ABSTRACT
SECURING A TISSUE DIAGNOSIS Cancer treatment usually involves major procedures with significant toxicity and the diagnosis of cancer has profound psychological, social and physical consequences for the patient. It is therefore mandatory to be certain of the diagnosis before informing the patient or starting therapy. This may entail a simple biopsy or a more invasive procedure such as a laparotomy or craniotomy. As a rule of thumb, the least invasive means of obtaining tissue should be employed. However, occasionally, several attempts at obtaining tissue from an ill-defined and poorly accessible tumour prove unsuccessful or the patient may be unfit to undergo an essential procedure by virtue of age or general condition. Under these circumstances, clinical judgement and common sense must prevail. Clearly it would be inappropriate to investigate exhaustively an elderly and infirm person with an extensive asymptomatic brain tumour or widespread metastatic disease if no treatment
or change in management would be considered. Specific methods of obtaining tumour tissue include the following techniques.
