Breast Cancer
Diagnosis
An abnormal area on a mammogram, a lump, or other changes in the breast can be caused by cancer or by other, less serious, problems. To find out the cause of any of these possible signs or symptoms of breast cancer, a woman's doctor does a careful physical exam and asks about her personal and family medical history. In addition to checking general signs of health, the doctor may do one or more of the breast exams listed below:
Palpation The doctor can tell a lot about a lump (its size, its texture, and whether it moves easily) by palpation, carefully feeling the lump and the tissue around it. Benign lumps often feel different from cancerous ones.
Diagnostic Mammography Diagnostic mammograms involve x-ray pictures of the breast to get clearer, more detailed pictures of any area that looks abnormal on a screening mammogram. They also are used to help the doctor learn more about unusual breast changes, such as a lump, pain, thickening, nipple discharge, or change in breast size or shape. Diagnostic mammograms may focus on a specific area of the breast. They may involve special techniques and more views than screening mammograms.
Ultrasonography Using high-frequency sound waves, ultrasonography (ultrasound) can often show whether a lump is a fluid-filled cyst (not cancer) or a solid mass (which may or may not be cancer). The doctor can view these pictures on a monitor. After the test, the pictures can be stored on video and printed out. This exam may be used along with a mammogram.
Magnetic Resonance Imaging For magnetic resonance imaging (MRI), a powerful magnet linked to a computer is sometimes used to make detailed pictures of tissue inside the breast. The doctor can view these pictures on a monitor and can print them on film. MRI may be used along with a mammogram.
Based on these exams, the doctor may decide that no breast cancer is present and that no further tests are needed and no treatment is necessary. (In such cases, the doctor may need to check the woman regularly to watch for any changes.)
Often, however, fluid or tissue must be removed from the breast to determine if breast cancer is present. A woman's doctor may refer her for further evaluation to a surgeon or other health care professional who has experience with breast diseases. These doctors may perform:
Fine Needle Aspiration A thin needle is used to remove fluid from a breast lump. This procedure may show whether a lump is a fluid-filled cyst (not cancer) or a solid mass (which may or may not be cancer). Clear fluid removed from a cyst may not need to be checked by a lab.
Needle Biopsy Using special techniques, tissue can be removed with a needle from an area that is suspicious on a mammogram but cannot be felt. Tissue removed in a needle biopsy goes to a lab to be checked by a pathologist for cancer cells.
Surgical Biopsy The surgeon cuts out part or all of a lump or suspicious area. A pathologist examines the tissue under a microscope to check for cancer cells.
When the Diagnosis is Breast Cancer
When breast cancer is diagnosed, the pathologist can tell what kind of cancer it is (whether it began in a duct or a lobule) and whether it is invasive (has invaded nearby tissues in the breast).
Special lab tests of the tissue help the doctor learn more about the cancer. For example, hormone receptor tests (estrogen and progesterone receptor tests) can help predict whether the cancer is sensitive to hormones. Positive test results mean hormones help the cancer grow, and the cancer is likely to respond to hormonal therapy. Other lab tests are sometimes done to help the doctor predict whether the cancer is likely to grow slowly or quickly. Sometimes a sample of breast tissue is checked for the human epidermal growth factor receptor-2 (HER2) or the HER2/neu gene. The presence of the HER2 receptor or gene may increase the chance that the breast cancer will come back. The doctor may order x-rays and blood tests. The doctor may also do special exams of the bones, liver, or lungs because breast cancer may spread to these areas.
The patient's doctor may refer her to other doctors who specialize in breast cancer, or she may ask for a referral. Treatment generally begins within a few weeks after the diagnosis. There will be time for the woman to talk with the doctor about her treatment choices, to get a second opinion, and to prepare herself and her loved ones.