Why Biopsy of A Tumor is needed before the Operation?

Question

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

Answer 1

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.