INVESTIGATIONS FOR DIAGNOSIS:
These can be part of a screening examination, and are performed on healthy women with no symptoms on a regular basis especially if they have risk factors. This helps to catch cancer in its early stages, when it is much more likely to respond to treatment. Typical breast screening exams include a clinical breast examination and a mammogram.
Breast Cancer Diagnosis: There are several procedures that can be used to diagnose breast cancer. Not every procedure will be done for each patient. The evaluation is based upon the patient’s examination and physician recommendations.
Radiological Investigations:
Fine Needle Aspiration (FNAC): a thin, hollow needle is inserted into the breast lump and cells are removed from the lump. While this test can help to determine if there is cancer present, it cannot determine if the cancer is invasive and additional biopsy may be needed if positive.
Biopsy: a small sample of the suspicious area of the breast is removed for examination under a microscope. Biopsies can be done in the following ways:
Core Needle biopsy: a thicker needle is used to remove one or more small cylinder-shaped tissue samples from the tumor. This can give us additional information including ER, PR, and HER2Neu status.
Surgical biopsy: an incision is made in the breast using a blade. In an excisional biopsy, the entire mass is removed. In an incisional biopsy, only a portion of the tumor is removed. Though if the lump is suspicious and radiological investigations, history and physical examination is indicating of a malignancy a wide local excision should be done.
Lymphatic drainage of breast
Lymphatic system is responsible for collecting the lymph which is the fluid which leaks out of the blood vessels due to high pressure. The lymph nodes are olive-sized glands and are stations where the lymphatic vessels collect. The lymphatic system can also carry cancer cells from the tumor site to other areas of the body. In breast cancer patients, the most common nodes to be affected are located under the armpit.
Axillary lymph node dissection is done along with the surgery for the primary to remove these suspicious glands. A standard axillary dissection yields more than ten nodes.
Alternatively a sentinel lymph node biopsy, a radioactive tracer is injected into the area before surgery. Then, the surgeon injects a blue dye near the tumor site, which shows up in cancerous lymph nodes. The node with the highest amount of tracer or blue dye is the “sentinel” node. The surgeon removes all nodes with blue dye. This procedure can spare healthy lymph nodes, which results in fewer side-effects such as lymphedema and is being tested in randomized phase III trials before becoming a standard of care.
STAGING (Source: National Cancer Institute)
The staging system allows doctors to help identify the extent of breast cancer involvement. By knowing the extent of disease, doctors can then determine the best treatment for each patient.
Stage 0 (carcinoma in situ): cancer has not spread from the site of origin.
There are 2 types of breast carcinoma in situ:
Ductal carcinoma in situ (DCIS) is a noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues, although it is not known at this time how to predict which lesions will become invasive.
Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are found in the lobules of the breast. This condition seldom becomes invasive cancer; however, having lobular carcinoma in situ in one breast increases the risk of developing breast cancer in either breast.
Stage I
The tumor is 2 centimeters or smaller and has not spread outside the breast.
Stage IIA
No tumor is found in the breast, but cancer is found in the axillary lymph nodes (the lymph nodes under the arm); or
The tumor is 2 centimeters or smaller and has spread to the axillary lymph nodes; or
The tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes.
Stage IIB
The tumor is larger than 2 centimeters but not larger than 5 centimeters and has spread to the axillary lymph nodes; or
The tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes.
Stage IIIA
No tumor is found in the breast. Cancer is found in axillary lymph nodes that are attached to each other or to other structures, or cancer may be found in lymph nodes near the breastbone; or
The tumor is 2 centimeters or smaller. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone; or
The tumor is larger than 2 centimeters but not larger than 5 centimeters. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone; or
The tumor is larger than 5 centimeters. Cancer has spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
Stage IIIB
The tumor may be any size and cancer:
Has spread to the chest wall and/or the skin of the breast; and
May have spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
Stage IIIC
There may be no sign of cancer in the breast or the tumor may be any size and may have spread to the chest wall and/or the skin of the breast. Also, cancer:
Has spread to lymph nodes above or below the collarbone; and
May have spread to axillary lymph nodes or to lymph nodes near the breastbone.
Stage IIIC: Breast cancer is found in: 10 or more axillary lymph nodes; or Lymph nodes above the collarbone; or
Axillary lymph nodes and in lymph nodes near the breastbone
Stage IV: The cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.
These can be part of a screening examination, and are performed on healthy women with no symptoms on a regular basis especially if they have risk factors. This helps to catch cancer in its early stages, when it is much more likely to respond to treatment. Typical breast screening exams include a clinical breast examination and a mammogram.
Breast Cancer Diagnosis: There are several procedures that can be used to diagnose breast cancer. Not every procedure will be done for each patient. The evaluation is based upon the patient’s examination and physician recommendations.
Radiological Investigations:
- Mammogram- Diagnostic mammograms are x-ray pictures of the breast. It can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium called micro calcifications. Technique: Each breast is placed between two photographic plates and compressed, while an X-ray is taken of the breast tissue. Mammograms should be conducted every year beginning at age 40 and possibly earlier if a woman has certain risk factors such as inherited genetic mutations.
- Magnetic Resonance Imaging (MRI): images of the breast are created with powerful magnets that interact with a computer.
- Ultrasound: a special instrument placed against the skin transmits sound waves, which bounce off breast tissue and are used create an image on a monitor.
Fine Needle Aspiration (FNAC): a thin, hollow needle is inserted into the breast lump and cells are removed from the lump. While this test can help to determine if there is cancer present, it cannot determine if the cancer is invasive and additional biopsy may be needed if positive.
Biopsy: a small sample of the suspicious area of the breast is removed for examination under a microscope. Biopsies can be done in the following ways:
Core Needle biopsy: a thicker needle is used to remove one or more small cylinder-shaped tissue samples from the tumor. This can give us additional information including ER, PR, and HER2Neu status.
Surgical biopsy: an incision is made in the breast using a blade. In an excisional biopsy, the entire mass is removed. In an incisional biopsy, only a portion of the tumor is removed. Though if the lump is suspicious and radiological investigations, history and physical examination is indicating of a malignancy a wide local excision should be done.
Lymphatic drainage of breast
Lymphatic system is responsible for collecting the lymph which is the fluid which leaks out of the blood vessels due to high pressure. The lymph nodes are olive-sized glands and are stations where the lymphatic vessels collect. The lymphatic system can also carry cancer cells from the tumor site to other areas of the body. In breast cancer patients, the most common nodes to be affected are located under the armpit.
Axillary lymph node dissection is done along with the surgery for the primary to remove these suspicious glands. A standard axillary dissection yields more than ten nodes.
Alternatively a sentinel lymph node biopsy, a radioactive tracer is injected into the area before surgery. Then, the surgeon injects a blue dye near the tumor site, which shows up in cancerous lymph nodes. The node with the highest amount of tracer or blue dye is the “sentinel” node. The surgeon removes all nodes with blue dye. This procedure can spare healthy lymph nodes, which results in fewer side-effects such as lymphedema and is being tested in randomized phase III trials before becoming a standard of care.
STAGING (Source: National Cancer Institute)
The staging system allows doctors to help identify the extent of breast cancer involvement. By knowing the extent of disease, doctors can then determine the best treatment for each patient.
Stage 0 (carcinoma in situ): cancer has not spread from the site of origin.
There are 2 types of breast carcinoma in situ:
Ductal carcinoma in situ (DCIS) is a noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues, although it is not known at this time how to predict which lesions will become invasive.
Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are found in the lobules of the breast. This condition seldom becomes invasive cancer; however, having lobular carcinoma in situ in one breast increases the risk of developing breast cancer in either breast.
Stage I
The tumor is 2 centimeters or smaller and has not spread outside the breast.
Stage IIA
No tumor is found in the breast, but cancer is found in the axillary lymph nodes (the lymph nodes under the arm); or
The tumor is 2 centimeters or smaller and has spread to the axillary lymph nodes; or
The tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes.
Stage IIB
The tumor is larger than 2 centimeters but not larger than 5 centimeters and has spread to the axillary lymph nodes; or
The tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes.
Stage IIIA
No tumor is found in the breast. Cancer is found in axillary lymph nodes that are attached to each other or to other structures, or cancer may be found in lymph nodes near the breastbone; or
The tumor is 2 centimeters or smaller. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone; or
The tumor is larger than 2 centimeters but not larger than 5 centimeters. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone; or
The tumor is larger than 5 centimeters. Cancer has spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
Stage IIIB
The tumor may be any size and cancer:
Has spread to the chest wall and/or the skin of the breast; and
May have spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
Stage IIIC
There may be no sign of cancer in the breast or the tumor may be any size and may have spread to the chest wall and/or the skin of the breast. Also, cancer:
Has spread to lymph nodes above or below the collarbone; and
May have spread to axillary lymph nodes or to lymph nodes near the breastbone.
Stage IIIC: Breast cancer is found in: 10 or more axillary lymph nodes; or Lymph nodes above the collarbone; or
Axillary lymph nodes and in lymph nodes near the breastbone
Stage IV: The cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.
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