Diagnosis of Breast Cancer

Signs and Symptoms

Common signs and symptoms of breast cancer include:

  • A lump or thickening inside the breast tissue or in the armpit area.
  • Change in shape or size of breast.
  • Change in appearance of skin in a part of the breast.
  • Inversion or turning in of the nipple.
  • Discharge from the nipple, particularly if blood stained

 

Detection and Diagnosis

Early detection of breast cancer improves the chances of successful treatment. New techniques are constantly being researched to improve the detection, diagnosis, and treatment of breast cancer.

The following techniques or methods are often used to detect and diagnose the breast cancer.

  • Clinical Breast Examination
  • Mammography
  • Other imaging tests such as ultrasound & MRI
  • Biopsy

 

Clinical Breast Examination (CBE)

The physical examination of the breast is performed by a health Professional. It is done to find a lump or any change in the breast which may be an indication of breast cancer. CBE should be a part of regular health check-up. American Cancer Society recommends a CBE once every three years for women in their 20’s and 30’s. Women aged 40 and older are recommended to get a CBE annually.

MammogramMammography

A Mammogram is an X-ray of the breast using a specially designed machine and is very useful in early diagnosis of breast cancer. Mammograms can be used both for screening and diagnostic purposes.
Screening mammogram is recommended every year for all women aged 40 years and above. Prior to age 40, screening may be necessary for the women who have risk factors for breast cancer. Screening mammogram is a key to early detection and is intended for women who are asymptomatic, or are not experiencing any breast problems.

A diagnostic mammogram is for women who are having a problem such as a lump or unusual nipple discharge or pain. The diagnostic mammogram focuses in on a particular lump or area of abnormal tissue. It involves special techniques and more views than screening mammograms.

Potential abnormalities on a mammogram may include cysts, hematomas, calcifications, fibroadenomas or tumor.

Imaging tests

If abnormal findings are revealed in a mammogram, other imaging tests may be needed for further evaluation. These imaging tests include ultrasound and MRI of the breast.

Breast Ultrasound: Breast Ultrasound also known as sonography creates pictures using high frequency sound waves through the breast. The great advantage of breast ultrasound is that it requires no radiation and is non-invasive. It is used to evaluate whether the lump is a cyst or a solid mass. It is also helpful to precisely locate the position of the tumor. If a biopsy is needed, ultrasound may be used to help guide the procedure.

Breast MRI:
Breast Magnetic Resonance Imaging (MRI) scans use radio waves and strong magnets. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue. Breast MRI can be used to distinguish between benign and malignant tumors. MRI is also helpful in detecting tumors even in dense breast tissue.

Biopsy: A biopsy is the removal of tissue from the suspicious area to determine the presence or extent of the cancer cells. Following a clinical examination or mammography, a biopsy is the only definitive way of confirming or ruling out breast cancer in suspected cases. There are several kinds of breast biopsy techniques, some of them are

  • Fine-needle aspiration– A fine needle aspiration (FNA) biopsy is an effective tool in evaluating and diagnosing suspected lumps or masses. It involves passing a thin needle through the skin to sample fluid or tissue from a cyst or solid mass. The sample is then sent to a pathology laboratory for analysis. It is non-invasive and only slightly uncomfortable, compared to a surgical biopsy.
  • Core needle biopsy– Core biopsy is a more invasive procedure than FNA, as it involves making a small incision in the skin. A large needle is then passed through this incision and several narrow samples of the tissue to be investigated are taken. Core biopsy is done under local anesthesia. This is the preferred way of diagnosing breast cancer.
  • Skin biopsy—If there are any skin changes on the breast, skin biopsy may be needed. A skin biopsy consists of removing a small sample of breast skin. The sample is then tested for breast cancer cells in the lymph vessels.
  • Surgical Biopsy—surgical biopsy can be either incisional or excisional.
    • Incisional Biopsy— An incisional biopsy involves removal of only a portion of the tumor.
    • Excisional Biopsy– An excisional biopsy involves removal of the entire lump or suspicious area.

 

Other Lab Tests With Breast Tissue

If a breast cancer is diagnosed, other lab tests are also done on the removed breast tissue. These tests consist of:
Hormone receptor tests: These tests will show whether or not estrogen and progesterone hormones fuel the tumor. Cancer that is hormone-sensitive has a better chance of responding to hormone therapy. Hormone-negative cancer will respond to other kinds of treatment.

HER2/neu test: Knowing HER2/neu status or human epidermal growth factor receptor 2 is an important part of the diagnosis. HER2/neu is a gene that sends control signals to the cells, telling them to grow, divide, and make repairs. A healthy breast cell has 2 copies of the HER2/neu gene. Some breast cancers get started when a breast cell has more than 2 copies of that gene, and those copies start over-producing the HER2 protein. As a result, the affected cells grow and divide much too quickly. If the breast tumor has too much HER2/neu, then targeted therapy is a treatment option.

Staging:
Staging is the process of finding out how widespread the cancer is when it is diagnosed. It helps the health care professional choose the best suitable treatment. Staging may involve other tests like bone scan, CT scan, lymph node biopsy and PET scans.

Bone Scan: A bone scan can help show whether a cancer has spread to the bones. For this test, a small amount of low-level radioactive material is injected intravenously. The substance settles in areas of bone changes throughout the entire skeleton. A scanner detects the radioactivity and creates pictures of the bones. The pictures may show cancer that has spread to the bones.

PET Scan: In this test a sugar molecule is bonded to a radioactive element (which releases positrons) and is injected into the body. After the sugar is injected it is taken up by the active cells within the body. The reason the PET scan is so successful is that cancer is, in general, more metabolically active than other body tissues, and so takes up more sugar. After the cancer takes up the sugar, the radioactive element is retained in the tissue and then positrons are released and visualized by the scanner.

CT Scan:
In women with breast cancer, this test is most often used to look at the chest and abdomen to see if the cancer has spread to other organs. The CT scan uses a device that rotates around the body spreading the x-rays beams while it rotates. These images are then processed by a computer, resulting in cross-sectional images of the internal organs of the body. Sometimes a contrast material is also injected into your blood vessel in your forearm or hand. Contrast can highlight specific areas inside the body, which creates a clearer image.

Sentinel Lymph Node Biopsy (SLN biopsy):
In this procedure the sentinel lymph node in the axilla – under the arm (first lymph node to which the cancer is likely to spread) is removed surgically and examined under a microscope to determine whether the cancer cells are present. For this procedure, a blue dye and a radioactive substance are injected near the breast tumor. A scanner is used to find out the sentinel lymph node containing the radioactive substance or stained with dye. This node is then removed surgically and checked for cancer cells.

 

Read more: Breast Cancer Stages & Treatment