Question 1

How is breast cancer diagnosed based on its hormone receptor status?

Dr. Nithin S.G. · Accepted Answer

Breast cancer is broadly split into three types: hormone receptor positive, HER2 positive, and triple negative. The diagnostic procedure itself does not change based on subtype: a biopsy is still required, with mammography used only for initial evaluation. IHC testing on the biopsy sample determines ER, PR and HER2 status; if all three come back negative, the cancer is classed as triple negative, a more aggressive subtype that is harder to treat once it reaches stage four.

Question 2

How does mammography compare to MRI for diagnosing breast cancer?

Dr. Nithin S.G. · Accepted Answer

Neither is simply better in every case. MRI is the more definitive test to rule out cancer, but mammography, a form of X-ray, can miss a tumour hidden in fattier breast tissue, which is common in women under 30 to 35. In younger women, ultrasound or MRI is preferred; mammography becomes more effective after around 35 to 40, once fibrous tissue outweighs fat. MRI is more accurate but costlier and more involved for the patient, which is why mammography is offered first, with a PET-CT or a CT of the chest, abdomen and pelvis used for staging.

Question 3

How effective is immunotherapy compared to other cancer medications?

Dr. Nithin S.G. · Accepted Answer

Immunotherapy is highly effective and carries far fewer side effects than standard chemotherapy. In cancers with a large initial tumour burden, such as lung cancer, it is usually combined with chemotherapy at first, since immunotherapy alone takes time to bring a heavy disease burden under control. Once the disease responds, treatment continues on immunotherapy alone to maintain that response.

Question 4

What specific investigation should be used to diagnose testicular cancer?

Dr. Nithin S.G. · Accepted Answer

Any scrotal swelling should first be evaluated with ultrasound, which will show a testicular mass or enlargement, but there is no test that gives a confirmed diagnosis before surgery, that only comes after radical orchiectomy. Of 100 patients presenting with a testicular swelling, roughly 80 to 90 percent will have cancer and about 10 percent tuberculosis, so for the large majority a biopsy is avoided, since it risks spreading the cancer, in favour of going directly to orchiectomy. Tumour markers such as AFP and beta-hCG, elevated in seminoma and yolk-sac tumours, can support the ultrasound finding, but the standard recommendation regardless of marker levels is orchiectomy rather than biopsy.

Question 5

How specific is PSA for prostate cancer, given a case where PSA was over 100 but the biopsy showed only BPH?

Dr. Nithin S.G. · Accepted Answer

PSA is not specific for prostate cancer at all, no tumour marker is specific for any single cancer. An elevated PSA in a patient with a prostatic mass could reflect BPH or cancer, and can rise even after a digital rectal exam or ejaculation. Very high values, such as over 100, are more suggestive of cancer, so if PSA is extremely elevated yet the biopsy shows only BPH, the biopsy may simply have missed the cancerous core, which does happen. In such suspicious cases, a gallium-68 PSMA PET scan, highly specific for prostate cancer, can help confirm or rule out malignancy before treating for BPH alone.

Question 6

Should breast cancer be diagnosed with a core biopsy or an excisional biopsy?

Dr. Nithin S.G. · Accepted Answer

Core needle biopsy is sufficient for breast cancer, and there is no need for excisional biopsy in most cases. For a small tumour such as a fibroadenoma, excisional biopsy is an option, but core needle biopsy is equally effective, and if the mass proves benign, surgery can be avoided altogether.

Question 7

Can precision oncology or targeted therapy offer a drug for uterine fibroids, since they are so common?

Dr. Nithin S.G. · Accepted Answer

Unfortunately there is no specific genetic mutation identified for uterine fibroids and no targeted drug role for them, since fibroids are benign tumours, not cancers. Treatment options remain limited to hormonal therapy or surgery.

Question 8

What is your opinion on targeted therapy for advanced cancer patients with a poor performance status?

Dr. Nithin S.G. · Accepted Answer

Targeted therapy's main advantage is that it is mostly oral medication without the classic side effects of chemotherapy, so it remains a reasonable option even in poor performance status, though this depends on the specific drug and its side-effect profile rather than being a blanket rule. Two cases illustrate this: a metastatic lung cancer patient with brain metastases who was bedridden with severe headache and vomiting, and a metastatic breast cancer patient with cerebellar metastasis causing incoordination, both showed marked improvement on targeted therapy despite their poor baseline state. Overall, more patients in poor performance status can be treated with targeted therapy than with chemotherapy, since chemotherapy is often not feasible in a very poor clinical state.

Question 9

What is the difference between FNAC, core biopsy and excisional biopsy?

Dr. Nithin S.G. · Accepted Answer

FNAC (fine needle aspiration cytology) involves inserting a needle into a tumour or fluid-filled cyst and aspirating fluid along with a few detached cells for slide evaluation under a microscope; sensitivity is low since so few cells come through, and a pathologist can typically only confirm abnormal cells are present, not the exact cancer subtype needed for hormone receptor and HER2 testing. Core biopsy uses a biopsy gun that removes a cylindrical piece of tissue roughly a centimetre long, providing enough tissue for full histopathological and genetic workup, which is why core biopsy, not FNAC, is preferred whenever cancer is suspected.

From Detection to Recovery: Navigating the Future of Cancer Care

Questions Doctors Asked Dr. Nithin S.G.