Breast Cancer Diagnosis

Breast Cancer Diagnosis

Breast Cancer Diagnosis
Beyond a breast exam or mammogram, there are various tests and methods for doctors to diagnose and track progress of breast cancer. The process involves imaging and lab tests, including ultrasounds, MRIs, a breast biopsy and even bones scans to locate tumors and stage the cancer. A medical oncologist or breast surgeon help explain a breast cancer diagnosis and provide treatment options. Learn more about diagnosing breast cancer with expert advice from Sharecare.

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    A , Health Education, answered

    Most women never think to question their diagnosis of breast cancer. If your doctor tells you that you have breast cancer, you probably do.

    But breast cancer is complicated and mystifying under a microscope, sometimes even for experienced pathologists, the specialist doctors who read and interpret tissue samples. To make a diagnosis between benign cells (noncancerous) and malignant cells (cancer) is much more complex than you would ever first imagine.

    Because of this complexity, the pathology reports diagnosing breast cancer can be wrong. For example, researchers at the Johns Hopkins University in Baltimore, Maryland, found that about 1.4 percent of the time, a pathologist mistakenly diagnoses cancer, misidentifies the type of cancer, or misses a cancer totally. Even more common are pathologists’ errors that can significantly change the type of treatment patients receive. These errors can make a world of difference between receiving conservative treatments versus aggressive surgeries.

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    A Surgery, answered on behalf of
    In the 1800s, Rudolph Virchow, a doctor and pathologist, described a whole slew of various tumors based on their appearance under a microscope. Until very recently, the appearance of the breast cancer under the microscope was the most important information doctors had to determine the type of tumor. The two most common types of tumors are infiltrating ductal cancer, which has a frequency of 70% to 80%, and invasive lobular cancer, which has a frequency of 5% to 10%.

    In the 21st century, there are new methods of classifying breast cancers. Doctors extract the nucleic acids from the breast cancer cells and look at the proteins expressed by the cancers in a DNA array. Thousands of genes have been observed, and breast cancers can be classified based on their gene expression. Doctors are learning more and more about the genes that drive the breast cancer and cause it to behave the way it does. This is leading to a shift in how cancers are classified. While in the past only chemotherapy was used, now tumors are classified by their molecular profiles and there are therapies that can target the molecular defect and leave the normal cells alone.
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    A Clinical Genetics, answered on behalf of
    Generally, yes. The National Comprehensive Cancer Network has recently revised their guidelines for BRCA genetic testing to include individuals who are diagnosed with a triple negative breast cancer under the age of 60. Many insurance providers have adopted these guidelines into their criteria for coverage.
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    During a biopsy, your doctor removes cells from the breast and a pathologist inspects the cells under a microscope to see if they are cancerous. Some common biopsies used to help doctors make a breast cancer diagnosis include the following: fine needle aspiration biopsy, which uses a small needle; core needle biopsy, which uses a larger needle; or surgical biopsy, in which all or part of a lump is removed and checked for cancer. Here are two other types of biopsy:
    • Sentinell lymph node biopsy: Your doctor may first perform a sentinel lymph node biopsy to determine whether cancer has spread to the lymph glands under the arm. First, a radioactive substance and/or a dye is injected near the tumor site. Then, the first lymph nodes that pick up the dye are removed and reviewed by a pathologist to check for the presence of cancer cells.
    • MRI-guided breast biopsy: A minimally invasive, image-guided procedure in which specially trained radiologists use MRI technology and targeting software to precisely locate and remove cells from a suspicious area in the breast for diagnosis and treatment planning.
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    Invasive ductal carcinoma (IDC), also known as infiltrating ductal carcinoma, is cancer that begins growing in the breast duct and then invades the fatty tissue of the breast outside of the duct. IDC is the most common form of breast cancer, representing 80 percent of all breast cancer diagnoses.

    To diagnose any breast abnormality, your doctor may perform any of the following tests:

    • Clinical breast exam - In this exam, your doctor manually checks your breasts for changes or abnormalities.
    • Mammogram - This is an image of the inside of your breast captured either on film like an X-ray or as a computerized digital image.
    • Ultrasound - In a breast ultrasound, high frequency sound waves exposed to breast area produce pictures of the inside of the breast, similar to an X-ray. This allows your radiologist to distinguish between a solid mass (benign or malignant tumors) and a liquid mass (cyst).
    • MRI - MRI stands for magnetic resonance imaging. An MRI uses a magnetic field and radio frequency waves to project a very detailed picture of the inside of your breast onto a computer.
    • Biopsy - For a biopsy, your doctor removes tissue from the inside of your breast to examine under a microscope. There are a variety of methods your doctor can use to obtain this tissue sample.
    • Pathology - After your doctor draws a sample of your affected breast tissue, a pathologist examines the tissue under a microscope, classifies your tissue sample, and makes make a diagnosis.
    • Staging Workup - Breast cancer staging is a system that describes the size, growth and type of your tumor and location of the cancerous tumor cells.
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    A , Oncology, answered
    For a PET scan, glucose (a form of sugar) that contains a radioactive atom is injected into the bloodstream. Because cancer cells in the body are growing rapidly, they absorb large amounts of the radioactive sugar. After about an hour, a special camera is used to create a picture of areas of radioactivity in the body.

    A PET scan is useful when your doctor thinks the cancer may have spread but doesn't know where. The picture is not finely detailed like a CT or MRI scan, but it provides helpful information about your whole body. Some newer machines are able to do both a PET and CT scan at the same time (PET/CT scan). This allows the radiologist to compare areas of higher radioactivity on the PET with the appearance of that area on the CT.

    So far, most studies show it isn't very helpful in most cases of breast cancer, although it may be used when the cancer is known to have spread
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    A , Oncology, answered
    A bone scan can help show whether a cancer has spread (metastasized) to your bones. It can be more useful than standard x-rays because it can show all of the bones of the body at the same time.
    For this test, a small amount of low-level radioactive material is injected into a vein (intravenously, or IV). The substance settles in areas of bone changes throughout the entire skeleton over the course of a couple of hours. You then lie on a table for about 30 minutes while a special camera detects the radioactivity and creates a picture of your skeleton.
    Areas of bone changes appear as "hot spots" on your skeleton -- that is, they attract the radioactivity. These areas may suggest the presence of metastatic cancer, but arthritis or other bone diseases can also cause the same pattern. To distinguish between these conditions, your cancer care team may use other imaging tests such as simple x-rays or CT or MRI scans to get a better look at the areas that light up, or they may even take biopsy samples of the bone.
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    Breast cancer doctors use advanced diagnostic tests and tools to accurately locate and stage the disease, and plan your individualized treatment. Throughout your breast cancer treatment, doctors use imaging and laboratory tests to track the size of the tumors, monitor your response to treatment and modify your treatment when needed. The following are common tests and exams used for diagnosing and treating breast cancer:
    • Breast exam
    • Biopsy
    • Ultrasound
    • Mammography
    • Other imaging tests: MRI or PET/CT scans, miraluma breast imaging and bone scans
    • Lab tests: tumor tests & genetic tests
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    Wire localization of the breast is a technique used to guide a surgeon to a nonpalpable suspicious abnormality seen on a mammogram or sonogram (image obtained by ultrasonography). This technique helps to ensure removal of the entire abnormality while minimizing the amount of normal breast tissue excised.
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    A Plastic Surgery, answered on behalf of

    Breast cancer recurrence after a mastectomy can be detected primarily by physical examination. If I notice something suspicious, I'll order a CT scan, ultrasound, or MRI to evaluate.

    Mammograms are not obtained of reconstructed breasts as this xray is best for breast tissue and is not effective for implant and TRAM tissue.

    If a woman has had mastectomy on one side, I encourage routine/yearly mammogram of the unopperated breast.