Biopsy is dangerous?

"I read today that if cancer is present, that a biopsy can spread the cancer. Is this true and if so, is there another way, a safer and perhaps less expensive way to detect cancer?"

I read this, also.

"Let me say this right up front: NEVER EVER get a needle biopsy. Most people, including many doctors, don't think of a needle as a knife. But if you look at a hypodermic needle under a magnifying glass, you'll see that it's beveled (ground down on one side) into a sharp, cutting edge. Essentially, it is a tiny, hollow knife. Experiments have demonstrated that after sticking a needle into cancer tissue, cancer cells can be found in the bloodstream."

I just don't want anything to go wrong.
My dad will have one on Monday.
Any reason to be worried?
Anything I should tell the doctors?

Edited July 23, 2011 at 11:36 pm

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Just about everyone with cancer has had a biopsy. I'm not sure about those facts. If it did make the cancer spread I don't think doctors would be doing it as often as it is done.

As far as expenses, does your dad have to pay for the biopsy?

Prayers, Tina.

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Some people thought cancer was contagious. While I would agree that biopsies can pose some risk, they can also provide important information. I would want to see a reliable medical source confirm that cancer could be spread in the way you mentioned before I would accept it.

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Mike,

Needle biopsies(FNA=Fine Needle Aspirate)can pose a risk in creating a pneumothorax(Lung collapse). There is also a high % of failure to retrieve tissue.
There has been speculation they "scatter" & disseminate ca cells but, there is no substantive evidence this occurs.

They are considered and accepted as part of any ca work-up.

G

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You can find out whether you have an active tumor with a PET scan, but you can't find out what kind of tumor it is so it can be treated appropriately without microscopic analysis--hence the need for a biopsy.

A carefully-done bronchoscopy has less danger of spreading cancer cells than a needle biopsy. Cancer cells have also been found along the track of a tube inserted to drain fluid from the lungs.

Welcome to the "heads you win, tails I lose" world of cancer therapy. Everything you do to fight The Beast is risky and uncertain, but it's all we have right now.

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Wait, are all biopsies with needles?

If it IS safer like you said, then why not have everyone do a bronchoscopy?

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My husband's original doctor did a bronchoscopy. He said he couldn't get to the tumor because of where it was. Fortunately he left town and had a needle biopsy at Mass General. He had no problems from the biopsy.

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Michael, you need to stop being so negative and reading nothing but negative info!!!! You're just driving yourself crazy. The biopsy is a necessity in diagnosing cancer as there is no other way to find out what type he has. With any type of procedure, there is always a chance of complications-even getting stitches on a cut. Not all people can have a bronchoscopy, which also can have complications. He will get through this, in and out within a few hours.
Take care, Judy

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My husband had 2 open chest biopsys,
It is a small surgery but it gave the doctors everything they needed to know to treat him, it was the only way,
he has mesotheloma and had his lung removed.

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Mike,

Where and what size is the lung tumor?

As MC points out, a bronc is an option but, is very dependent on the location of the tumor.

So, is this a single lung tumor?

G

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A Tru-Cut or Core needle biopsy uses a disposable needle with outer cannual and inner, notched rod in which a tissue specimen is cut, trapped and withdrawn. The needle is commonly used for percutaneous biopsy of lymph nodes, liver, kidney, etc.

A fine needle aspiration biopsy takes a sample of tissue or fluid is removed with a needle but does not preserve the histological architecture of the tissue cells.

An incisional biopsy or core biopsy (tru-cut) takes a sample of tissue with preservation of the histological architecture of the tissue cells. An excisional biopsy takes an entire lump or suspicious area and removes it.

The sensitivity of fine needle aspiration biopsy is approximately 90% and specificity near 100%, while sensitivity of tru-cut biopsy is approximately 97% and specificity 100%. The tru-cut (large needle) biopsy is more accurate than fine needle aspiration biopsy.

Some physicians tend to settle on the smallest amount of tumor tissue possible, often with a fine needle aspirate that collects just a few cells, for biopsy analysis. Larger bore needles (tru-cut) are needed to perform core biopsies or even remove entire lymph nodes, so that they can collect enough "live" tissue to more reliably determine the histologic and molecular features of a cancer. Imaging technologies cannot substitute for the biologist's thorough examination of the features of a cancer cell.

Greg

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There is no one "best" way to do a biopsy. It depends upon the patient, type and location of tumor. Just because someone else had a needle biopsy or a thoracotomy or whatever, doesn't mean it will be what is best for you. But bottom line, you need to know that the ONLY way they can definitively diagnose your cancer AND identify the BEST form of treatment is by getting a sample of those little buggers (cancer cells) under a microscope to study them. That requires a biopsy.

So are there some risks with biopsy? Yes. But I think there is a greater risk of not getting one. Otherwise your treatment plan will be based on guesswork.

I'm a nurse, and I couldn't get my biopsy done fast enough because I knew how important it is to have that data.

While it's good to question your physician and even get a second opinion, at some point I believe that we need to make a decision to put a certain amount of trust and faith in our physicians. If we don't, we'll be second-guessing everything they say and do and will hamper the process in which they are trying to help us. We go to them for their expertise, so we really ought to listen carefully to what they say.

I'm not saying to blindly follow. Not at all. But once I made my decision and chose my oncologist, I also decided that he would be my "head coach" so to speak (although I see us as having a collaborative sort of partnership). I listen to him. If something really doesn't make sense, I question him and do some research. But I don't make any major changes without consulting with him and getting his opinion (which usually makes sense).
S

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Due to the location of my tumor I wasn't able to get a biopsy before surgery. Once the Lobectomy was done a sample of the tumor was taken and analyzed after words.
I never heard that a Needle biopsies(FNA=Fine Needle Aspirate) was dangerous.
Cancer is dangerous, period!
The procedures, whatever they may be, are part of the rituals of dealing with this disease.
In my opinion I don't care what is done to me. I just want help to get rid of the cancer.

Alta

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Shargle,
Well said!!! We need to trust our experts and let them guide us with loving hands and their experties!!!

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Shargle presents some very sound advice, caveats and suggestions.

There is one major flaw. Typically, biopsies only differentiate type, ie NSCLC(& it's subtypes), SCLC, etc.
The choice of chemo from there IS a guess!
Unless sufficient tissue is harvested and sent for Cell Culture Assay then, it's just throwing darts at a dart board or WORSE! Chemo is selected on the basis of which is most profitable for the oncologist.
Carbo/Taxol for me may be great, for you it may "inflame" the tumor into wild rapid growth.

G

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Stage4survivor, you ertainly make a valid point about further testing that is done although the specimen (obtained via some sort of biopsy) is still needed for such tests - can't do cell cultures without cells. Still a valid point, thank you.

However I would dispute your comment that oncologists recommend treatments according to what is most "profitable" for them. That is blatently unfair to the larger group of oncologists who are caring people who want to help their patients. It's may be true that what you suggest has happened and I'm guessing that you've had a bad experience to have made such a comment. But I believe this to be the exception and not the rule.

I've worked with a lot of physicians over the past 25 years. A couple were jerks who I'd not recommend to to anyone. But the vast majority are caring people whose motive is to help others and not just to make a buck. And as a general rule I found oncologists to be among the most sensitive and caring of the bunch. It takes more than a desire for money to chose oncology as a speciality. If all they were after was the money there are other specalties they could go into that earn FAR more.

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shargle

The chemotherapy concession is very real. The shift in the United States, more than 20 years ago, from the institution-based, inpatient setting to community-based, ambulatory sites for treating the majority of the nation's cancer patients has prompted in large part additional costs. The chemotherapy concession gave oncologists the financial incentive to select certain forms of chemotherapy over others because they receive higher reimbursement. This was first brought to attention at a Medicare Coverage Advisory Committee meeting in 1999, in Baltimore, Maryland.

A joint Michigan/Harvard study confirmed that before the new Medicare reform in 2003, medical oncologists were more likely to choose cancer drugs that earn them more money. A "Patterns of Care" survey showed results that the Medicare reforms had not solved the problem of variations in oncology practice.

A patient wants a physician's decision to be based on experience, clinical information, new basic science insights and the like, not on how much money the doctor gets to keep. A patient should know if there are any financial incentives at work in determining what cancer drugs are being prescribed.

Although the new Medicare bill tried to curtail the chemotherapy concession, private insurers still go along with it. What needs to be done is to remove the profit incentive from the choice of drug treatments. Medical oncologists should be taken out of the retail pharmacy business and force them to be doctors again.

http://cancerfocus.org/forum/showthread.php?t=3096

Greg

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I expect there is some validity to what you say. However, physicians still have a wealth of options in what treatments to recommend. Given this, they are going to recommend one that has a likelihood of helping the patient versus one that does not. Not only would it be unethical to do otherwise, it might be, in some cases, illegal as well.

Of course I do realize that there are many shades of gray in the world of treatment and patient response. Having some evidence that indicates a course of treatment MAY be useful does not always mean that it WILL be. And within this gray zone arguments can sometimes be made either way (whether a treatment is in the patient's best interest). It is also likely in this gray zone, that some of the things you suggest do occur. Not a good thing. I agree on that point.

However I think we need to take care and not condem physicians as a group and oncologists in particular with comments that suggest they all knowingly pick treatments that will NOT work for their patients for selfish reasons of personal income. The law requires that they recommend medications and treatments for which there is compelling reason (based on research) to believe the patient may benefit. The laws enacted to prohibit the old snake oil peddling were created with this intent. In the old days a "doctor" could peddle any tonic he wanted and make all sorts of claims about its' healing powers. It didn't matter whether it helped or not, or even if it hurt. No laws prohibited it.

These days physicians must be able to make a case for the decisions they make. Not that patients must always get better. That (unfortunately) just isn't realistic. People get sick. Sometimes they die. However, physicians are obligated to recommend treatments in which the benefits to the patient are deemed to outweigh the risks (given research evidence). How any one patient will respond is not totally within their control. But if a patient fails to respond favorably or worse, responds poorly, then the physician's obligation is to recommend a change in the treatment plan.

I think that the public in general fails to appreciate that medical science is not the exact science we all wish that is was. Just because a medication or treatment helped the majority of patients in research trials, does not mean it will help everyone. And if you (or I) fall into the smaller percentage of people who don't respond, doesn't mean the doctor messed up. I've seen a number of angry patients over the years who were unhappy about this. I knew that it wasn't because the physician or the medication were "bad". But trying to convice a disgruntled patient of this is often impossible.

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There is some innate goodness of people who go into oncology. At the time when most oncologists practicing today made the decision to become oncologists, there was no chemotherapy concession. Most of them probably had a personal life experience which created the calling to do battle against the great crab. At the time people make their most important decisions in life, people are at the most idealistic period of their lives.

In their environnment, it is mandatory from a purely human standpoint, to take refuge in the smallest of successes. The shrinkage of a tumor lasting four weeks. The temporary relief of pain. Just like a trauma victim will love forever the surgeon who fixed his/her compound fracture, the cancer patient feels genuine, heartfelt gratitude to the oncologist during periods when the cancer crab retreats.

But the oncologist knows it is just the eye in the hurricane. The eye passes all to quickly, and then the patient is beaten by the back half of the storm, which is more deadly than the front. So the oncologist only rarely gets to share in the celebration of remissions. He/she's already worried about the day to come, when the really bad news needs to be delivered to the patient and the remission is instantly forgotten.

But even bettersweet victories are better than no victories at all. So oncoloigsts will still give more chemotherapy than otherwise warranted, even without the financial incentives. Some oncologists prescribe chemotherapy drugs with equal efficacies and toxicities. I would imagine some are influenced by the whole state of affairs, possibly without even entirely admitting it. Social science research shows that people can be biased by self-interest without being aware of it. There are so many ways for humans to rationalize their behavior.

I think the key is to begin to pay oncologists (and other specialists) more for talking to and listening to patients, and less for treating them with very expensive, very aggressive treatment. The solution is to change the system. Take physicians out of the retail pharmaceutical business and let them be doctors again.

Greg

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I agree. In addition to what you say, I think that physicians (in general) practice too much defensive medicine and do too much, and prescribe too much, often because they think this is what patients (or families) want and/or because they are afraid not to.

Certainly there is much about the current system that could be improved. I suspect most of us can agree on that.

S

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The NCI-recognized cancer treatment centers receive a substantial portion of their funding from research grants and donations. They are usually part of university-based medical schools in which oncologists are salaried professors. There's very little profit motive for them, because they receive tenure, promotions and pay raises on the basis of research grants and publications that are derived from their patient care work. The medical school usually owns the rights to their IP. Some medical school faculty do receive grants and "perks" from pharmaceutical companies and there is a definite risk of conflict of interest when oncologists become obligated to use a company's drugs and/or dosages on their patients in order to fulfill the terms of a research contract.

This is why it is so important to keep checking and challenging, to continue to get second opinions, and to refuse or stop treatments that are not helping.

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