Explore cancer diagnosis and staging processes that guide personalized and effective treatment plans.

Learn how childhood cancer is diagnosed through exams, blood tests, imaging, biopsies, and molecular testing. Understand preparation, procedures, and result interpretation.

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Doctors

The Roadmap to Recovery

The waiting period between “suspicion” and “diagnosis” is often the most agonizing part of the cancer journey. The fear of the unknown can be paralyzing. At Liv Hospital, we understand that speed is not just a convenience; it is a clinical necessity.

Our diagnostic philosophy is built on two pillars: Rapid Access and Molecular Precision. While patients in many countries wait weeks for a PET scan or pathology report, our integrated Oncology Center typically completes the entire “Check-Up to Staging” process in 3–5 days. We do not just tell you if you have cancer; we tell you exactly what kind it is, where it is, and which genetic mutation is driving it. This “Precision Diagnosis” allows us to skip ineffective treatments and start immediately with the therapy that will work for you.

Advanced Imaging

Before we treat, we must see. Traditional X-rays show shadows; modern oncology requires high-definition, 3D, and metabolic imaging.

cancer

PET-CT (Positron Emission Tomography)

This is the gold standard for cancer staging.

  • How it works: Cancer cells have a high metabolism—they are “hungry” for energy. We inject a safe, radioactive sugar tracer (FDG) into your vein.
  • What we see: The scanner detects where this sugar is being consumed. Cancer cells light up like bright spots on the screen, while healthy tissue remains dark.
  • The Benefit: It detects tumors as small as 4–5mm and reveals if the cancer has spread (metastasized) to lymph nodes or other organs, which changes the treatment plan entirely.

Multiparametric MRI (mpMRI)

Standard MRI is good; Multiparametric MRI is smarter. It is crucial for Prostate and Brain cancers.

  • The Tech: It looks at tissue density, blood flow, and water diffusion simultaneously.
  • The Benefit: It can distinguish between a harmless scar and an aggressive tumor without a needle. For prostate cancer, it guides the biopsy needle to the exact suspicious spot (Fusion Biopsy), rather than poking blindly.

Digital Mammography with Tomosynthesis

For breast cancer screening, we use 3D Tomosynthesis.

  • The Difference: Standard mammograms take 2D pictures (flattening the breast). Tomosynthesis takes slices (like a CT scan).
  • The Benefit: It sees through dense breast tissue, finding tiny lumps that would be hidden on a regular mammogram.

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Doctors

The Biopsy: "Tissue is the Issue"

Imaging suggests cancer, but only a Biopsy (taking a sample of cells) can prove it. This is the most critical step. A wrong biopsy result means wrong treatment.

Image-Guided Needle Biopsy

Gone are the days of cutting patients open just to get a sample.

  • The Procedure: Using Ultrasound or CT guidance in real-time, the interventional radiologist inserts a thin needle precisely into the core of the tumor.
  • The Comfort: It is performed under local anesthesia or light sedation. It is virtually painless and leaves no scar.
  • Rapid On-Site Evaluation (ROSE): A pathologist is often in the room during the biopsy to check the sample immediately under a microscope. If the sample is good, we stop. You don’t have to come back for a “re-do.”

Liquid Biopsy (The Non-Invasive Future)

For some patients (especially with Lung Cancer), the tumor is in a dangerous spot to reach with a needle.

  • The Innovation: Tumors shed tiny fragments of DNA (ctDNA) into the bloodstream.
  • The Test: We draw a simple tube of blood. Our advanced lab filters out this DNA and sequences it.
  • The Result: We can identify the specific mutation driving the cancer (e.g., EGFR) without ever touching the tumor. It is also used to monitor if the treatment is working months later.

Pathology and Genetics: The "Fingerprint" of Your Tumor

Once we have the tissue, the real detective work begins. Not all breast cancers are the same; not all lung cancers are the same.

Histopathology

The pathologist looks at the cells under a microscope to determine the Grade (how aggressive the cells look).

  • Grade 1 (Well-differentiated): Cells look mostly normal and grow slowly.
  • Grade 3 (Poorly differentiated): Cells look chaotic and grow rapidly.

Immunohistochemistry (IHC)

We stain the cells with special dyes to see what “receptors” they have.

  • Example (Breast Cancer): Is it Estrogen Positive (ER+)? Is it HER2 Positive? If it is ER+, we can use hormone pills. If it is HER2+, we use targeted drugs like Herceptin.

Next-Generation Sequencing (NGS)

This is the frontier of Precision Oncology.

  • The Test: We scan the tumor’s DNA for hundreds of potential mutations (BRCA, KRAS, ALK, ROS1).
  • The Goal: To find a “druggable target.” If we find a specific mutation, we can often use a “Smart Drug” (pill) that targets only that mutation, sparing you from chemotherapy.

Staging: Decoding the "TNM" System

After diagnosis, you will receive a Stage (I to IV). This describes how far the cancer has spread. We use the global TNM System.

T = Tumor (Size and Extent)

  • T1: Small tumor, contained within the organ (e.g., <2cm in breast).
  • T2: Larger tumor.
  • T3: Tumor has grown into nearby tissues (e.g., muscle or skin).
  • T4: Tumor is invading vital structures or is very large.

N = Nodes (Lymph Node Involvement)

Lymph nodes are the “checkpoints” of the immune system. Cancer often travels there first.

  • N0: No cancer in lymph nodes.
  • N1: Cancer found in nearby (regional) nodes (e.g., underarm for breast).
  • N2/N3: Cancer found in distant nodes or many nodes.

M = Metastasis (Spread)

  • M0: No spread to other organs.
  • M1: Cancer has spread to distant organs (e.g., Liver, Bones, Brain). This is Stage IV.

Why Staging Matters:

  • Stage I–II: Usually treated with Surgery (Local Control).
  • Stage III: Usually requires a combination (Surgery + Chemo + Radiation).
  • Stage IV: Usually treated with Systemic Therapy (Chemo, Immunotherapy, Targeted Drugs) to control the disease throughout the body.

The Tumor Council

Once all the data—PET scan, Biopsy, Genetic Report—is ready, your case goes to the Liv Tumor Council.

  • The Debate: The surgeon might say, “I can remove this.” The radiologist might say, “Wait, the PET scan shows a spot on the liver. Surgery is risky.” The medical oncologist might say, “Let’s give Immunotherapy for 3 months first to shrink it.”
  • The Consensus: They agree on a binding plan. You receive a Roadmap that aligns with NCCN (US) and ESMO (European) guidelines.
  • The Benefit: This eliminates the “second opinion” chase. You get 10 opinions in one room.

Diagnosis for International Patients

Speed is our promise.

  • Day 1: Arrival, initial consultation, and PET-CT scan.
  • Day 2: Biopsy (if needed) or Molecular Blood Test. MRI/Endoscopy if required.
  • Day 3–4: Pathology processing. (Complex genetic tests may take 10–14 days, but preliminary results are faster).
  • Day 5: Tumor Council decision and start of treatment.

FREQUENTLY ASKED QUESTIONS

Is a PET-CT scan dangerous?

The radiation dose from a PET-CT is low—about the same as natural background radiation you would receive over 3–5 years. The radioactive sugar tracer (FDG) has a very short half-life and leaves your body through urine within hours. Drink plenty of water after the scan to flush it out.

This is a common myth. There is no scientific evidence that a needle biopsy causes cancer to spread or “seed” into the track. The risk is theoretical and extremely rare. The risk of not knowing the cancer type is far, far greater.

  • Clinical Staging: Based on scans (CT/MRI) before surgery. It is an estimate.

Pathological Staging: Based on what the pathologist sees under the microscope after surgery. This is the definitive stage and may upgrade or downgrade your treatment plan.

No. You must fast for 6 hours.

Why? The scan looks for sugar uptake. If you eat, your insulin levels rise, and the sugar goes to your muscles instead of the tumor, making the scan blurry or useless. You can drink water only.

Comprehensive genomic profiling (looking at 300+ genes) is complex. It typically takes 10–14 business days. While waiting, we may start standard treatment, then adjust course once the genetic “roadmap” arrives.

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