Diagnosing Breast Cancer

Diagnosing breast cancer
Tests and procedures used to diagnose breast cancer include:
 Breast exam. Your doctor will check both of your breasts

and lymph nodes in your armpit, feeling for any lumps or
other abnormalities.
 Mammogram. A mammogram is an X-ray of the breast.

Mammograms are commonly used to screen for breast
cancer. If an abnormality is detected on a screening
mammogram, your doctor may recommend a diagnostic
mammogram to further evaluate that abnormality.
 Breast ultrasound. Ultrasound uses sound waves to produce

images of structures deep within the body. Ultrasound may
be used to determine whether a new breast lump is a solid
mass or a fluid-filled cyst.
 Removing a sample of breast cells for testing (biopsy). A

biopsy is the only definitive way to make a diagnosis of
breast cancer. During a biopsy, your doctor uses a
specialized needle device guided by X-ray or another imaging
test to extract a core of tissue from the suspicious area.
Often, a small metal marker is left at the site within your
breast so the area can be easily identified on future imaging
tests.
Biopsy samples are sent to a laboratory for analysis where

experts determine whether the cells are cancerous. A biopsy
sample is also analyzed to determine the type of cells
involved in the breast cancer, the aggressiveness (grade) of
the cancer, and whether the cancer cells have hormone
receptors or other receptors that may influence your
treatment options.
 Breast magnetic resonance imaging (MRI). An MRI machine

uses a magnet and radio waves to create pictures of the
interior of your breast. Before a breast MRI, you receive an
injection of dye. Unlike other types of imaging tests, an MRI
doesn't use radiation to create the images.
Other tests and procedures may be used depending on your situation.
Once your doctor has diagnosed your breast cancer, he or she works
to establish the extent (stage) of your cancer. Your cancer's stage
helps determine your prognosis and the best treatment options.
Complete information about your cancer's stage may not be available

until after you undergo breast cancer surgery.
Tests and procedures used to stage breast cancer may include:
 Blood tests, such as a complete blood count
 Mammogram of the other breast to look for signs of cancer
 Breast MRI
 Bone scan
 Computerized tomography (CT) scan
 Positron emission tomography (PET) scan
Not all women will need all of these tests and procedures. Your doctor
selects the appropriate tests based on your specific circumstances
and taking into account new symptoms you may be experiencing.
Breast cancer stages range from 0 to IV with 0 indicating cancer that

is noninvasive or contained within the milk ducts. Stage IV breast
cancer, also called metastatic breast cancer, indicates cancer that
has spread to other areas of the body.
Breast cancer staging also takes into account your cancer's grade; the
presence of tumor markers, such as receptors for estrogen,
progesterone and HER2; and proliferation factors.
Treatment
Your doctor determines your breast cancer treatment options based
on your type of breast cancer, its stage and grade, size, and whether
the cancer cells are sensitive to hormones. Your doctor also considers
your overall health and your own preferences.
Most women undergo surgery for breast cancer and many also receive
additional treatment after surgery, such as chemotherapy, hormone
therapy or radiation. Chemotherapy might also be used before surgery
in certain situations.
There are many options for breast cancer treatment, and you may feel
overwhelmed as you make complex decisions about your treatment.
Consider seeking a second opinion from a breast specialist in a breast
center or clinic. Talk to other women who have faced the same
decision.
Breast cancer surgery
Operations used to treat breast cancer include:
 Removing the breast cancer (lumpectomy). During a

lumpectomy, which may be referred to as breast-conserving
surgery or wide local excision, the surgeon removes the
tumor and a small margin of surrounding healthy tissue.
A lumpectomy may be recommended for removing smaller

tumors. Some people with larger tumors may undergo
chemotherapy before surgery to shrink a tumor and make it
possible to remove completely with a lumpectomy
procedure.
 Removing the entire breast (mastectomy). A mastectomy is

an operation to remove all of your breast tissue. Most
mastectomy procedures remove all of the breast tissue —
the lobules, ducts, fatty tissue and some skin, including the
nipple and areola (total or simple mastectomy).
Newer surgical techniques may be an option in selected

cases in order to improve the appearance of the breast. Skin-
sparing mastectomy and nipple-sparing mastectomy are
increasingly common operations for breast cancer.
 Removing a limited number of lymph nodes (sentinel node

biopsy). To determine whether cancer has spread to your
lymph nodes, your surgeon will discuss with you the role of
removing the lymph nodes that are the first to receive the
lymph drainage from your tumor.
If no cancer is found in those lymph nodes, the chance of

finding cancer in any of the remaining lymph nodes is small
and no other nodes need to be removed.
 Removing several lymph nodes (axillary lymph node

dissection). If cancer is found in the sentinel lymph nodes,
your surgeon will discuss with you the role of removing
additional lymph nodes in your armpit.
 Removing both breasts. Some women with cancer in one

breast may choose to have their other (healthy) breast
removed (contralateral prophylactic mastectomy) if they
have a very increased risk of cancer in the other breast
because of a genetic predisposition or strong family history.
Most women with breast cancer in one breast will never

develop cancer in the other breast. Discuss your breast
cancer risk with your doctor, along with the benefits and
risks of this procedure.
Complications of breast cancer surgery depend on the procedures you

choose. Breast cancer surgery carries a risk of pain, bleeding,
infection and arm swelling (lymphedema).
You may choose to have breast reconstruction after surgery. Discuss

your options and preferences with your surgeon.
Consider a referral to a plastic surgeon before your breast cancer

surgery. Your options may include reconstruction with a breast
implant (silicone or water) or reconstruction using your own tissue.
These operations can be performed at the time of your mastectomy or
at a later date.
Medical management
Radiation therapy
Radiation therapy uses high-powered beams of energy, such as X-rays

and protons, to kill cancer cells. Radiation therapy is typically done
using a large machine that aims the energy beams at your body
(external beam radiation). But radiation can also be done by placing
radioactive material inside your body (brachytherapy).
External beam radiation of the whole breast is commonly used after a

lumpectomy. Breast brachytherapy may be an option after a
lumpectomy if you have a low risk of cancer recurrence.
Doctors may also recommend radiation therapy to the chest wall after
a mastectomy for larger breast cancers or cancers that have spread to
the lymph nodes.
Breast cancer radiation can last from three days to six weeks,
depending on the treatment. A doctor who uses radiation to treat
cancer (radiation oncologist) determines which treatment is best for
you based on your situation, your cancer type and the location of your
tumor.
Side effects of radiation therapy include fatigue and a red, sunburn-like

rash where the radiation is aimed. Breast tissue may also appear
swollen or more firm. Rarely, more-serious problems may occur, such
as damage to the heart or lungs or, very rarely, second cancers in the
treated area.
Chemotherapy
Chemotherapy uses drugs to destroy fast-growing cells, such as

cancer cells. If your cancer has a high risk of returning or spreading to
another part of your body, your doctor may recommend chemotherapy
after surgery to decrease the chance that the cancer will recur.
Chemotherapy is sometimes given before surgery in women with larger

breast tumors. The goal is to shrink a tumor to a size that makes it
easier to remove with surgery.
Chemotherapy is also used in women whose cancer has already

spread to other parts of the body. Chemotherapy may be recommended
to try to control the cancer and decrease any symptoms the cancer is
causing.
Chemotherapy side effects depend on the drugs you receive. Common

side effects include hair loss, nausea, vomiting, fatigue and an
increased risk of developing an infection. Rare side effects can include
premature menopause, infertility (if premenopausal), damage to the
heart and kidneys, nerve damage, and, very rarely, blood cell cancer.
Hormone therapy
Hormone therapy — perhaps more properly termed hormone-blocking

therapy — is used to treat breast cancers that are sensitive to
hormones. Doctors refer to these cancers as estrogen receptor
positive (ER positive) and progesterone receptor positive (PR positive)
cancers.
Hormone therapy can be used before or after surgery or other

treatments to decrease the chance of your cancer returning. If the
cancer has already spread, hormone therapy may shrink and control it.
Treatments that can be used in hormone therapy include:
 Medications that block hormones from attaching to cancer

cells (selective estrogen receptor modulators)
 Medications that stop the body from making estrogen after

menopause (aromatase inhibitors)
 Surgery or medications to stop hormone production in the

ovaries
Hormone therapy side effects depend on your specific treatment, but

may include hot flashes, night sweats and vaginal dryness. More
serious side effects include a risk of bone thinning and blood clots.
Targeted therapy drugs
Targeted drug treatments attack specific abnormalities within cancer

cells. As an example, several targeted therapy drugs focus on a
protein that some breast cancer cells overproduce called human
epidermal growth factor receptor 2 (HER2). The protein helps breast
cancer cells grow and survive. By targeting cells that make too
much HER2, the drugs can damage cancer cells while sparing healthy
cells.
Targeted therapy drugs that focus on other abnormalities within

cancer cells are available. And targeted therapy is an active area of
cancer research.
Your cancer cells may be tested to see whether you might benefit from
targeted therapy drugs. Some medications are used after surgery to
reduce the risk that the cancer will return. Others are used in cases of
advanced breast cancer to slow the growth of the tumor.
Immunotherapy
Immunotherapy uses your immune system to fight cancer. Your body's

disease-fighting immune system may not attack your cancer because
the cancer cells produce proteins that blind the immune system cells.
Immunotherapy works by interfering with that process.
Immunotherapy might be an option if you have triple-negative breast

cancer, which means that the cancer cells don't have receptors for
estrogen, progesterone or HER2.
Supportive (palliative) care
Palliative care is specialized medical care that focuses on providing

relief from pain and other symptoms of a serious illness. Palliative care
specialists work with you, your family and your other doctors to
provide an extra layer of support that complements your ongoing care.
Palliative care can be used while undergoing other aggressive
treatments, such as surgery, chemotherapy or radiation therapy.
When palliative care is used along with all of the other appropriate
treatments, people with cancer may feel better and live longer.
Palliative care is provided by a team of doctors, nurses and other
specially trained professionals. Palliative care teams aim to improve
the quality of life for people with cancer and their families. This form
of care is offered alongside curative or other treatments you may be
receiving.

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Diagnosing breast cancer

Tests and procedures used to diagnose breast cancer include:

 Breast exam. Your doctor will check both of your breasts

 Mammogram. A mammogram is an X-ray of the breast.

 Breast ultrasound. Ultrasound uses sound waves to produce

 Removing a sample of breast cells for testing (biopsy). A

Biopsy samples are sent to a laboratory for analysis where

 Breast magnetic resonance imaging (MRI). An MRI machine

Other tests and procedures may be used depending on your situation.

Complete information about your cancer's stage may not be available

Tests and procedures used to stage breast cancer may include:

 Blood tests, such as a complete blood count

 Mammogram of the other breast to look for signs of cancer

 Computerized tomography (CT) scan

 Positron emission tomography (PET) scan

Breast cancer stages range from 0 to IV with 0 indicating cancer that

Breast cancer surgery

Operations used to treat breast cancer include:

 Removing the breast cancer (lumpectomy). During a

A lumpectomy may be recommended for removing smaller

 Removing the entire breast (mastectomy). A mastectomy is

Newer surgical techniques may be an option in selected

 Removing a limited number of lymph nodes (sentinel node

If no cancer is found in those lymph nodes, the chance of

 Removing several lymph nodes (axillary lymph node

 Removing both breasts. Some women with cancer in one

Most women with breast cancer in one breast will never

Complications of breast cancer surgery depend on the procedures you

You may choose to have breast reconstruction after surgery. Discuss

Consider a referral to a plastic surgeon before your breast cancer

Radiation therapy uses high-powered beams of energy, such as X-rays

External beam radiation of the whole breast is commonly used after a

Side effects of radiation therapy include fatigue and a red, sunburn-like

Chemotherapy uses drugs to destroy fast-growing cells, such as

Chemotherapy is sometimes given before surgery in women with larger

Chemotherapy is also used in women whose cancer has already

Chemotherapy side effects depend on the drugs you receive. Common

Hormone therapy — perhaps more properly termed hormone-blocking

Hormone therapy can be used before or after surgery or other

Treatments that can be used in hormone therapy include:

 Medications that block hormones from attaching to cancer

 Medications that stop the body from making estrogen after

 Surgery or medications to stop hormone production in the

Hormone therapy side effects depend on your specific treatment, but

Targeted therapy drugs

Targeted drug treatments attack specific abnormalities within cancer

Targeted therapy drugs that focus on other abnormalities within

Immunotherapy uses your immune system to fight cancer. Your body's

Immunotherapy might be an option if you have triple-negative breast

Supportive (palliative) care

Palliative care is specialized medical care that focuses on providing

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