January 31, 2013

Today, we talked about some advantages and disadvantages of a general surgical resection.  The advantages include:

• No biological resistance
• No potential carcinogenic effects
• No “tumor heterogeneity” to cause treatment failure
• Can cure large portion of cancers
• Provides the most accurate evidence for staging

The disadvantages include:

• No specificity for malignant tissues (normal tissue destroyed along with neoplasm)
• Risks significant morbidity, deformity and/or loss of function
• May require limited resections to limit damage to vital organs (Debulking Surgery)
• Metastases not curable by localized resection alone

Needle aspiration is one way to diagnose a cancer, which seems odd to use in diagnosis of cancer.  Needle aspiration cannot differentiate an invasive versus non-invasive cancer because it can obtain individual cells rather than a tissue.  It seems to me that needle aspiration would only be good for tumors near the spine.  If I were to order a test for cancer, I would not use needle aspiration because it is possible that as the needle is being extracted cancerous cells are left behind in healthy tissues with the possibility of creating a second tumor location that might be outside the margins of radiation therapy.

Needle biopsies should probably replace needle aspiration.  I think this because the needle biopsy is capable of getting a tissue sample.  The difficult part is that you have to use some form of live imaging to know where the needle is.  Live imaging isn’t three dimensional so as the needle goes in it may be in front of the tissue you want or behind it, which would be useless since you are trying to get a tissue sample of the tissue growth (maybe cancer).  The needle biopsy also needs local anesthesia because it uses a larger gauge needle to get its specimen.  I have had two needle biopsies done on my skin to find out if I had dermatitis or something worse (it turned out to be dermatitis).  It was a little different than the typical needle biopsy because they used a needle that took healthy tissue and unhealthy tissue, which is similar to the incisional biopsy (I got one maybe two sutures each).  I have one protruding scar and the other biopsy didn’t site did not scar.  I am guessing scar tissue will be a risk with the needle biopsy.  When I showed and talked to my doctor about it, I think he was a little surprised by the scar tissue; I think it is somewhat uncommon.

            The incisional biopsy is probably one of the best diagnostic procedures for accessible tumors.  You can open the body up, look at the tumor, and take some normal and presumed cancerous tissue with a scalpel.  The incisional biopsy can then be sutured and the body sutured allowing the patient to heal.  The largest drawback with incisional biopsy is cutting out the cancerous tissues and healthy tissues together.  The reason is if the cancer is well differentiated it will look and act similarly to normal healthy tissue making it difficult to distinguish what to take and what to leave.  It would be much easier if the cancerous tissue is somewhat undifferentiated or completely undifferentiated because it would make it easier to tell what is healthy tissue and what is unhealthy tissue.      I think excisional biopsy is the best method for cancer biopsy because you are cutting out all of the tissue that you think is cancerous, plus a margin of healthy tissue.  With incisional biopsy you would have to later do an excisional biopsy if the growth turns out to be cancerous.  If that cancerous tissue is decided to be benign, then only some of the cancer has been taken out and a resection of the leftover cancer would have to be done.  If it is an invasive cancer, then further treatments will probably be necessary because the cancer may have metastasized, which means the cancer has spread from the origin to another location in the body.  I will continue more of today’s learning tomorrow.

https://www.youtube.com/watch?v=QcjGCBO83DQ
This is a video of a simple excisional biopsy.  I chose it because it isn't too disgusting.  Though I think that the incisions made could not have created the cavity created by the excision.  It was also right on the skin surface, so it is simple to see.