Biopsy

A cancer diagnosis is typically confirmed through a biopsy or similar type of tissue sampling. There are different types of biopsies, including needle aspiration, endoscopy, incisional, punch, excisional, and stereotactic. The type of biopsy selected is dependent on the type of cancer suspected, where it is located, size of the tumor, and so on. A diagnosis of cancer is not confirmed until the cells collected during the biopsy are examined under microscope and are identified as cancer cells.

• The biopsy is uncomfortable and medications can be taken to help reduce the discomfort, both during and following the biopsy. Some Native patients do not like to ask for such medication. If you accompany the woman to her biopsy appointment, ask the provider to provide such assistance for the patient.

• Someone should drive the patient to and from the appointment when a biopsy is performed. The patient is likely to need assistance getting home – emotionally, spiritually, mentally, and occasionally, physically.

• For most patients, the biopsy procedure is uncomfortable, but only for a short period of time. But occasionally, a patient will experience a great deal of pain during the biopsy. Sometimes the loved one is allowed to accompany the patient while the biopsy is being performed. Providers are not very enthusiastic about having non-medical people in the room because they frequently faint or vomit. Now the provider has to deal with a "crisis" while trying to do a sensitive and careful biopsy procedure.

Linda B’s Editorial. We have worked with Indian women who had been taking part in spiritual ceremonies to cure the cancer. But when we obtained the woman’s medical records, found that the woman had never even had a biopsy or other laboratory test to confirm the cancer diagnosis. A biopsy or equivalent test must be completed, and it is important to get a second diagnosis from a provider who is not associated with the first provider to confirm the patient’s diagnosis.

Types of Procedures to Determine If a Lump or Suspicious Cluster Is Cancer

Fine Needle Aspiration (FNA) Uses fine-gauge needle to take fluid out of a cyst or to take cells out of a lump. Usually done in doctor’s office or outpatient area of hospital. No scar. May be followed by excisional or incisional biopsy.

Core needle biopsy Uses larger needle with special cutting edge to take a core of tissue out of breast. Use local anesthesia. Not used for very small lumps. Usually done in doctor’s office or outpatient area of hospital. Usually no scar

Needle localization; may also be called localization biopsy or mammographic localization with biopsy Two-part procedure. Fine needle containing a wire is put into breast so that tip rests in area of change seen on mammogram. Second mammogram confirms needle is in right place. Surgeon takes out lump or cluster in area where wire is. Fine needle portion done in radiology department, with surgery in operating room with local anesthesia. Scar depends upon amount of tissue taken out.

Stereotactic biopsy or stereotactic localization biopsy Patient may be sitting up or lying on table with hole in it to allow breast to hang down. Computer plans exact position for needle. Either fluid or cells can be taken from lump. Local anesthesia may be needed. No scar.

Incisional Takes out part of the lump to be examined by a pathologist. Uses local or general anesthesia. Usually done in outpatient department of hospital. Operation lasts less than one hour, followed by an hour or two in the recovery room. Small scar. Since the advent of fine needle and core biopsy, rarely used for breast cancer.

Excisional Takes out the entire lump or the suspicious area. Used for lumps that are small. Uses local or general anesthesia. Usually done in the outpatient department of a hospital or a surgical center. Operation lasts less than one hour, followed by an hour or two in the recovery room. May change the shape of your breast, depending on size of lump, where located and how much additional tissue is removed. Scar depends on type of surgery done.

Printed with permission. Morra and Potts, Choices, Avon Books, 1994, p. 314.

Second Opinion

• Help the loved one find a way to get a second opinion from a medical provider about the cancer diagnosis. The patient is always advised to obtain second and third opinions of their diagnosis. This is not an insult to the original provider who diagnosed the cancer, but rather is prudent patient behavior. Unfortunately, the patient who uses IHS contracted health services may have difficulty obtaining a second medical opinion from a facility other than the one contracted facility. But there are other oncologists within the facility who may be used for a second or third consultation and opinion (we have had several oncologists donate their time and the costs of additional tests to verify the accuracy of the diagnosis of cancer in American Indian patients who could not afford additional tests or appointments). Health providers should encourage patients to obtain a second opinion. It is better to have an accurate diagnosis than to erroneously diagnose and treat the wrong condition.

• If the cancer patient has insurance, contact the insurance agent and find out how you can get a second opinion within the next day or so from a facility other than the one which made the original diagnosis.

Try and get second opinions ... I really didn’t have time to research it because I procrastinated so long ... the minute you think you have something unusual, a little lump or whatever ... get attention right away, because it does not go away.

Martha Red Willow - Oglala Sioux

... I think if I had been more insistent, saying well, I really think I ought to have a second opinion on this, and I think that might be important .... I do think that a second opinion would have helped.

Mary Lou Davis - Caddo / Cherokee

I was able to contact some people that gave information to me and . . . , it helped me understand that I didn't have to make a decision right away, so . . . with reading the books . . . I was able to at least understand the type of cancer that I had . . . and the different stages of development or whatever.

Candi Miller - Haida