• To detect signs and symptoms of cancer
• To monitor side-effects and complications of treatment
• To rule out other diseases that may be causing symptoms
• To monitor the effectiveness of treatment
• To monitor for a cancer recurrence
• To help diagnose a disease
• To help stage a disease, plan treatment, and determine the prognosis

Blood Tests

Routine blood tests are a common part of cancer screening, diagnosis, staging, and treatment. Blood tests are used to detect the levels of different substances in the blood, and may be recommended to monitor general health and organ function during cancer treatment.

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Complete Blood Count (CBC)

A complete blood count (CBC) measures the levels of cells in a person’s blood, including red blood cells (carry oxygen throughout the body), white blood cells (fight infection by attacking viruses and bacteria), platelets (stop bleeding and help the blood clot), hemoglobin, and others. A CBC is mainly used to monitor the patient’s general health and organ function and detect any side-effects of the disease or its treatment. Changes in blood counts may be caused by cancer and/or cancer therapy. Chemotherapy and radiation therapy can cause low levels of blood cells, and certain cancers can cause an increase or decrease in the different types of blood cells. However, changes may be caused by other diseases and non-cancerous conditions, and the doctor may recommend a CBC to rule out more common diseases.

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Blood Chemistry Profile

A blood chemistry profile measures the levels of different substances in your blood, such as creatinine, calcium, blood urea nitrogen, and protein. These values provide important information on the function of your kidneys, liver, and other organs. For example, high levels of BUN and creatinine may indicate kidney dysfunction, while high calcium levels may indicate bone damage. A blood chemistry profile is important because these organs may be affected by the disease and chemotherapy.

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Hormone Panel

For certain types of cancer, the doctor may recommend tests which detect the levels of hormones in the blood. Some types of cancer (endocrine cancers) can cause elevated levels of certain hormones. For example, adrenal cancer may produce excess cortisol, aldosterone, testosterone, and estrogen. These hormones can cause additional symptoms and complications and must be monitored carefully. For thyroid cancer, the doctor may test for elevated levels of thyroid-stimulating hormone (TSH).

Urine Tests

Urine tests are used to measure the levels of different substances in the urine. These tests can also be useful in monitoring general health and organ function, and ruling out signs of infection.

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24-hour Urine Analysis

With this test, the doctor collects all of the urine for a 24-hour period. By collecting all urine for 24 hours, the doctor can measure the average levels of a substance in the urine over the entire day and get a better understanding of what is going on in the body.

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Urine Culture

A sample of urine is sent to a lab to be analyzed for germs and signs of infection. This test may be used to rule out infection as the cause of your symptoms.

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Urine Cytology

A urine cytology is used to detect abnormal cells in the urine. The doctor will take a urine sample and send it to a lab to be analyzed for any signs of cancer cells. Certain types of bladder cancer may release cancer cells into the urine.

Stool Tests

For some cancers, the doctor may recommend testing the levels of different substances in the stool or checking for blood in the stool.

Collapsed Fecal Immunochemical Test (FIT)

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Fecal Immunochemical Test (FIT)

A fecal immunochemical test (FIT) may be used to find traces of blood in the stool. The doctor collects a stool sample and sends it to a laboratory to be tested for it for human hemoglobin, a protein in the blood. If there is hemoglobin in the stool, it means there are probably traces of blood.

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Stool DNA Test

A stool DNA test is used to detect DNA mutations in the stool that have been linked with colorectal cancer and colorectal polyps. The role of this test in colon cancer screening has yet to be defined. While the FDA has approved it for marketing and Medicare covers the test, the US Task Force on Prevention has not yet weighed in on whether they will add the test to their list of approved screening tests. For more information about this test, please discuss with your physician.

Tumor Markers

Tumor markers are substances that can be found in higher than normal amounts in a person's blood, urine, or bodily tissues when they have a specific type of cancer. Some substances are tumor markers for a specific cancer, while others are tumor markers for multiple cancers. Tumor markers can be used in different ways, depending on the specific type of cancer. Most tumor markers can be used to monitor the extent of the disease and the patient’s response to treatment. Some tumor markers can also be used to detect a cancer recurrence, to give doctors an idea of the prognosis (chance of recovery), to help doctors with treatment-planning, to confirm a diagnosis (in conjunction with other tests), and/or to screen for cancer in undiagnosed individuals.

Tumor markers are not perfect. Not all cancers produce tumor markers. High levels of a tumor marker do not necessarily mean you have cancer, and low levels do not necessarily mean you do not. Elevated levels of tumor markers may be caused by other types of cancer and non-cancerous diseases. In some cancers, tumor markers are not detectable until an advanced stage. Additionally, tumor markers behave differently in different patients. Two patients with the same levels of tumor markers in the blood could be at very different stages of the disease.

• Please see Understanding Tumor Markers for more information.

Biopsy

A biopsy is the only way to be certain if cancer is present. During a biopsy, the doctor removes a tissue sample from a suspicious area and sends it to a laboratory to be examined under a microscope. This tissue sample may be taken from the tumor or from other bodily tissues such as the lymph nodes, bone marrow, mucus coughed up from the lungs (sputum cytology), urine (urine cytology), blood (peripheral blood smear), or fluid from the abdomen (peritoneal washings). The sample may be extracted using a variety of methods, depending on the type and location of the cancer. For many cancers, the doctor can extract a cell sample using a needle inserted through the skin. For cancers located more deeply in the body, the doctor may use an endoscope (a flexible, narrow tube with a camera and light on the end) or laparoscope to reach the tumor and perform a biopsy. For other cancers, such as skin cancer or sarcoma, the doctor may use a special surgical instrument or scalpel to remove a tissue sample.

Genetic Testing

Genetic testing looks for mutations or alterations in a person’s genes. Studies have shown that genetic variations in the chromosomes can predispose certain people to cancer. For example, women with Hereditary Breast and Ovarian Cancer Syndrome (HBOC) have mutations in the BRCA1 or BRCA2 genes that greatly increase the risk of developing breast or ovarian cancer. People with Lynch Syndrome, also know as Hereditary non-polyposis colon cancer (HNPCC), have genetic mutations that increase their risk of developing colorectal cancer. There are over fifty hereditary syndromes that can increase the risk of developing cancer, including: Familial Adenomatous Polyposis, Li-Fraumeni Syndrome, Multiple Endocrine Neoplasia, Neurofibromatosis, Birt-Hogg-Dubé syndrome, Peutz-Jeghers Syndrome, and others. Genetic testing allows people to determine if they have any genetic abnormalities that may increase their risk for certain cancers. Genetic counseling helps patients understand how genetic changes are passed from one generation to the next, and the risk of passing the mutation to their children. Genetic counseling also helps patients understand possible risk-reduction strategies such as pre-emptive mastectomy and salpingo-oopherectomy, so they are better prepared to make decisions.

Genomic Testing

Genomic testing refers to new tests that are available to obtain information about the molecular characteristics of a tumor. Cancer is a disease caused by certain changes in the genes that control how our cells grow and function. Genes are made up of DNA and carry instructions for making RNA, and then RNA to proteins that control how our cells behave. Changes, such as mutations in the genes or an alteration in the number of genes (amplification etc.), can cause cells to make too many proteins or cause proteins to not function properly. These proteins can cause normal cells to grow out of control and become cancerous.

Genomic testing can identify specific genetic changes in the DNA or RNA expression level of cells that cause cancer cells to grow and multiply. By identifying the genetic changes in the DNA or RNA of your cancer cells, doctors can recommend new targeted therapies that attack the specific genetic changes causing your cancer to grow.

• Please see Understanding Genomic Testing for more information.

Cellular Tests

The following tests may be performed to confirm a cancer diagnosis and identify specific characteristics of the cancer cells. This information may help the doctor determine the sub-type of the disease, the status of different receptors, the prognosis, and potentially effective treatments.

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Immunohistochemical Staining

In these tests, special stains or antibodies will be applied to a biopsy sample. These substances react with certain types of cells present in cancer, and produce visible stains that can be seen under a microscope. For example, there is one stain that causes granules in leukemia cells to appear as black spots, allowing doctors to distinguish between acute myeloid and lymphoid leukemias. Another example would be using this test to determine whether a lung cancer is an adenocarcinoma, squamous cell carcinoma, or another type.

Collapsed Flow Cytometry (Fluorescence-activated cell sorting, FACS)

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Flow Cytometry (Fluorescence-activated cell sorting, FACS)

Doctors commonly use this test to help diagnose blood-based cancers such as leukemia and lymphoma. In this procedure, the doctor exposes a sample of blood or bone marrow to special antibodies that attach themselves only to certain substances in the cancer cells. The doctor then moves the sample through a laser beam, which causes the antibodies to light up. This test helps the doctor identify the specific types of cells in the cancer, helping him get a better idea of the maturity and origin of the cancer cells. This test is especially useful in diagnosing leukemia and lymphoma, but may also be used in other cancers. For breast cancer, immunohistochemistry may be used to detect estrogen or HER2 receptors on the cancer cells, which may provide valuable information about prognosis and effective treatments.

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Cytogenetics

The doctor examines the cancer cells for chromosome changes in order to determine the specific characteristics and subtype of the disease. For these tests, the doctor will grow a sample of bone marrow cells in the laboratory and examine the chromosomes under a microscope once the cells start dividing. Cell division is the easiest time to see the chromosomes. Cytogenetic tests are very useful in the diagnosis of leukemias, lymphomas, and sarcomas, and may help determine the prognosis of the disease.

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Fluorescent in situ hybridization (FISH)

Doctors also use this test to detect changes in the chromosomes and DNA of blood or tumor samples. This test can detect changes that are too small to be seen with standard cytogenetic tests. The doctor will expose the sample to special dyes that will bind to specific parts of certain chromosomes. These dyes help the doctor detect any abnormalities in the chromosomes known to play a role in cancer. This test can help doctors identify potentially useful targeted therapies that attack specific genetic mutations in a patient’s cancer.

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Polymerase Chain Reaction (PCR)

The doctor may perform this DNA test on a sample of your tumor, blood, lymph node, or bone marrow. Doctors use this test to detect chromosome abnormalities that cannot be seen under a microscope because they are too small. This test is very sensitive and can detect these abnormalities even if there are very few cancer cells in the sample. This test may be able to help doctors sub-classify cancers, and determine the prognosis and most effective treatments.