Anish, is a senior engineer in a private sector power company. His mother was recently suspected as having cancer of the gall bladder. CT Scan was suggestive of malignancy but not 100% certain.
For any cancer, it is important to have a biopsy and a confirmation of the diagnosis, to have a look at the tissue under a microscope and to make a pathological diagnosis. This is the final proof that it is malignancy. So many times benign conditions mimic malignancy and it is really not appropriate to treat any patient as cancer unless it is confirmed 100%. So I had suggested a biopsy to Anish. He was ‘terrified’ and said, “No doctor, if biopsy is done, I believe that cancer is likely to spread faster”.
This is a complete myth. A biopsy will never lead to spread of cancer. Perhaps the reason for this myth is that many times the patients undergo what’s called exploratory surgery or laparotomy after the diagnosis of malignancy in which we may find that the disease is advanced much more than even the CT Scan has shown. In such situations, the surgeons are forced to abandon the surgery and obviously the patient would deteriorate. It has nothing to do with the surgery or the biopsy. It is just a progression of the disease.
That brings us to the question – are there situations where we do not need a biopsy? The answer to that is Yes. In some critical areas when some other tests are completely collaborative, we may not need a biopsy and sometimes we may not be able to get a biopsy because of the location of the lesion. In such situations we are justified in planning treatment without a biopsy. In most of the situations biopsy is also important because as I said earlier, cancer is not a single disease, there are many different types of cancers that need different treatment. Similar to ‘Fever’, which is not a diagnosis eg. typhoid would be treated differently from malaria. Likewise cancer is not a diagnosis, histological type is definitely important. Some of the types of cancers respond dramatically to drug treatment and radiation, they do not need surgery. So it is important for the cancer specialist to identify the type of cancer.
So Anish had to be convinced that Biopsy had to be done for his mother and as she was lucky that it was not a cancer and could undergo a surgery for removal of gall bladder.
Dont be scared if the doctor suggests a biopsy. It will make a difference and is essential.