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Diagnosis

Peripheral Nerve CANCER DIAGNOSIS

Receiving the diagnosis of cancer can be a difficult process for patients to go through. At the Peripheral Nerve Cancer Center we will do our best to help you navigate through this process as compassionately, safely, and successfully as possible. Your comfort is our primary concern. We will work with you to provide the most up-to-date and aggressive treatments if necessary to help you get the best result possible given your diagnosis.

Cancer can affect the peripheral nerves just as it can affect any other part of the body. In some cases, patients discover a lump along the course of a nerve in the arm or leg. In other cases, the cancerous lesion is discovered incidentally. Other patients may have a genetic disorder that predisposes them to certain types of cancer. In these cases surveillance imaging may reveal the presence of a new lesion. Other patients become aware of a neoplasm based on screening studies such as blood tests or other radiographic imaging studies.

Depending on the location of the lesion there are number of different ways to investigate the nature of the lesion and identify a specific diagnosis. When a new lesion occurs along a nerve an MRI scan is typically performed. This is done with and without contrast. The purpose of the scan is to give a detailed picture of the three dimensional anatomy of the lesion. The purpose of the contrast is to help assess how the lesion behaves with other tissues. Contrast can be helpful in determining whether the lesion is spreading along the course of the peripheral nerve or if it is invading surrounding tissues.

If the MRI scan is suggestive of an aggressive lesion such as malignancy or if the clinical presentation is suggestive of an aggressive lesion, then a specific type of imaging study called a PET scan is usually utilized. The PET scan measures the metabolic activity of the lesion. More aggressive lesions such as cancer typically display higher metabolic rates and this can be measured on a PET scan. A PET scan can also ascertain if there is evidence of other lesions present, suggestive of metastatic disease. Metastasis occurs when cells migrate away from the primary lesion and implant elsewhere in the body, forming lesions of their own. A PET scan usually scans the entire body and can indicate the presence of metastatic tumors anywhere in the body.

Nerve tumors that grow rapidly, present with neurological deficits such as weakness or numbness, or present with pain, might be malignant.  Unfortunately, there is really no way to be sure based on these findings. Sometimes benign lesions can grow rapidly, or present with neurological deficits or pain.  So it is important that you undergo a thorough evaluation by your healthcare team.  This may involve actually getting a piece of the tumor so the pathologists can determine with certainty whether the tumor is benign or malignant.

Therefore, if the PET scan is suggestive of a malignancy, then at that point it is important to obtain diagnostic tissue. This is usually done with an image-guided needle biopsy. Image guidance allows the radiologist to obtain a tissue sample from the lesion safely while avoiding other nearby structures such as blood vessels, organs or nerves. In some cases lesions are located where it is not entirely safe to perform a needle biopsy. In those cases we perform an excisional biopsy. In excisional biopsies we use a limited surgical approach to access the lesion safely and it allows us to obtain a tissue sample for pathological evaluation. Once the biopsy is performed a frozen section can provide some preliminary results. This is where the pathologist examines the tissue immediately after the biopsy is taken and while the patient is still in the procedure room, but these results are preliminary and are not relied upon for major treatment decisions. It is best to wait for the final pathology results, which can take a few days. We understand that the wait during this period of time for patients can be agonizing but it is important to get a final definitive results prior to contemplating any sort of major surgery.

Once the final pathology has been determined, and it shows the lesion to be malignant, we will arrange for you to consult with an oncologist if you do not already have one. If you already have an oncologist, we can certainly work with your existing healthcare team to optimize your care here at Columbia and beyond.

Depending on the exact type of cancer, a number of treatments may be utilized either alone or in combination. Some cancers respond best to chemotherapy, some respond best to radiation, and others respond best to surgery. Some respond best to surgery plus any other combination of treatments including radiation and chemotherapy. In some cases there are multiple lesions and multiple surgeries are required, but that is not always the case.

The goals of surgical excision are to completely remove the malignant lesion, including negative margins (which is a border of normal tissue that surrounds the cancer), so we can be sure the entire lesion has been resected completely. Radiation and chemotherapy may then be utilized to treat any metastatic disease or subclinical disease that is not yet apparent on an imaging study. It is usually a combination of therapy or therapies that offers the best results.

We can also help direct patients into ongoing clinical trials looking at different surgical, chemotherapy and radiosurgical therapeutic options if available. Some of these trials are going on at Columbia and some are going on at other institutions. Our goal at the Columbia Peripheral Nerve Cancer Center is to provide you the best treatment possible and enhance your outcomes including survival as well as patient satisfaction.

If you wish to undergo an evaluation at the Columbia Peripheral Nerve Cancer Center, please contact Dr. Christopher Winfree or Dr. Philip Meyers to schedule an appointment. Although making an appointment to see one or more physicians can be a time consuming process, we understand that a potential diagnosis of cancer is an important one and we treat this urgently. We are usually able to accommodate patient visits within a few days of a request as needed. Please do not hesitate to contact us for an expedited review of your situation should you feel it be necessary and we will do our best to initiate an appropriate treatment plan as quickly as possible.

patient journey

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