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This page was reviewed under our medical and editorial policy by
Lusi Tumyan, MD, Radiologist, City of Hope | Duarte
This page was updated on June 8, 2023.
If you’re experiencing cancer symptoms, or the results of a screening test indicate you may have cancer, further diagnostic testing is needed. Sometimes, other conditions mimic cancer, so it’s important to rule them out. After collecting your personal and family health history and performing a physical examination, your doctor may order additional diagnostics such as laboratory or imaging scans and other tests, as there is no standalone test to detect cancer.
If a suspicious area or tumor is detected, the only way to confirm a cancer diagnosis is through a biopsy, which involves taking a tissue or fluid sample.
Diagnostic testing involves tests and procedures to confirm the presence of disease and identify the correct tumor type, location, extent and stage. At City of Hope, we use sophisticated diagnostic technology to pinpoint and evaluate tumors and develop a personalized treatment plan. We use a variety of technologies and medical devices to empower our clinicians and inform medical diagnoses.
Our diagnostic team includes physicians across many medical specialties, including radiologists and pathologists. They have years of training and expertise in using advanced, minimally invasive diagnostic tests and procedures to diagnose cancer.
A thorough and accurate cancer diagnosis is the first step in developing an individualized cancer treatment plan. Our care team works together, sharing electronic medical records and collaborating under one roof to monitor patients and support a seamless decision-making process.
Diagnostic tests we perform may include:
The tests and procedures we use in diagnosing cancer vary depending on the type of cancer the disease and the needs of each patient. Diagnostic evaluations generally fall into one of four categories:
A variety of imaging options are available to help detect cancer based on its location in the body.
Barium swallow or barium enema: A barium swallow may be used to detect cancerous changes to your throat or esophagus. During this procedure, a solution containing barium is ingested orally, and X-rays are taken. Similarly, a barium enema may be given in order to view the colon and rectum. Your doctor will deliver the solution via a thin tube before taking X-rays.
Bone scan: To help detect cancer that has spread to the bone, a small amount of radioactive dye may be injected intravenously before nuclear imaging is used to examine the bone on a cellular level for cancerous changes.
Computed tomography (CT) scan: This is one of the most commonly used imaging tests in the detection of cancer. CT scans provide precise images to help detect cancer and determine its exact location.
DEXA (dual-energy X-ray absorptiometry) scan: This scan provides a measurement of bone mineral density to help doctors determine your overall bone health and function.
Magnetic resonance imaging (MRI): This test uses radiofrequency waves to create images of your internal organs. MRIs help your care team to detect cancerous tissue, and they’re used frequently in cancer diagnosis.
Mammography: Used to detect breast cancer, mammograms utilize a low-dose X-ray to produce images of your breast tissue, allowing your doctor to visualize any abnormalities.
Nuclear medicine imaging: A small amount of radioactive dye is administered orally, intravenously or by inhalation, and a camera is used to take detailed images of internal structures. This type of imaging helps detect cancers of the brain, breast, bladder, kidney, thyroid, liver, lung and bone.
Ultrasound: Frequently used to help detect cancer, ultrasounds use high-frequency sound waves to produce images of your internal organs. These tests allow your doctor to view the inside of your body in real time, capturing organ movement and function.
X-ray: This imaging test is used on multiple areas of the body in order to help detect, stage and treat cancer. X-rays use high-energy electromagnetic radiation to produce images.
These tests are used to help detect cancer by analyzing a tissue or blood sample.
Anoscopy: To check for abnormalities of the rectum or to take a biopsy, an anoscopy may be performed. A tool called an anoscope is used to view the rectum and anus to help detect cancer.
Biopsy: Your doctor may remove a tissue or fluid sample to test it for cancerous cells. Biopsies are the only way to know for sure if you have cancer.
Bronchoscopy: To help detect cancers of the lung or esophagus, a thin instrument with a lighted camera is inserted through the nose or mouth to look for abnormal areas and/or collect a biopsy.
Colonoscopy: Cancer of the colon and/or rectum is often detected through a colonoscopy. During the test, your doctor will insert a thin, lighted tube called a colonoscope into your colon, and any suspicious growths will be removed and analyzed.
Lumbar puncture: Also known as a spinal tap, this procedure is used to collect a sample of your cerebrospinal fluid in order to help detect cancers of the brain, spine or leukemia.
Pap test: A screening test used to detect cervical cancer, the Pap test allows your doctor to collect a sample of cervical cells to be examined microscopically in a laboratory.
Lab tests to examine blood, urine and other fluid samples may be used to look for tumor markers or abnormal cells indicative of cancer.
CellSearchTM Circulating Tumor Cell (CTC) Test: This diagnostic blood test detects circulating tumor cells (cells from a cancerous tumor that have entered the bloodstream) in order to help doctors monitor metastatic breast, prostate and colorectal cancers.
Complete blood count (CBC) test: Used to measure your levels of white and red blood cells and platelets as well as hemoglobin and hematocrit, a CBC test helps detect leukemia and monitor your blood counts during cancer treatment.
Flow cytometry: As a tool to detect cancers such as leukemia and lymphoma, flow cytometry may be used to evaluate cells in bone marrow, lymph nodes or blood samples. It’s also useful in detecting abnormal amounts of DNA in cancerous cells, which may point to a recurrence.
MammaPrint + BluePrint® test: These breast cancer recurrence tests help predict the likelihood that your cancer will come back.
Oncotype DX® test: This test is useful in determining whether chemotherapy may be of benefit to breast cancer patients.
Tumor marker tests: Certain substances known as tumor markers are present in the blood when you have cancer. Tumor marker tests (such as the CA-125 test) are often used in combination with a biopsy to help diagnose cancer.
Prostate specific antigen (PSA) test: Men with prostate cancer often have elevated levels of the hormone PSA in their blood.
Changes to your DNA, known as gene mutations, may increase the risk of cancer. These abnormalities to your DNA may be acquired (caused by environmental factors) or inherited (passed down through your family). Examples of inherited gene mutations are BRCA1 and BRCA2, both known to increase the risk of developing breast and ovarian cancers.
These tests help determine whether you have genetic mutations associated with a higher risk of developing specific cancers.
Advanced genomic testing: Cancerous cells are extracted from a biopsy sample and their DNA is sequenced in a lab to identify characteristics resembling known mutations. This helps your doctor determine treatment options.
Genetic testing: Typically done with a blood test or mouthwash, a sample is taken to detect gene mutations that may contribute to increased cancer risk.
Even after the validation of your diagnosis, our diagnostics program continues to play an important role throughout your cancer treatment. First, we’ll locate tumors and stage the disease. Tests to determine the stage of your cancer help you and your doctor know how much cancer is present and help determine an appropriate treatment plan tailored to you, based on your diagnosis and personal goals. Staging procedures may include imaging tests, endoscopy exams, lab tests and biopsies. Most cancers are given a stage of 0 to 4. The higher the stage number, the farther the cancer has spread.
We understand that waiting for diagnostic test results can create a great deal of stress. To ease anxiety and help you begin your cancer treatment as soon as possible, we work to reduce wait times for appointments and test results. In some cases, we offer telehealth appointments so that you can ask questions via a smartphone or computer.
The tests and procedures we use in diagnosing cancer vary depending on the type of the disease and the needs of each patient. Diagnostic evaluations generally fall into one of four categories: