Before your doctor can develop a customized breast cancer treatment plan the diagnosis of breast cancer must be made. In the previous article we discussed the various types of breast cancer and the best breast cancer treatment is customized to the specific type of cancer as well as the stage of the cancer.
Monthly self breast examinations are recommended. The finding of a new lump should be discussed with your health care provider. Breast cancer diagnosis on mammogram shows tumors that are not yet palpable. Many groups have recommended a mammogram at the age of 40, such as American College of Radiology and American Cancer Society.
A mammogram can find breast changes that could be cancer years before physical symptoms develop. Results from many decades of research clearly show that women who have regular mammograms are more likely to have early diagnosis, are less likely to need aggressive treatment (mastectomy and chemotherapy), and are more likely to be cured.
Mammograms are not perfect. They miss some cancers. And sometimes a woman will need more tests to find out if something found on a mammogram is or is not cancer. There’s also a small possibility of being diagnosed with a cancer that never would have caused any problems had it not been found during screening. It’s important that women getting mammograms know what to expect and understand the benefits and limitations of screening.
The need for yearly mammograms is controversial, as many studies demonstrate than a mammogram every other year makes the diagnosis just as well and limits the amount of radiation that the breast is exposed to.
Here is how a breast cancer could look on a Mammogram:
If a mass is diagnosed either on breast examination or a specific type of abnormality is noted on mammogram, then a biopsy is absolutely necessary to make the breast cancer diagnosis. This is performed by the Surgeon or else a Radiologist with a needle. This is called a FNA or fine needle biopsy. The tip of the needle is inserted into the mass and a small piece of tissue is removed.
This small piece is then given to the Pathologist to examine under a microscope. Often, specific stains or antibodies to specific proteins are spread over the specimen to help in the diagnosis. There are characteristic findings that the Pathologist looks for such as a high growth rate (frequent mitosis), a high nuclear to cytoplasmic ratio, and invasion into the deeper tissues. There are also several specific markers that are very important
in determining treatment, they include the presence or absence of the Estrogen Receptor and the Progesterone Receptor, or the presence of the Human Epidermal Growth Factor Receptor 2.
Other tests that might be ordered by your doctor in investigating the breast abnormality could include a breast ultrasound, which uses sound waves to produce images of various tissues within the breast. This is sometimes used to investigate if the lump is solid or a fluid filled cyst. To make a breast cancer diagnosis, MRI of the breast is sometimes
done, this is a highly sophisticated test which uses a super strong magnet and directed radio waves to create interior pictures of the body, and is used to differentiate the various tissues in the breast. This test is controversial as there is no clear evidence of benefit other than in highly select cases and is quite expensive and often results in unnecessary biopsy.
After the diagnosis of cancer, medical professionals need to determine the stage of the cancer. Staging is a way of describing the size of the cancer, if it has spread to the regional lymph nodes, and whether it is affecting or has spread to other parts of the body. There are various diagnostic tests to find out a cancer’s stage so information about staging may not be available until the tests are finished. The stage often determines what treatment options are best for you, and helps your medical professional give an honest assessment of your chances for cure. The most common Staging system is the TNM stage, short for Tumor, Node, Metastasis. There are almost always 5 stages of cancer with various subgroups within each number; these subgroups address different aspects of the cancer that may change the way the cancer responds to therapy.
Stage 0 means it is noninvasive.
Stage 1 means that the cancer is less than 2cm and has not spread into the lymph nodes.
Stage 2 means that the cancer either has spread to the axillary (underarm) lymph nodes or is larger than 2 cm, but smaller than 5cm.
Stage 3 means that the tumor is either larger than 5cm, or has spread to many lymph nodes in the axilla. Other reasons could be direct spread to the skin or the chest muscles.
Stage 4 means that the tumor has spread into other organs, such as bone, liver, lung, brain.
The following tests and procedures also may be used in the staging process:
Sentinel lymph node biopsy : The removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes.
Chest x-ray : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more radioactive glucose than normal cells do