancreatic cancer patients
MAKE CANCER who received a biopsy had a better outcome and longer survival
SPREAD? than patients who did not have a biopsy.

In a 2013 study published in Endoscopy, the researchers

examined outcomes in 256 pancreatic cancer patients treated at
Mayo Clinic in Jacksonville, Florida. They found no difference in
cancer recurrence between 208 patients who had ultrasound-
guided fine needle aspiration (EUS-FNA) and the 48 patients who
did not have a biopsy. https://newsnetwork.mayoclinic.org/discussion/mayo-
researchers-find-cancer-biopsies-do-not-promote-cancer-
spread/
 SPREAD OF CANCER in Biopsy
DOES BIOPSY There are reports showing concerns of spread of cancer caused
MAKE CANCER by biopsy.
SPREAD? Examples:
For fear of spread, a needle biopsy usually isn't used in
diagnosing testicular cancer. Instead, if a surgeon suspects
testicular cancer, the testicle is removed.
Same reasons (fear of spread) are being given by specialists in
biopsying ovarian cancers, thymus tumors, and soft tissue
sarcomas.
 SPREAD OF CANCER in Biopsy
DOES BIOPSY The National Cancer Institute has also addressed this concern in
MAKE CANCER a statement on Common Cancer Myths and Misconceptions.
SPREAD? It also admits that there are cases but EXTREMELY LOW.

“The chance that surgery will cause cancer to spread to other

parts of the body is EXTREMELY LOW. Following standard
procedures, surgeons use special methods and take many steps
to prevent cancer cells from spreading during biopsies or surgery
to remove tumors. For example, if they must remove tissue from
more than one area of the body, they use different surgical tools
for each area.”
https://www.cancer.gov/about-cancer/causes-prevention/risk/
myths
 SEEDING and SPREAD of CANCER in Biopsy
DOES BIOPSY Overall, based on the findings,
MAKE CANCER the likelihood of tumor recurrence and spread as consequences
SPREAD? of a biopsy procedure appears very low.

Nevertheless, VIGILANCE for this potential complication is still

advised.

Anxious patients, who may inquire about this potential

complication, can be reassured that, although it does occur, the
clinical effect appears negligible and biopsy as a cause of disease
recurrence and spread appears very rare.
 What is the origin of the fear of spread of cancer
DOES BIOPSY in biopsy?
MAKE CANCER
SPREAD?
 What is the origin of the fear of spread of cancer
However, as
DOES BIOPSY in biopsy?
mentioned above,
MAKE CANCER there are reported
“A few months or years after a biopsy procedure,
SPREAD? cases in which biopsy
the patient dies of the disseminated cancer.”
procedure causes
The reality is that at the very start or at the time spread to distant
of the biopsy procedure, the cancer is already organs, disseminated
disseminated or far advanced, leading to early diseases and cause
death. Relatives cannot accept this reality and death. BUT these are
relate, associate, and blame the death to the RARE.
biopsy procedure.
 What are ROJoson’s advice on the issue?
DOES BIOPSY
MAKE CANCER
SPREAD?
 ROJoson’s Advice on SEEDING and SPREAD of CANCER
DOES BIOPSY in Biopsy
MAKE CANCER • Take note of the POSSIBILITY but also take note of
SPREAD? RARITY.
• Weigh and balance the benefits and risks of biopsy
and then decide.
• Ask the physician for advice on the indication and
benefit-risk weighing of biopsy.
• Consider other options aside from biopsy or other
types of biopsy in getting to a more definitive
diagnosis prior to the definitive treatment.
 ROJoson’s Advice on SEEDING and SPREAD of
DOES BIOPSY CANCER in Biopsy
MAKE CANCER Take note of the usefulness of benefit of biopsy
SPREAD? in cancer treatment. It can prove the existence
of cancer and help plan treatment.

Under certain circumstances, however take note

that treatment can be instituted even without
biopsy confirmation of cancer.
 Situations in which biopsy may be skipped
DOES BIOPSY • Physicians quite certain of cancer diagnosis based on clinical
MAKE CANCER examination and imaging studies and other tests that biopsy may
SPREAD? not have to be done
• Deeply located tumors which may be extremely difficult to biopsy
• Tumors with track record of high chance of seeding and spread
such as ovarian cancers and thymus tumors
• When biopsy will not alter treatment – an excision or wide
excision has to be done regardless of whether cancer or not
• Tumor-associated emergencies – no time to do biopsy, such as
acute intestinal obstruction secondary to a tumor
 What are ROJoson’s practices related to the
DOES BIOPSY issue?
MAKE CANCER
SPREAD?
 ROJoson’s Practices on Biopsy ROJoson chooses a
DOES BIOPSY ROJoson does biopsy only when strongly biopsy options that
MAKE CANCER indicated and after considering other options for will avoid the risks of
seeding and
SPREAD? a more definite diagnosis and also after weighing
the benefits and risks of biopsy. spreading as much
as possible.
Indications for biopsy:
Need to come out with a more definite diagnosis Example: doing
of the presenting medical disease or condition excision biopsy
prior to instituting definitive treatment. without cutting
through the cancer
Need to be more definite in diagnosis after tumor and with a
clinical exam and other diagnostic tests good margin.
 Situations in which biopsy may be skipped ROJ follow these guidelines:
DOES BIOPSY • Physicians quite certain of cancer diagnosis based on clinical
MAKE CANCER examination and imaging studies and other tests that biopsy may
SPREAD? not have to be done
• Deeply located tumors which may be extremely difficult to biopsy
• Tumors with track record of high chance of seeding and spread
such as ovarian cancers and thymus tumors
• When biopsy will not alter treatment – an excision or wide
excision has to be done regardless of whether cancer or not
• Tumor-associated emergencies – no time to do biopsy, such as
acute intestinal obstruction secondary to a tumor
 Contents
- What is a biopsy?
Summary
DOES BIOPSY
- What are the different types of biopsy? Take Away
MAKE CANCER
- What are benefits of biopsy?
SPREAD? - Does biopsy make cancer spread?
- What is the origin of the fear of spread of
cancer in biopsy?
- What are ROJoson’s advice on the issue?
- What are ROJoson’s practices related to the
issue?
 Be always in touch with reliable medical
Take Away in
DOES BIOPSY information on WHETHER BIOPSY MAKE CANCER
relation to
MAKE CANCER SPREAD?
Patient
SPREAD?
Knowledge is power; it gives power. Empowerment
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan to gain greater control over
decisions / make better decisions on
WHETHER BIOPSY MAKE CANCER SPREAD
as part of your health management.
 This ends my PEP
Empowerment TALK today on:
objective - for laypeople DOES BIOPSY MAKE
DOES BIOPSY to have an essential CANCER SPREAD?
MAKE CANCER understanding on
WHETHER BIOPSY
SPREAD?
MAKE CANCER SPREAD
as part of their health
management.
Reminder after the PEP
Talk:

Take the Online Learning

cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.

Link is in Chat Box.

Reminder:
25 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.
 ROJOSON’S REQUEST:

Empowerment FEEDBACK TO THIS

objective - for laypeople PEP TALK!
DOES BIOPSY to have an essential
understanding on Pls. type in your
MAKE CANCER feedback in the chat
WHETHER BIOPSY
SPREAD? box during the open
MAKE CANCER SPREAD
as part of their health forum and before we
management. adjourn!

Thank you!
 LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
Empowerment START Q&A AND
objective - for laypeople INTERACTIONS!
DOES BIOPSY to have an essential
MAKE CANCER understanding on Pls. turn on your
WHETHER BIOPSY video!
SPREAD?
MAKE CANCER SPREAD Show your face!
as part of their health
management.