I know that Biopsy is the standard procedure to identify the type of the tumor and also if that is malignant or not. And depending on this info the medication is determined. So far so good.
However either malignant or not, if patient wants the tumor to be removed, it will be eventually removed with an operation (assuming that it is an easy to remove one, one with low risk etc). A biopsy could still be done on the removed tumor (which is done anyway) and medication could be determined accordingly.
What is the benefit to Operator Doc of having a biopsy results before the OP? Would that change during the OP? How important is that to the operations success?
Thanks in advance.
In: Biology
The type of tumour alters how you remove it and how much of the surrounding tissue you remove to make sure you get all of it, other issues involve damage to it before removing it so that no parts of it break off and float to another part of the body.
As you said, the type of tumor will determine the treatment plan. Depending on the tumor, the plan may be to do chemotherapy or some other kind of medication to shrink the tumor as much as possible before removal. A good surgeon will want to remove as little tissue as possible.
Great question.
For starters, we need a biopsy to get an idea of what we’re dealing with which allows us to tailor chemotherapy, immunotherapy and even hormonal therapies against that specific cancer. We can also often deduce the grade of tumour based on cellular features and surrounding architecture from the biopsy.
This is different from staging where we use tools like CTs and MRIs (imagine 3D slices through a person like a stick of salami) to look at local, regional and distant metastasis. Otherwise we can do other stuff like PET-CTs where we look for glucose-hungry hot-spots which suggest cancer. A combination or one of these approaches is how we get the TMN staging which corresponds to the various Stage 1, 2, 3 and 4 that most people are familiar with.
Sometimes we do cool stuff like biopsy-ing as part of the actual operation (intra-op frozen section) to determine the final extent of how much we remove as part of establishing our cancer-free margins. Other-times, we may even cut away parts of nearby organs and send those for frozen sections to determine if tiny metastasis occur. The presence of these would inevitably extend the extent of resection as we would then need to remove more organs and tissues.
However, there are also times where we don’t want to biopsy because tumours may bleed, or even deposit cancer cells as part of the trajectory of the typical biopsy needle. Hence, we would just cut away the entire diseased portion as much as possible.
As others have said, it is so they can make sure they get all the tumor. The other reason, for the USA, is if the surgery is medically necessary. This could change how the operation is billed to the insurance or the individual.
Removing the tumor is one thing. You need to know how likely it is to have spread nearby. For some, you cut it out and you’re fine. Others, you need to follow up with some chemo. Others, you need to take out the whole organ, like a kidney. Others, you need to be cautious and remove the nearby lymph nodes.
How much effort you put into the surgery is why you do the biopsy. You can’t just lop off the bad part and assume you’re in the clear…for a lot of cancers…
Some tumors aren’t even significantly dangerous. Why go through all that for something that isn’t a problem?
In addition to treatment comments.
I will add there are some “excisional biopsies” where the biopsy is the resection. For example, some skin cancers and breast masses.
As others have said, other biopsies are done when a tissue diagnosis is needed to determine the presurgical (eg neoadjuvant chemotherapy) and surgical plan.
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Different cancers can present similarly and require different treatments and even different surgeons. It also might not even be cancer and instead a benign overgrowth.
1. Cancer or not: This often changes what surgeon does it (surgical oncologist vs general surgeon for example) and how much additional tissue needs to come out too (just the mass or do you need lymph nodes, etc…).
2. What type of cancer? Is that mass in your lung a primary lung cancer or is it a metastasis of a different cancer. If its lung cancer you are correct that part of your lung may need to be cut out, but if its a metastasis from somewhere else the answer may be that you need chemotherapy and a major surgery is of little benefit to you. Different cancers also need a different types of chemotherapy.
3. What specific sub-type of cancer. Laypeople think of things in broad categories, like “Colon cancer, lung cancer, breast cancer” but there are different types of each of those that require different treatments. A different surgery or chemotherapy/radiation right off the bat before any surgery.
It’s not always needed! I had a cancerous tumor removed- no biopsy beforehand- it was approximately 3-4 weeks from discovery to getting it removed in a major abdominal surgery.
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