Screening, Diagnostic Tests and Staging for Breast Cancer

SCREENING

Breast cancer and medical tests go hand in hand.
Most tests will fall into the following categories:
1.Screening tests (ST) :
- For people who appear healthy
- Purpose to find breast cancer early

2.Diagnostic tests (DT):
- For people who are suspected of having breast cancer
due to symptoms or screening test results.
- to determine whether breast cancer is present
- if Yes, has the cancer travelled outside the breast
- to gather more information to make decisions for treatment

Will first focus on screening tests

Clinical Breast Examination
- Doctor looks for differences in size/shape between breasts.
- Skin checked for rahs, dimpling or abnormal signs.
- Nipples checked for fluid
- Breasts felt for lumps, including underarm and collarbone area.

Screening Mammogram
- Picture of breasts made with X-rays
- Aged >40 to undergo screening every 1-2 years.
- Might show lumps before it is felt (early detection)

Breast Self Examination
- Performed monthly to check for any change in breasts.


DIAGNOSTIC TESTS

Clinical Breast Exam
- Doctor feels each breast for lumps and looks for other problems.
- If lump is present, feel its size, shape and texture
- Benign lumps – soft, smooth, round and movable.
- Malignant lumps – firmly attached and oddly shaped

Diagnostic Mammograms
- X-ray pictures of the breast
- To learn more about unusual breast changes
- Focus on specific area of the breast
(may have special techniques and more views than screening mammograms)

Ultrasound
- Pictures made from reflected sound waves off tissues and processed by a
computer.
- Shows whether lump is solid or filled with fluid (cyst-not cancer).
- May be used along with a mammogram.

Magnetic Resonance Imaging (MRI)
- Uses powerful magnet linked to a computer.
- Makes detailed pictures showing different planes of the tissue.
- May be used along with a mammogram.

Biopsy
- Fluid or tissue removed from breast to determine whether it is cancer
- Fine-needle aspiration
~ thin needle used to remove fluid from a breast lump
(checked for cancer by a pathologist)
- Core biopsy/needle biopsy
~ thick needle used to remove breast tissue (checked for cancer cells)
- Surgical biopsy
~ surgeon removes a sample tissue (checked for cancer cells)

Hormone receptor test
- Test done on breast tissue if it is determined to be cancerous
- Shows whether tissue has certain hormone receptors
~Tissues with these receptors needs hormones (estrogen/progesterone)
to grow


STAGING
Before treatment can be carried out, the extent (stage) of cancer needs to be known.
Stages based on SIZE of the tumour and whether it has SPREAD.
Involves X-rays and lab tests.

Stage 0 (carcinoma in situ-abnormal cells remain in the tissue where they first formed)
-Lobular carcinoma in situ
-Ductal carcinoma in situ


Stage I
- Early stage of invasive breast cancer
- Tumour no more than 2cm

Stage II (4types)
Size of Tumour Spread to lymph nodes under the arm?
<2cm Yes
2-5cm No
2-5cm Yes
>5cm No

Stage III (locally advanced cancer - spread from where it started to nearby tissue or lymph nodes)

IIIA
- No more than 5 cm across/ more than 5cm
- Spread to underarm lymph nodes that are attached to each other or other
structures
- Spread to lymph nodes behind to breastbone.

IIIB
- Grown into chest wall OR skin of the breast.
(swelling and lumps in breast skin)
- Spread to underarm lymph nodes that are attached to each other or other
structures
- Spread to lymph nodes behind to breastbone.
- Inflammatory breast cancer (red and swollen because cancer cell blocks
lymph vessels)

IIIC
- Tumour of any size.
- Spread to lymph nodes behind breastbone and under the arm.
- Spread to lymph nodes above or below the collarbone.

Stage IV (distant metastatic cancer)
-spread to other parts of the body.

Recurrent cancer

Links
http://www.breastcancer.org/
http://ncipoet.org/cancertopics/types/breast