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What is a Biopsy?


A biopsy is required to confirm the diagnosis of cancer, the procedure involves removing a tissue sample from the suspected lesion, mass, or lump. A pathologist analyses the tissue under a microscope, performs special tests and issues a report that determines the exact diagnosis.

The pathologist examines cells or tissues obtained during a biopsy (which is a procedure to remove a cell or tissue specimen for examination by a pathologist) or surgery or from bodily fluids.

A biopsy specimen can be obtained in several ways, such as by

· taking a tissue sample from the surface of the skin

· using a needle inserted through the skin to withdraw tissue or fluid

· inserting a thin, lighted tube called an endoscope through the mouth, anus, urethra, or a small incision in the skin to look at areas inside the body and remove a sample using special tools that pass through the tube

If surgery is used to remove part or all of a tumor, some or all of the removed tumor specimen will be examined by the pathologist. If the entire tumor is removed, typically the surgeon will attempt to remove some normal tissue around the tumor (known as the margin) for examination by the pathologist to make sure that it doesn’t contain tumor cells.

For some cancer types, especially breast cancer and melanoma, the surgeon may also remove nearby lymph nodes, called the sentinel lymph nodes, so the pathologist can see if these contain cancer cells. The Sentinel Lymph Node Biopsy fact sheet describes this procedure and its use in determining the extent, or stage, of cancer in the body.

A pathologist may also examine cells that are present in bodily fluids, such as urine, cerebrospinal fluid (the fluid around the brain and spinal cord), sputum (mucus from the lungs), peritoneal (abdominal cavity) fluid, pleural (chest cavity) fluid, cervical/vaginal smears, and bone marrow.

In most cases, doctors need to do a biopsy to diagnose cancer. 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 your diagnosis. Pathology reports play an important role in diagnosing cancer and helping decide treatment options. Learn more about pathology reports and the type of information they contain.

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 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 anesthesia.

Sedatives are medicine that help you relax and stay very still or sleep during a biopsy.

Anesthesia 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 anesthesia.

· local anesthesia, which causes loss of feeling in one small area of the body

· regional anesthesia, which causes loss of feeling in a part of the body, such as an arm or leg

· general anesthesia, 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 you have cancer, you may have more tests to help your doctor plan treatment. For instance, your doctor will need to figure out the stage of your cancer. For some cancers, knowing the grade of the tumor or risk group that you fall into are important for deciding on the best treatment. Your tumor may also be tested further for other tumor or genetic markers.

To learn more about other tests that may be used to plan treatment for your cancer, see the PDQ® cancer treatment summaries for adult and childhood cancers for your type of cancer.

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