Why Choose Alternative Cancer Treatments (11)

Biopsy & Surgery Can Spread Cancer

I was contacted by a lady who successfully dealt with her breast cancer from 1994 to present. She refused all conventional medical procedures. Last year her conventional oncologist convinced her that she was a fool not to get a needle biopsy. This lady now has new tumors growing at each puncture site. Of course her oncologist now has detailed information to help decilde which chemos to use for this now rapidly metastasizing cancer. I repeatedly make this same observation with prostate cancer. I rarely see distant metastasis until after a biopsy -- and then it rapidly goes everywhere including the bones.
Dr. Vincent Gammill, Center for the Study of Natural Oncology (CSNO), Solana Beach, California (non profit)

About biopsies: can a biopsy spread cancer?

Excerpted from article formerly published at http://leiomyosarcoma.org.uk/biopsies.htm, written and compiled by doctordee

Introduction

A biopsy is the removal of some tissue from a body, for examination in order to diagnose a condition. Biopsies may be surgical removal of the tumor, in part or completely, or completely with wide margins. Biopsies can also be done with needles, either a core needle biopsy or a fine needle aspiration [FNA].

Cells have to undergo several mutations before they become cancer cells. Besides reproducing uncontrollably, they also must lose the 'stickiness' and orderliness of normal tissue, and be able to invade and get loose and travel and set up colonies outside the primary site. Because of the loss of cohesion, and the willingness of these cells to emigrate and colonize, it is sometimes very easy to dislodge cancer cells from a tumor during biopsy or surgical procedures.

Every cell in your body has a capillary, a very small blood vessel, near it. The Capillary comes from the smaller and smaller branching of arteries, and joins with other capillaries to form veins...to take the blood back to the heart.

Every cell in your body is bathed in 'interstitial' fluid. This is the fluid that surrounds all the cells, and drains into the lymphatic system, goes through the lymph channels and past the lymph nodes, up to the upper left chest, where the major lymphatic channel drains directly into a blood vessel.

Tumor cells also have capillaries nearby, and are also bathed in interstitial fluid that goes to the lymphatic system.

If you stick a needle into a tumor, you run the risk of dislodging a tumor cell into either a blood vessel or into the interstitial fluid.

Different tissues will have different cell-to-cell stickiness. Tumors that metastasize must have decreased cell-to-cell stickiness. Tumor cells will be easier to dislodge and more likely to travel. Tumor cells that land in blood vessels will travel to distant sites. Tumor cells that are pushed into the interstitial fluid will go to local lymph nodes. And then travel up the chain of lymph nodes.

[...] Excision of the tumor with wide margins is the way to go, if it is possible. If it is not possible, then fine needle or core biopsies might be necessary. Think clearly and carefully about this, and ask questions.

So, in summary, during biopsies or other procedures, one can dislodge some cancer cells, either into the interstitial fluid where they are carried away to lymph nodes, or possibly into the veins draining the tissue where they enter the vascular tree and travel to the lungs. It is also possible to drag some cells along the needle track or along the surgical incision. So it is possible to increase the incidence of lymphatic and hematogenous spread of the cancer, as well as local implantation along the surgical route or needle tracks.

Some cancers are more notorious for seeding by track implantation than others; some are more likely to metastasize if biopsied before complete removal. snipWhether the larger needle of a core needle biopsy causes more disruption in the tumor and more likelihood of track implantation or metastasis than a fine bore needle, or whether an open biopsy is even more likely to cause metastatic travel.... Is simply not known at this time. It is very likely that the 'interference' with an LMS tumor for a biopsy will increase the risk of metastasis, and possibly local recurrence as well. Which biopsy technique is the least likely to cause metastatic/recurrent problems is simply not known. The needle biopsy methods are more cost effective and less invasive than open biopsy. Core needle biopsy, because of the larger needle diameter, requires fewer passes than does the fine needle, and provides more adequate information. It is unknown whether there is a greater risk of tumor disruption and spread with the larger needle versus repeated passes with the smaller needle.

Fine Needle Biopsies

Fine needle aspiration (aka "FNA") utilizes a smaller needle to aspirate cells (as opposed to a core of tissue) from the tumor. This is processed for cytology (as opposed to pathology in the case of core biopsy) to determine sarcoma subtype and sometimes grade. The sample aspirated with this technique consists of scattered cells that do not usually maintain the typical "architecture" of the tumor. This makes establishing a diagnosis more challenging. Despite these challenges, FNA is a safe and reasonably accurate biopsy technique in experienced hands.

Fine needle biopsies have advantages to surgery in that they can be done quickly, with only sedation and local anesthetic. If they are positive for malignancy, they are useful, but a negative result is not reliable because it is possible to miss the malignant sector of a nonhomogeneous tumor. In about 20% of cases it is not possible to make a diagnosis from the material.

The problems with fine needle biopsies:

  1. they may not give enough tissue for a diagnosis
  2. they may miss the cancerous part of the tumor
  3. they may loosen cancer cells to float through the bloodstream and set up secondary tumors at other sites [distant metastases]
  4. they may loosen cancer cells to float through the lymph system and set up secondary tumors at other sites [lymphatic metastases]
  5. they may drag cancer cells with them along the tract of their path and set up secondary tumors at other sites [tract or track implantation]
  6. the tumor is still there

Insertion of a needle into an LMS tumor might liberate LMS cells into the lymphatic or blood circulation, or possibly seed cells along the needle track. For this reason, I personally feel that biopsies should be kept to a minimum, and used only when situations are inoperable, and a diagnosis is imperative. If lesions are operable, an excisional biopsy with wide margins would remove the suspicious lesion, treat it, give a diagnosis, and also provide tissue for chemoresistance and other testing. Fine needle biopsies can miss the malignant part of the lesion, can remove too little tissue for adequate diagnosis, and do not remove enough tissue for chemosensitivity testing.] Most importantly, to accurately diagnose and classify most sarcomas, an expert cytopathologist to examine the specimen is paramount.

Needle biopsies should be taken seriously as they can indeed cause seeding along the path of the needle. The best course of action would be to surgically remove the tunnel the needle had followed in the next surgery. Fine needle aspiration may also shed breast cells into peripheral blood.

Core Needle Biopsies

Core needle biopsies, sometimes called tru-cut biopsies, use a larger bore needle than fine needle biopsies. A larger sample of tissue is obtained than with FNA (fine needle aspiration). A larger sample is removed, with fewer passes, more often allowing a specific cell type to be diagnosed. Most importantly, to accurately diagnose and classify most sarcomas, an expert sarcoma pathologist to examine the specimen is paramount. Needle biopsies should be taken seriously as they can indeed cause seeding along the path of the needle. The best course of action would be to surgically remove the tunnel the needle had followed in the next surgery. Furthermore, tumor cell displacement was observed in 32% of patients who had undergone large-gauge needle core biopsy of the breast.

Open Biopsies

Open, or Incisional, biopsy utilizes a surgical procedure to open the tumor to obtain a large sample of the tissue for analysis. This technique is rarely required for satisfactory diagnosis, and is overly invasive and riskier than the less invasive needle biopsy techniques described above. Incisional biopsy carries all the risks of surgery and anesthesia including infection, bleeding, and incorrect choice of incision. As a biopsy technique, it should be utilized only when fine needle and/or core biopsy (performed in an experienced center) cannot accurately diagnose a soft tissue tumor.] To accurately diagnose and classify most sarcomas, an expert sarcoma pathologist to examine the specimen is paramount.

Many patients suffer poor outcomes as a direct result of open biopsy (eg, local recurrences, extensive unnecessary reconstructions, and amputations in cases that were potentially amenable to limb-salvage resection). Admittedly, better surgical biopsy planning and technique could have prevented some of these adverse events; however, virtually all may have been avoided by the use of fine needle or core needle biopsy instead of open biopsy.

However, to obtain an adequate amount of tissue if testing of the tumor for various treatment markers, chemoresistance, or DNA or RNA microarray is desired, only complete excision or open biopsy can provide the amount of tissue needed for testing.

Seeding Local Tumors by Track Implantation

Instances in which sarcomas were seeded along needle biopsy tracks are easier to document as iatrogenic [doctor-caused] because the tumors are obviously growing in an artificial path.

Viable tumour spread in FNA biopsy tracks has been histologically confirmed. Although this complication is not common and is of unknown clinical significance, it is one that all clinicians who undertake FNA of malignant neoplasms should be aware of. There are documented instances in which sarcomas were seeded along needle biopsy tracks. At least one cancer so frequently implants along the needle track that fine needle biopsies of its suspected lesions are no longer routinely recommended. It is also possible to track and implant tumor deposits with other devices than needles, including gastrostomy tubes, stereotactic cannulas, and postoperative drains. Implantation also can occur after percutaneous ethanol injection into the tumors and thoracoscopic or laparoscopic or other surgical intervention.

"The incidence of implantation metastases after fine-needle procedures is probably underestimated. There is a slight but definite risk that the procedure may render an otherwise curative resection palliative. Implantation metastases cause local complaints of varying severity and seem to have a tendency to recur locally. We recommend that fine-needle biopsy should be restricted to patients who will truly benefit from a more accurate preoperative diagnosis."

"Two cases are reported in which percutaneous biopsy of resectable liver tumours was performed unnecessarily and resulted in needle track seeding. In both instances patients who underwent potentially curative liver resection were rendered incurable because of biopsy track recurrence. The common practice of performing percutaneous ultrasound or CT guided biopsy of potentially resectable lesions in the liver is generally neither necessary nor desirable."

The risk of implantation metastases induced by fine-needle biopsy warrants consideration in patients with abdominal malignancies since it may compromise the outcome of radical surgery. It should only be performed when the result of the procedure has a direct impact on the choice of therapy.

Seeding of Metastases

Tumors that are biopsied or otherwise 'interfered with' have a higher incidence of metastasis than tumors that were removed in an untouched block with wide margins and good tumor hygiene.

In a study reported in The American Journal of Surgical Pathology, the clinical features of 42 LEIOMYOSARCOMAS were analyzed. " In a univariate analysis age >62 years, size >4 cm, extensive necrosis, modified updated French Federation of Cancer Centers (FFCC) grade, and whether the tumor had been "disrupted" by a previous incisional biopsy or incomplete excision were significantly correlated with metastasis.... Disruption was the only significant risk factor for metastasis in a multivariate analysis (relative risk 2.70; p = 0.0001) but was strongly correlated with large size and deep location ."

The study concluded, "The risk of metastasis can be calculated from a model incorporating age, FFCC grade, and disruption. Because disruption correlates with size and depth, it could represent a surrogate as opposed to causal marker for metastasis. Nevertheless, in view of their vascular origin, the possibility that tumor disruption may facilitate or promote access to the bloodstream merits further study."

Tumor cell displacement was observed in 32% of patients who had undergone large-gauge needle core biopsy of the breast. Fine needle aspiration may shed breast cells into peripheral blood.

In addition, in people on the LMS list, three of the people with regional lymph node metastasis either had multiple FNA biopsies of the primary lesion (2) or major manipulations to get the primary tumor removed (1).

Inadvertent spread of cancer at surgery

Fortner JG., Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021., Source: J Surg Oncol, 1993 Jul, 53:3, 191-6

Surgical cure requires that a given cancer be removed without inadvertent spillage of cancer cells by technical error. Potential mishaps include pressing a ligature, while tying, against a protruding tumor and cutting into it; inserting a hemostat into the tumor area to gain control of an escaped short pancreaticoduodenal artery stump which has retracted; grasping a lymph node with forceps which invariably fragments it spilling any cancer cells it may contain; and injecting local anesthesia into or adjacent to a lesion for biopsy. If the lesion is a cutaneous melanoma or other cancer the resulting pressure may force cancer cells into the lymphatic or bloodstream. Other misadventures [??] include touching that portion of a biopsy needle which has been in the tumor and doing an intraoperative biopsy which allows blood or tissue fluid to flow out the opening from the tumor. Sensitivity to such dangers appears [?!] essential to avoiding spillage of cancer cells and obtaining maximal benefit from surgery.

The original abstract can be read at http://ncbi.nlm.nih.gov

More comments by C.C.: [An] eye-opening abstract submitted by the #2 cancer hospital in the United States. I doubt that the informed consent form states this risk emphatically enough and I'm quite sure no doctor will routinely discuss it--not if he wants the cancer sufferer as a customer--er, patient--that is.

Cancer surgery the principal cause of metastasis?

Ernst Krokowsk, a German professor of radiology, was the first to provide proof that cancer surgery - whether for diagnostic or therapeutic purposes - not only triggers metastasis but can actually be its main cause, and other medical doctors have followed in his footsteps. See the detailed article "Proof that cancer surgery increases mortality" at www.health-science-spirit.com/cancersurgery.htm.

Recent research (published in Cancers in 2010) out of Harvard School of Public Health came to similar conclusions in their study "Surgery triggers outgrowth of latent distant disease in breast cancer: an inconvenient truth?"

A related example is furnished by morcellation which can rapidly spread cancer: women have died of uterine cancer shortly after undergoing myomectomy or hysterectomy surgery.

High incidence of in-transit metastases after sentinel node biopsy in patients with melanoma

Estourgie SH, Nieweg OE, Kroon BB., Department of Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. Br J Surg. 2004 Oct;91(10):1370-1.

BACKGROUND: The occurrence of in-transit metastases in patients with a tumour-positive sentinel node varies greatly between centres and it has been suggested that the incidence is high in this patient group. METHODS: The incidence of in-transit metastases in 61 patients who had lymph node dissection because of a tumour-positive sentinel node was compared with that in 60 patients who had palpable nodal metastases dissected. RESULTS: The incidence of in-transit metastases was 23 per cent in patients with a positive sentinel node and 8 per cent in those with palpable nodes (P = 0.027). CONCLUSION: Sentinel node biopsy was associated with a higher risk of in-transit metastases. This finding does not support the routine use of sentinel node biopsy in the management of melanoma. Copyright (c) 2004 British Journal of Surgery Society Ltd

The original abstract can be read at http://ncbi.nlm.nih.gov .

Two private comments on needle biopsies

“Before my wife had surgery the original doctor we consulted suggested a 'needle biopsy'. He mentioned that as thin as my wife was it would not leave a large 'needle track'. I checked on the internet what a 'needle track' was and nixed the idea of a 'needle biopsy'. The tumor was so large it had to come out anyway and they could do a biopsy during surgery and not leave 'tracks' all through her tissue. Needless to say this doctor didn't do the surgery.

I would caution anyone to check out the dangers of having a 'needle biopsy' done. Especially if your are a normal size or larger. The needle leaves cancer cells all along the puncture it makes and these cells can and will proliferate.... a bad, bad thing.

There may be a time and place a needle biopsy may be appropriate but I would suggest you get a second and third opinion.”

“My wife had microcalcifications seen in her breast, We spoke to a surgeon after we had researched the requested stereotactic needle biopsy, which horrified us quite frankly. The surgeon assured us that it would not metastisize into the needle pathways. We spoke to our naturopath who advised us that several of her patients had metasisized tumors exactly where the needles had traveled. What radiology had recommended would have been upwards of 8 or more different angled penetrations! This for a statistically 80% chance there will be no cancer found, or for the other 20%, a relatively slow growth, which could be monitored to see if there is a change over time to warrant further action.

We opted to watch, follow the Budwig protocol and diet, do non-invasive thermogram followups (HIGHLY RECOMMENDED) and follow some concepts and add some supplements as recommended by breast surgeon Dr Christine Horner in her book "Waking The Warrior Goddess" (HIGHLY RECOMMENDED).

The thermograms showed at 4 months after being on the protocol that what previously had been a cause for concern was now in the words of our naturopath who deals with a lot of cancer patients, 'NO cancer present'.

My personal view is that many of the doctors have a belief in what they know and do but often have little time to research constantly or ability to be open to other modalities. They are also responsible to act in your best interest, QUICKLY, to rescue you from possible life-threatening disease. Often this is done without considering a slow and steady, options rich, carefully considered and researched solution. This is our responsibility as receivers of care to do this work. We had to ask the complex 'what if' questions to evaluate and create our option paths in each scenario and how we would act in each. This approach has given us back the power in the each situation. With that came a sense of conviction that we are making intelligent decisions based on all available information.”
Compare Take time to decide-alternative or allopathic.

Some links on cancer metastasis (“tumor seeding”) due to biopsies

  • karlloren.com/biopsy/index.htm
  • karlloren.com/biopsy/p46.htm
  • karlloren.com/biopsy/p31.htm
  • www.ikp.unibe.ch/lab2/Seeding.html
  • healingdaily.com/conditions/biopsy.htm

A google or other internet search will bring up many more informative links.

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