Tests Before Surgery

Staging tests

• CT of the chest, abdomen and pelvis with contrast — the baseline test: the tumor, lymph nodes, distant metastases;
• MRI — depending on the organ: of the liver (shows small lesions more accurately), of the pelvis (in rectal and cervical cancer);
• PET-CT — not for everyone, only when indicated: when the extent of spread is unclear or for certain tumors;
• endoscopy — colonoscopy, gastroscopy and, if needed, endoscopic ultrasound;
• diagnostic laparoscopy — sometimes before a major operation, when small peritoneal lesions not visible on CT need to be ruled out.

To assess the images, discs with the images are needed, not only written reports. If the images were done long ago or treatment has been given since, they are usually repeated.

Pathology and molecular tests

A cancer diagnosis is established by pathological examination of a biopsy or the removed tumor. When the report is incomplete or doubtful, the tissue blocks and slides are reviewed in another laboratory. For some tumors additional tests that guide treatment are needed: microsatellite instability testing in bowel cancer, BRCA testing in ovarian cancer, molecular testing in cholangiocarcinoma.

A biopsy is not always performed: for some tumors that appear operable, the diagnosis is confirmed on the removed specimen, and for adrenal tumors or retroperitoneal sarcomas it matters how, and whether, it is done at all.

Tumor markers

Tumor markers help with diagnosis and monitoring, but do not establish a diagnosis on their own. They are chosen according to the tumor type:

• CEA — in colorectal cancer; CA 19-9 and CEA — when indicated in biliary tract cancer;
• CA-125, HE4 — in ovarian tumors;
• alpha-fetoprotein — in liver cancer;
• chromogranin A — in neuroendocrine tumors; 5-HIAA — in small bowel tumors and symptoms of carcinoid syndrome;
• hormonal activity of adrenal tumors — assessed separately from tumor markers: dexamethasone suppression test, metanephrines and the aldosterone-to-renin ratio, according to specific indications.

Assessment of general condition

• blood tests — blood type and Rh factor, complete blood count and blood chemistry, coagulation panel and urinalysis when indicated;
• ECG and, when indicated, echocardiography and a cardiology consultation;
• lung assessment — when indicated, especially before major operations;
• function of the organs involved in the operation — the liver and the volume of the future remnant before a liver resection, each kidney separately if kidney removal may be needed;
• consultations with other specialists — for coexisting conditions.

How to prepare for surgery

Preparation follows the principles of the enhanced recovery (ERAS) protocol. What you can do in advance:

• quit smoking;
• stay as physically active as you can;
• if you have lost weight, take care of nutrition, with nutritional support if needed;
• correct anemia, blood sugar and blood pressure together with your doctor;
• discuss medications that affect blood clotting with your doctor: they are not stopped on your own.

What can be done where you live

Most blood tests, CT, MRI and endoscopic tests can be done wherever is convenient for you — as long as they are performed according to the right protocol; whether CT or MRI needs contrast is decided separately. I will tell you exactly what to do and what to pay attention to. Some tests are better done where the operation is planned — for example, pathology review or special MRI protocols.

If you are from another city, the documents can be sent in advance — how to do this is described on the page “Online Oncologist Consultation”.

What to bring to the consultation

• CT, MRI, PET-CT discs with reports — the discs themselves;
• the pathology report, tissue blocks and slides;
• endoscopy reports;
• recent blood tests and tumor markers;
• summaries of previous operations and treatment, a list of medications.

If some materials are missing, that is no reason to postpone the consultation: I will tell you what further tests are needed. Book a consultation by phone or through the form. The in-person consultation is free.