Cancer is diagnosed with a number of tests but usually a biopsy is needed. This is where a sample of the lesion/growth is sent to the laboratory to be examined under the microscope. This can tell the doctors exactly what type of cancer is present and guides them to what sort of treatment might be best.

Samples can be obtained with different techniques:

• Fine needle aspirate (FNA): a small needle is inserted into a lump and some cells are sucked out and sent to the laboratory. If the lump is on the surface of your body the doctor will do this in the consultation room with some local anaesthetic injected into the skin so the procedure won’t hurt. If the tumour is inside your body an FNA can still be done but it is done with guidance from a CT scanner or ultrasound so the doctor can see where the needle needs to go. This is done by a specialist radiologist (a doctor trained in the speciality of x-rays).
• Biopsy: a small piece of a lesion is cut out and sent to the laboratory. If it is on the outside of your body this procedure is done with local anaesthetic (makes the area numb so it doesn’t hurt). Sometimes it can be done by putting tiny telescopes into areas they can’t reach to take the biopsy. Sometimes an operation is required to be sure about the diagnosis.
• Endoscopy: a flexible tube with a viewing lens and a fibre optic light on the end is passed through natural body orifices (openings) to view the colon (colonoscopy), stomach (gastroscopy) or lungs (bronchoscopy).
• Laparoscopy: similar to endoscopy, but requires a small cut (incision) to be made in the body such as the abdominal (tummy) wall. The laparoscope is then pushed through the incision to look for possible areas of cancer, which can then be biopsied. When this type of procedure is done in the chest it is called a thoracoscopy or mediastinoscopy.

Other tests are often needed to establish the diagnosis and extent of a cancer. These include blood and urine tests, CT or MRI scans, ultrasounds, nuclear medicine scans.

Once the diagnosis is established you will meet with various specialists to talk about what treatment options are available and the benefits and risks of those treatments as well as what the diagnosis means. It is a good idea to have a support person with you for these consultations as a lot of information is often given and it can be hard to take it all in. It is a good idea to write down a list of questions you might want to ask.

Radiation therapy uses special equipment to deliver high doses of radiation (beam of x-rays) to cancerous tumours, to kill or damage them so they cannot grow or spread. Normal cells may be affected by radiation, but most appear to recover fully from the effects of the treatment. Radiation therapy affects only the tumour and the surrounding area. Some cancers are very sensitive to radiation but not all.

Radiotherapy is usually given in small doses over a period of time; this is known as a course. A doctor who manages your radiotherapy is called a radiation oncologist.

Some common side effects of radiation treatment include:

• Fatigue or tiredness
• During the first 2 weeks of treatment, a faint and short lasting redness may occur on your skin. Dryness and peeling of the skin may occur in 3 to 4 weeks. The skin over the treatment area may become darker.
• Mucositis (inflammation of the lining of the mouth) is a temporary side effect that may happen when radiation is given to the head and neck area.
• Radiation to the head and neck area can increase your chances of getting cavities. Before starting radiation therapy, notify your dentist and plan for a complete check-up.
• When radiation treatments include the chest area, the lungs can be affected and you may experience shortness of breath or cough.
• Radiation to the abdomen may result in swelling and inflammation of the intestines, causing nausea, vomiting, or diarrhoea.