Breast Cancer (cont.)
Breast Cancer Diagnosis
Diagnosis of breast cancer usually is comprised of several steps, including
examination of the breast, mammography, possibly ultrasonography or MRI, and,
finally, biopsy. Biopsy is the only definitive way to diagnose breast cancer.
Examination of the Breast
- A complete breast examination includes visual
inspection and careful palpation (feeling) of the breasts, the armpits, and the
areas around your collarbone.
- During that exam, your health-care provider may
palpate a lump or just feel a thickening.
- Mammograms are X-rays of
the breast that may help define the nature of a lump. Mammograms are also
recommended for screening to find early cancer.
- Usually, it is possible to
tell from the mammogram whether a lump in the breast is breast cancer, but no
test is 100% reliable. Mammograms are thought to miss as many as 10%-15% of
- A false-positive mammogram is one that suggests malignancy
(cancer) when no malignancy is found on biopsy.
- A false-negative mammogram is
one that appears normal when in fact cancer is present.
- A mammogram alone is
often not enough to evaluate a lump. Your health-care provider will probably
request additional tests.
- All breast lumps need to be clearly defined as
benign or should be biopsied.
- Ultrasound of the breast is often
done to evaluate a breast lump.
- Ultrasound waves create a "picture" of the
inside of the breast.
- It can demonstrate whether a mass is filled with fluid
(cystic) or solid. Cancers are usually solid, while many cysts are benign.
Ultrasound might also be used to guide a biopsy or the removal of fluid.
MRI may provide additional information and may clarify findings which have been
seen on mammography or ultrasound.
- MRI is not routine for screening for cancer
but may be recommended in special situations.
- The only way to diagnose breast cancer with certainty is to biopsy
the tissue in question. Biopsy means to take a very small piece of tissue from
the body for examination under the microscope and testing by a pathologist to determine if cancer is
present. A number of biopsy techniques are available.
- Fine-needle aspiration
consists of placing a needle into the breast and sucking out some cells to be
examined by a pathologist. This technique is used most commonly when a
fluid-filled mass is identified and cancer is not likely.
- Core-needle biopsy
is performed with a special needle that takes a small piece of tissue for
examination. Usually the needle is directed into the suspicious area with
ultrasound or mammogram guidance. This technique is being used more and more
because it is less invasive than surgical biopsy. It obtains only a sample of
tissue rather than removing an entire lump. Occasionally, if the mass is easily
felt, cells may be removed with a needle without additional guidance.
biopsy is done by making an incision in the breast and removing the piece of
tissue. Certain techniques allow removal of the entire lump.
- Regardless of how the biopsy is taken, the tissue will be reviewed by a
pathologist. These are physicians who are specially trained in diagnosing
diseases by looking at cells and tissues under a microscope.
- If a cancer is diagnosed on biopsy, the tissue will be tested for hormone
receptors. Receptors are sites on the surface of tumor cells that bind to
estrogen or progesterone. In general, the more receptors, the more sensitive the
tumor will be to hormone therapy. There are also other tests (for example,
measurement of HER-2/neu receptors) that may be performed to help characterize a
tumor and determine the type of treatment that will be most effective for a
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