Cancer is an abnormal unregulated growth of cells in any part of the body. Solid organ tumors present as lumps such as lumps in the breast or soft tissue tumors while tumors in the alimentary canal or airway present as ulcers/ tumors that might bleed or cause pain. Depending on their location, they produce symptoms. In early stages, it remains localized to the organ of origin while as the disease progresses it may infiltrate surrounding organs and then spread to other parts of the body.

To establish a diagnosis of Cancer, a Biopsy from the primary tumor is essential. No imaging alone without the assessment of tissue samples can establish the diagnosis. It is a crucial pre-requisite not only to establish the diagnosis but also to type the tumor. Certain types of tumors will need chemotherapy, to begin with for example Triple-negative Breast cancer or Her 2 positive Breast Cancer. While for some other types of cancers, surgery might not be the choice of treatment. A biopsy thus helps to plan the treatment modality to be selected for a particular type of tumor. So, a biopsy is the initial investigation to be done when a patient is suspected or known to have Cancer.

While a few cancers might be treated with chemotherapy alone like Blood Cancers, a majority of solid cancers will need a multi-modality approach for curative treatment. Usually, surgery is done with curative or palliative intent.

Curative – When patients are diagnosed with non-metastatic disease, a curative intent surgery is planned either with chemotherapy/radiotherapy/chemoradiation before or after surgery ( neo-adjuvant or adjuvant chemotherapy/radiotherapy/chemoradiation). So, if a patient is offered surgery, it indirectly implies a chance at cure. So, in a way, it is good news for the patient and family.

Palliative- In case of metastatic disease, the usual therapeutic option left is chemotherapy or radiation therapy in some instances. Occasionally the patient will need surgery to palliate the symptoms; eg: bleeding, intestinal/gastric outlet obstruction. In such cases, the patient will still need surgery to relieve symptoms which cannot be done by chemotherapy alone.