Diagnosis of cancer often begins when a person notices an unusual health symptom and consults a doctor. Early warning signs of cancer include changes in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, thickening or a lump in the breast or any other part of the body, indigestion or difficulty swallowing, change in appearance of a wart or mole, or a nagging cough or hoarseness.

People with early warning signs should consult their family doctor, who will evaluate symptoms and may refer the patient to a physician who specializes in cancer. A physician will first take the patient’s medical history to learn about current symptoms, past history of disease, and family members diagnosed with cancer. The procedures used in a physical exam depend on the patient’s clinical symptoms and may include a digital rectal examination, in which the physician uses a gloved finger to gently check the smoothness of the rectal lining. The physician may perform a breast exam on female patients, in which the breasts are gently probed to feel for lumps or unusual masses.

During the examination the physician may use a thin, lighted tube called an endoscope to look for tumors in internal body cavities. The endoscopy procedure used depends on the organ or body cavity examined. In gastric endoscopy, the doctor feeds a specialized endoscope down the throat to examine the lining of the esophagus, stomach, and first part of the small intestine. Fiberoptic sigmoidoscopy, in which a flexible instrument is inserted into the lower intestinal tract through the anus, enables a physician to visually examine the interior of the colon and rectum. Colonoscopy uses a much longer flexible instrument to view the entire length of the large intestine.

Cervical Cells
Healthy cervical cells (left) are fairly uniform in size and shape, while diseased cervical cells (right) are irregular and disfigured. Gynecologists use a Pap smear to detect abnormalities in cervical cells, which may signal cancer. Cells are scraped from the cervix, and then are spread on slides and studied with a microscope.

A number of laboratory tests help narrow the possible diagnoses. In a Pap smear, cells are removed from the cervical epithelium with a small plastic brush. These cells are examined under a microscope for cell changes that are a sign that cancer may be developing as well as signs of malignancy. If a patient’s clinical signs suggest colorectal cancer, the doctor may search for blood in the stool using a fecal occult blood test. A small sample of the patient’s stool is smeared on a card coated with a chemical called guaiac, which reacts with blood. The card is analyzed in a laboratory for occult (hidden) blood. Certain blood tests determine if levels of red and white blood cells are low, a possible indication of leukemia. Others test for the presence of tumor markers, chemicals that are present in higher levels when certain cancers are present. For example, a prostate-specific antigen (PSA) test measures levels of prostate-specific antigen in the blood. Prostate cancer cells overproduce this protein, causing an elevation of PSA levels in blood.

Medical imaging techniques help doctors locate and evaluate a tumor. These include computed tomography (CT) and magnetic resonance imaging (MRI) scans. CT and MRI scans use computers to form a three-dimensional image of the tumor and surrounding tissues. X-ray images of the breast called mammograms help physicians detect and evaluate breast cancer. Ultrasound scanning bounces high-frequency sound waves off a tumor and surrounding tissue to create an image of the tumor. The multimodality display technique combines the images from several imaging tools into one picture, providing a final three-dimensional image with much greater detail. Computer-aided diagnosis uses complex computer programming technology called artificial intelligence to scan mammograms and X rays to help look for signs of cancer and offer an automated second opinion.

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