IF YOU SUSPECT BREAST CANCER
If you have any symptoms that might be a sign of breast cancer, be sure to see your doctor as soon as possible. After the doctor ask you some questions and doing a complete physical exam (including a clinical breast exam), your doctor may want to do more test.
Imaging test
Mammograms: Although mammograms are mostly used for screening, they can also be used if there is a breast problem. these are called diagnostic mammograms. This kind of mammogram might show that everything is ok and you can go back to having yearly mammograms. Or it might show that a biopsy should be done. Even if the mammogram doesn't show a tumor, if you or your doctor can feel a lump you may need a biopsy. The exception would be if ultrasound shows that the lump is a cyst.
Mammograms often don't work as well in younger women, mostly because their breast are dense and this can hide a tumor. This is also true for a pregnant women and women who are breast feeding. Since most breast cancers occur in older women, this is usually not a major problem. But it is a problem for young women who have a genetic risk factor for breast cancer because they often develop breast cancer at a young age. For this reason, some doctors now suggest MRI along with mammograms for screening these women.
A mammogram cannot show for sure whether or not cancer is present, if your mammorgram shows a possible problem, a sample of breast tissue is removed and looked at under a microscope. This is called a biopsy.
MRI scans: MRI scans can be used along with mammograms for screening women who have a high risk of getting breast cancer. Or the can be used to look at suspicious areas found by a mammogram. MRI is also used for a women who have breast cancer in order to help figure out the size of the cancer.
MRI scans use radio waves and strong magnets instead of x-rays. A contrast material called gadolinium is often injected into a vein before the scan to better show up details. MRI scans can take a long time-often up to an hour. You have to lie inside a narrow tube, which may upset people with a fear of enclosed spaces. The machine makes loud buzzing and clicking noises that you may find disturbing. Some places will give you headphones with music to block this out.
Breast ultrasound: An ultrasound uses sound waves to outline a part of the body. the sound wave echoes are picked up by a computer to create a picture on a computer screen.
ultrasound is a good test to use along with mammograms because it is widely available and costs less than other tests. But ultrasound should not be used instead of mammograms. usually,it is used to look at a certain area of concern found by the mammogram. It also helps to tell the difference between cysts and solid masses without using a needle to draw out fluid.
Ductogram (also called a galactogram): This is a special kind of x-ray that is sometimes helpful in finding the cause of a nipple discharge. A very thin plastic tube is place into the opening of the duct at the nipple. A dye is injected outline the shape of the duct on a x-ray picture. It will show if there is a tumor inside the duct. If there is a discharge, the fluid can be tested for cancer cells.
Biopsy
A biopsy is done when other tests show that you might have breast cancer. The only way to know for sure is for you to have a biopsy. During
this test, cells from the area of concern are removed so they can be studied in the lab. There are many kinds of biopsies. The doctor will use the one best for you.
Fine needle aspiration biopsy (FNAB): For this test, a very thin, hollow needle is used to pull out fluid or tissue from the lump. Your doctor might use ultrasound to guide the needle into the lump. Medicine may be used to make the skin numb. Sometimes the process of giving the anesthetic (the numbing medicine) causes more discomfort than the biopsy itself. The needle used in FNAB is thinner than the ones used for blood test.
If the fluid drawn out is clear, the lump is most likely a benign cyst. Bloody or cloudy fluid can mean either a cyst or , rarely, cancer. If the lump is solid, small pieces of tissue are taken out. These will be looked at under a microscope to see if they are cancer.
If the biopsy do not give a clear answer, or your doctor is still not sure, a second biopsy or a different type of biopsy may be needed.
Stereotactic core needle biopsy: The needle used for this test is larger than the one for fine needle biopsy. It is used to remove 3 to 5 cores of tissue. The biopsy is done with local anesthesia in an outpatient setting.
There are two new methods that may be used, Mammotome and ABBI (Advanced Breast Biopsy Instrument). These remove more tissue than a core biopsy.
Surgical biopsy: Sometimes surgery is needed to remove all or part of a lump so it can be looked at under a microscope. The entire lump as well as some normal tissue around it may be removed. Most often this is done in the hospital's outpatient center. Local anesthesia is used ( the area around the lump is numbed) and you may also be given drugs to relax you and make you less aware of the process. Ask your doctor which kind of biopsy you will have and what you can expect during and after the test.
Breast cancer grad
If it is cancer, the biopsy sample is also given a grade from a 1 to 3. Cancers that look more like normal breast tissue tend to grow and spread more slowly. In general, a lower grad number means a slower-growing cancer, while a higher number means a faster-growing cancer. The grade helps predict the outcome (prognosis) for the woman. The tumor grad is most important in women with a small tumors without lymph node involvement. These women may not need further treatment after the tumor is removed, while women with higher grade tumors usually get hormone therapy or chemotherapy.
Hormone receptor status
Receptors are proteins on the outside surfaces cells that can attach to hormones in the blood. Estrogen and progesterone are hormones that often attach to these receptors and fuel the growth of breast cancer cells.
The biopsy sample can be tested to see whether it has receptors for estrogen and/or progesterone. If it does, it is often referred to as ER-positive or PR -positive. Such cancers tend to have a better outlook than respond to hormone treatment. About 2 to 3 breast cancers have at least one of these receptors.
HER2/neu status
About 1 out 5 breast cancers have too much of a protein called HER2/neu. Tumors with increased levels of HER-2/neu are referred to as "HER-positive." These cancers tend to grow and spread faster than other breast cancers.
HER/neu testing should be done on all newly diagnosed breast cancers. HER2-positive cancer can be treated with drugs that target the HER2/neu protein, such as trastuzumab (Hercetin) and lapatinib (tykerb)
Other lab test may be done to help figure out how quickly the cancer is growing and what treatments might work best.
Test of gene patterns
Research has shown that looking at the patterns of a number of genes at the same time can help tell whether or not an early breast cancer is likely
to come back after the first treatment. This can help when deciding whether or treatment, such as chemotherapy, might be useful. There are now 2 of these tests which look at different sets of genes-Oncotype DX and MammaPrint.
The information you find on our site is for education only it does not take the place of you seeking medical help from a license professional if you have any signs of breast cancer or any other medical issues.