Diagnosis and Staging of Breast Cancer

Breast cancer accounts for 23% of all cancer cases and is the most common cause of cancer in women. A woman has a 13% lifetime risk of developing invasive breast cancer, with more than one million women diagnosed with breast cancer every year in the world. A biopsy is used to definitively diagnose breast cancer.

BreastCancer_BlogTypes of breast biopsy procedures:

Fine Needle Aspiration Biopsy: A very thin needle is placed into the lump or suspicious area to remove a small sample of fluid and/or tissue. No incision is necessary. A fine needle aspiration biopsy may be performed to help to differentiate a cyst from a lump.

Core Needle Biopsy: A large needle is guided into a lump or suspicious area to remove a small cylinder of tissue (also called a core). No incision is necessary.

Surgical Biopsy (Open Biopsy): A surgeon removes part or all of a lump or suspicious area through an incision into the breast. There are two types of surgical biopsies: an incisional biopsy, where a small part of the lump is removed, and an excisional biopsy, where the entire lump is removed.

 Lymph Node Involvement

Before or during surgery to remove an invasive breast cancer, the doctor removes one or some of the underarm lymph nodes so they can be examined under a microscope for cancer cells.

Ductal Lavage

For women who are at high risk for breast cancer, a procedure called ductal lavage may be used. Ductal lavage is a procedure that collects cells from inside the milk ductal system – the location where most breast cancers begin. Ductal lavage technique is used to detect pre- cancerous and cancerous breast cell changes in women who are at high risk.

Staging Breast Cancer

Once the clinician has diagnosed breast cancer, the next step would be to establish the extent (stage) of cancer. The patient’s cancer stage helps determine prognosis and the best treatment options. Complete information about cancer’s stage may not be available until one undergoes 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. The doctor selects the appropriate tests based on patient’s specific circumstances. Breast cancer stages range from 0 to IV, with 0 indicating cancer that is very small and non-invasive. Stage IV Breast Cancer, also called metastatic breast cancer, indicates that the cancer that has spread to other areas of the body.

To know more about status and tests related to Breast Cancer, Click on http://blog.oncquest.net/?p=93

Predicting Genetic Risks in Breast Cancer: BRCA-1 and BRCA-2 Mutations

Dr Vinay Bhatia, Assistant Manager – Molecular Biology

Rekha, a 50 year old mother of two, discovered a lump in her breast during self-examination. After completing a careful medical history and physical examination with her physician, a mammogram showed a suspicious lump. A biopsy from the lump indicated breast cancer. The tumor was tested for hormone receptors and for a growth-promoting gene and protein called HER-2/neu. The results pointed to a potentially aggressive tumor (HER2 positive). A PET scan combined with CT confirmed metastasis. To complete her evaluation, laboratory tests, including serum tumor markers (CEA and serum HER-2/neu), and additional blood tests, including CBC were done.


Rekha and her physician decided on a treatment course that included biological therapy to specifically prevent HER-2/neu cancer cells from growing. Her serum tumor markers were serially monitored to help track treatment efficacy. With the treatment, the levels of Rekha’s serum tumor markers dropped. Rekha’s ongoing care includes a combination of serial serum prognostic tumor-marker tests and non-invasive imaging studies. Concerned that her daughter might have a genetic predisposition for breast cancer, Rekha asked for a referral. A genetic specialist told Rekha that genetic test panels, combined with clinical data, could help assess her daughter’s risk many years before breast cancer could develop.

Rekha’s is a typical case, where the physician is usually consulted at an advanced stage of breast cancer, leading to a diagnostic dilemma that may affect treatment decisions. Breast cancer accounts for 23% of all cancer cases and is the most common cause of cancer in women. A woman has a 13% lifetime risk of developing invasive breast cancer, with more than one million women diagnosed with breast cancer every year in the world.


Tests and procedures used to diagnose breast cancer include:

Breast Exam: Examination of breast 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, the clinician might recommend a diagnostic mammogram to evaluate that abnormality further.

Breast Ultrasound: Ultrasound uses sound waves to produce images of structures deep within the body. Ultrasound may help distinguish between a solid mass and a fluid-filled cyst.

Breast Magnetic Resonance Imaging (MRI): An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast.

Biopsy: Imaging studies such as mammogram and MRI, often along with physical exams of the breast, can lead doctors to suspect that a person has breast cancer. However, the only way to know for sure is to take a sample of tissue from the suspicious area and examine it under a microscope. 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 the patient’s treatment options.

To know about different types of biopsy procedure and staging of breast cancer, click this link http://blog.oncquest.net/?p=67 .