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Diagnosis of Breast Cancer
Assessing Breast Changes
- Determine where the cancer has spread
- Detect any cancer cells that are in the ducts
- Determine if cancer has spread to the lymph nodes in the underarm area
Diagnosis of Breast Cancer
- Fine needle aspiration —A thin needle is used to remove fluid and/or cells from a breast lump.
- Core needle—A larger, hollow needle is used to remove a wider area of tissue.
- Vacuum-assisted—A small incision is made in the skin before a hollow device is placed into the breast tissue. The suspicious tissue is pulled into the device. A small knife inside the device can also cut the biopsy sample from the remaining breast tissue.
- Surgical —During a surgical biopsy, all or part of a breast lump is removed for microscopic examination. An incisional biopsy removes a small portion of a large lump, while an excisional biopsy removes the entire lump (usually a small one).
Staging of Breast Cancer
- Imaging tests—To help determine how deep the tumor has moved into the layers of the breast or nearby structures. They may also help to determine if there are any metastatic growths in other areas of the body. Imaging tests may include:
Lymph node biopsy—Cancer cells can drain from the tumor site into nearby lymph nodes. From here, cancer cells can travel through the lymph fluid to the bloodstream and other areas of the body. Lymph nodes under the arm are normally checked if suspicious tissue is removed, or if they are swollen or felt during the physical exam. Lymph biopsies can be done with a fine needle aspiration during the breast biopsy. Specific types of lymph node biopsies include:
- Sentinel lymph node biopsy—Sentinel lymph nodes are the first nodes that a tumor will drain into. These nodes are located by injecting a traceable material near the tumor and watching which nodes take up the material first. If these nodes are free of cancer cells, it is unlikely that the cancer has spread. If cancer cells are present, then more lymph nodes may need to be removed to determine how far the cancer has spread.
- Axillary node dissection—Removal of a lymph node from the underarm. Will be done if the sentinel lymph nodes have cancer cells. This is also done as part of a modified radical mastectomy for breast cancer treatment.
- Tissue evaluation—Cancer tissue from the biopsy will be closely examined to look for characteristics that can help with prognosis and treatment selection. Important characteristics include presence of :
- Estrogen and progesterone receptors
- HER2/neu and Oncotype DX
- Stage 0—Carcinoma in situ—A very localized group of abnormal cells are still contained in the primary site. The cancer remains in the breast and has not spread.
- Stage IA—The tumor is no larger than 2 centimeters (cm) in size and has not spread beyond the primary tumor site in the breast.
- Stage IB—The tumor is not present OR up to 2 cm in size WITH small clusters of cancer cells in the lymph nodes.
- The tumor is not present OR is up to 2 cm in size WITH cancer found in 1-3 lymph nodes in the underarm or in the lymph nodes near the breastbone (in the center of the chest) OR
- The tumor is 2-5 cm in size, but has NOT spread to any lymph nodes
- The tumor is 2-5 cm in size WITH small clusters of cancer cells found in the lymph nodes OR
- The tumor is 2-5 cm in size WITH cancer found in 1-3 lymph nodes in the underarm or in lymph nodes near the breastbone OR
- The tumor is more than 5 cm in size, but has NOT spread to any lymph nodes
- The tumor is not present OR is any size WITH cancer in 4-9 lymph nodes in the underarm or in lymph nodes near the breastbone OR
- The tumor is more than 5 cm in size WITH small clusters of cancer cells found in the lymph nodes OR
- The tumor is more than 5 cm in size WITH cancer found in 1-3 lymph nodes in the underarm or in lymph nodes near the breastbone
- The tumor is any size and WITH cancer in the the chest wall WITH/WITHOUT swollen or ulcerated skin on the breast AND
- Up to 9 lymph nodes in the underarm OR in lymph nodes near the breastbone
- Note: If cancer has spread to the skin causing swelling or ulcers, it may be inflammatory breast cancer. This type of cancer can be stage IIIB or higher.
- The tumor is not present OR is any size WITH/WITHOUT cancer in the chest wall AND/OR swollen or ulcerated skin on the breast WITH spreading to 10 or more lymph nodes in the underarm OR
- To lymph nodes above and below the collarbone OR
- To the lymph nodes in the underarm and lymph nodes in the breastbone
- Stage IV—Cancer has spread beyond the breast and lymph nodes to other parts of the body. The most common sites for metastatic breast cancer are in the bones, lungs, brain, and liver.
- Reviewer: Mohei Abouzied, MD
- Review Date: 12/2014
- Update Date: 10/26/2015