Breast Cancer diagnosis
Breast Cancer diagnosis: Mammogram
More than 90% of all breast cancers are detected by mammogram (a low-dose
x ray of the breast). Mammograms should be done to evaluate a suspicious lump. Screening
mammograms should be ordered according to the doctor's guidelines. Despite the controversy
about the cost-effectiveness of mammograms for women in their 40s, most doctors agree with
the current American Cancer Society guidelines that recommend screening mammograms every
year or two for women between 40 and 49, and every year after age 50. Women with a family
history of breast cancer may want to have a mammogram every year after age 40.
A typical mammography screening includes two views of each breast (one from above, and
one from the side). Normally, the technician examines the x-ray pictures immediately to
make sure no further x rays are needed, or to decide whether an ultrasound may be
required.
If anything irregular is detected, such as a mass, changes from earlier mammograms,
abnormalities of the skin, or enlargement of the lymph nodes, further testing may be
recommended. This could include an ultrasound of the breast, a biopsy or needle sampling, or consultation with a
breast surgeon.
Breast Cancer diagnosis: Biopsy
Biopsy of the breast is a removal of breast tissue for examination by a pathologist. An
excisional biopsy is a surgical procedure in which the entire lump area and some
surrounding tissue is removed for examination. If the mass is very large, an iNational Cancer institutesional
biopsy is done where only a portion of the area is removed and analyzed. Needle biopsy can
be done in two methods. An aspiration needle biopsy uses a very fine needle to withdraw
cells and fluid from the mass for analysis. A large core needle biopsy uses a larger
diameter needle to remove small pieces of tissue from the mass that can be analyzed. These
analyses can determine whether the mass is benign (non-cancerous) or cancerous and
therefore, whether further treatment is required.
Breast Cancer diagnosis: Ultrasonography
Ultrasonographic screening is useful to differentiate between solid and cystic breast masses when a palpable mass is not
well seen on a mammogram. Ultrasonography is especially helpful in young women with dense
breast tissue when a palpable mass is not visualized on a mammogram. Ultrasonography is
not to be used for routine screening, primarily because microcalcifications are not
visualized and the yield of carcinomas is negligible.
Breast Cancer diagnosis: stages
To find out if the cancer has spread to other parts of the body (metastasized), doctors
remove some underarm lymph nodes to test for cancer cells that have spread and to assist
in making decisions for treatment. Checking to see if there are cancer cells in the lymph
nodes is also a way to tell how advanced the cancer is ("staging" cancer).
Breast cancer is rated from Stage 0 to Stage IV. Staging uses the diagnostic information
to tell the cancer physician (oncologist) how widespread the disease is and includes:
- STAGE 0. In Situ ("in place") disease in which the cancerous cells are in
their original location within normal breast tissue
- STAGE I. Tumor less than 2 cm in diameter with
no spread beyond the breast
- STAGE IIA. Tumor 2 to 5 cm in size without spread to axillary (armpit) lymph nodes or
tumor less than 2 cm in size with spread to axillary lymph nodes
- STAGE IIB. Tumor greater than 5 cm in size without spread to axillary lymph nodes or
tumor 2 to 5 cm in size with spread to axillary lymph nodes
- STAGE IIIA. Tumor smaller than 5 cm in size with spread to axillary lymph nodes which
are attached to each other or to other structures, or tumor larger than 5 cm in size with
spread to axillary lymph nodes
- STAGE IIIB. The tumor has penetrated outside the breast to the skin of the breast or of
the chest wall or has spread to lymph nodes inside the chest wall along the sternum
- STAGE IV. A tumor of any size with spread beyond the region of the breast and chest
wall, such as to liver, bone, or lungs
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