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Cancer Diagnosis

Cancer Diagnosis Research

The following information was gathered through our extensive research on Breast Cancer. Please let us know of any sites and/or pages that you feel are important for others to know about and consider adding them to our pages. You can also find more links on our User Submitted Links page.

Our goal is to provide simple, understandable information in a format that follows how a women (and men) progress through their own experience (discovery, panic, surgery, treatments, etc). It will start as a simple outline and then fill in as we prepare content. If there is anything you wish covered, please contact us and let us know. Information is power and you can control your destiny through this awful disease.


II. Breast Cancer Diagnosis

A. Radiology (This section links to the Prevention page)

1. Mammogram
2. Sonogram
3. Digital Imaging

B. Biopsy

1. Needle Aspiration
2. Core Needle Biopsy
3. Open Surgical Biopsy
4. Mammotome Breast Biopsy System
5. Axillary Dissection
6. Sentinel Node Biopsy
7. Bone Marrow Biopsy

C. Pathology

1. Phases
2. TNM Staging

D. Prognosis

II. Breast Cancer Diagnosis

Ductal Carcinoma In-Situ (also known as "non-infiltrating" or "intraductal carcinoma") is defined as the identification of malignant cells within the ducts or lobules of the breast, not extending into the surrounding tissue. It generally can not be felt by the patient or physician so most diagnosis derive from an abnormal screening mammogram. DCIS presently accounts for 50% breast malignancies. DCIS is not an invasive cancer. It stays in the ducts and does not invade the surrounding breast. It is considered a pre-cancer. Some research suggests that if it is left untreated it can progress to invasive cancer. Mastectomy is reported to be curative in 98-99% if DCIS patients. Refer to the treatment section for further information.

A. Radiology

1. Mammogram

2. Sonogram

3. Digital Imaging

B. Biopsy

Questions to Ask Doctors About Breast Biopsies

  1. What type of biopsy will I have? Why?
  2. Can the lump be aspirated (the fluid drained or a small number of cells removed with a needle?
  3. How reliable is a needle biopsy?
  4. Will a sonogram be used to guide the biopsy?
  5. If a needle aspiration is not enough can a core biopsy be performed? How reliable is a core biopsy?
  6. If a biopsy is necessary, how much of the lump will be taken and when will the results be available?
  7. What type of pathology will be performed on the biopsy?
  8. What information will the pathology report give us (ie. Stage, estrogen receptors, type, etc.)?
  9. How and where will the procedure be performed? What degree of anesthesia will be used?
  10. What side effects can I expect from the procedure? Pain, swelling, bleeding, fever?)
  11. Should I have someone with me? Will I be able to drive?
  12. How large a scar should I expect to have after the biopsy?
  13. How long should I remain out of work, anything to avoid, etc.?
1. Needle Aspiration

A needle aspiration is done to determine if the lump is fluid filled or solid. A cyst would be fluid filled and a tumor would be solid. The doctor performs this biopsy using local anesthesia. A needle is inserted and a sample of the fluid is aspirated (taken out). If it is a clear yellowish brown liquid it is usually a cyst. If it is cloudy, bloody, or not liquid then another biopsy should be recommended. The fluid can be tested based on the doctor and the situation.

2. Core Needle Biopsy

A less invasive nonsurgical biopsy in which the sampling needle is guided by stereotactic images and withdraws tissue through a spring-loaded device fired into the breast. The noise may be shocking so ask your doctor to let you hear it a few times before beginning the procedure. A single sample is obtained each time the device is fired, so multiple insertions are needed to obtain sufficient breast tissue. Usually, 10 to 20 samples are taken.

3. Open Surgical Biopsy

First a radiologist places a wire into the breast via mammography, locating the suspicious site. Then the surgeon, using the wire as a guide, makes an incision in the breast and removes a large section of tissue, about golf ball size, for examination. Removal of such a large piece of tissue can permanently disfigure the breast. Some recuperation time is usually needed following this procedure.

4. Mammotome Breast Biopsy System

The Mammotome Breast Biopsy System is a technological advancement that assists physicians in obtaining the right amount of breast tissue for a definitive diagnosis without surgery. The Mammotome's ability to sample tiny abnormalities called microcalcifications- which can be the earliest or only sign of cancer--makes early detection and accurate diagnosis easier. Stereotactic (x-rays from two angles) or ultrasound (sound waves) images guide the Mammotome probe into the abnormal area and multiple tissue samples are removed. Under guidance, the Mammotome probe is positioned in the breast, aligning the sample chamber with the lesion. Once in position, the vacuum system draws tissue into the sample chamber. The rotating cutting device is advanced, capturing a tissue sample. The sample is then carried through the probe to the tissue collection area. The physician rotates the probe, moving the sample chamber to the next position. The sequence is repeated until all desired areas have been sampled. The probe is removed, pressure will be applied to the biopsy site and an adhesive bandage applied to the skin nick.

You can receive a video and location guide for your area by calling this toll free number 1.888.298.9378 or 1.888.329.4224 This video is great and will show you exactly what to expect. It can alleviate fear of the unknown or misconceptions.

5. Axillary Dissection

The lymph system carries lymph, a thin watery fluid throughout the body. The lymph nodes in the armpit drain fluid from the breast and arm. It is a common route for the spread of cancer cells. There are lymph nodes throughout your body. The lymph system also provides protection against infections.

During breast cancer surgery doctors check nearby lymph nodes in the armpit to see whether the cancer has spread (Axillary dissection). Conservative doctors remove and biopsy 15 to 30 underarm lymph nodes, which drain fluid from the breast. Along with these nodes goes a good amount of tissue. Surgeons cant remove each node individually so they sample a large area of the armpit. If those nodes contain cancer cells, the doctor knows additional treatment will be required.

Lymphodema is a condition caused because the lymph fluid doesn't drain as easily. In mild cases the arms swells a bit and aches. Patients should not carry heavy objects. They should avoid gardening and activities that could cause injury to that arm to avoid infections. In severe cases, the affected arm can be grossly swollen, painful and vulnerable to infection. Hand swelling can impair fine motor work like typing or playing the piano. Rings don't fit. For patients eager to resume an active life after cancer, Lymphodema is a frustrating speed bump. Special exercise, elevation, massage and compression pumps all help drain the trapped fluid. Wearing an elastic sleeve during sports or long airline air flights prevents swelling. While there's no cure, Lymphodema sufferers can learn to manage this condition.

6. Sentinel Node

Sentinel node biopsy aims to trim the underarm biopsy from 30 to one or two key nodes. To perform it doctors inject a small amount of blue dye or radioactive material into the breast. Then they track the flow of lymph fluid to see which node is the first to drain the breast. This first checkpointthe so called sentinel nodewould be the first place wandering cancer cells would spread, the reasoning goes. If that node is cancer free then the rest are probably also and the cancer may be limited to the breast.

This procedure is relatively new and all research indicates that you should choose the doctor to perform this wisely. Make sure the doctor has performed enough of the procedures to be experienced. Check closely the credentials of the facility performing this procedure.

7. Bone Marrow

A bone marrow biopsy is a sampling of marrow from your bones to help with the staging of the disease. It can be performed in the doctor's office using a local. The sample is taken from the hip bone on both sides. The patient curls up into the fetal position and the doctor uses a device similar to an apple corer. He turns this in the bone to take a sample. This is done on both sides. Prepare to have some discomfort during and for a few days after the procedure.

C. Pathology

1. Phases of Breast Cancer

Breast cancer begins in the lobules that produce milk and ducts that channel it to the nipples. It appears first as a few abnormal cells. If untreated the cancerous cells spread to the womans lymph system, through which they can spread to other organs.

Stages of breast cancer.

Hyperplasia is an overgrowth of normal cells, which may begin to block the duct. Some of these cells might begin to appear abnormal.

Stage 0
"In situ carcinoma" is confined to the duct. It rarely causes a noticeable lump but may be detected by mammogram.
Stage 1
Lumps develop when abnormal cells escape the ducts or lobules and invade adjoining tissue. Tumor less than about inch and no lymph node involvement.
Stage 2
The tumor is 1 to 2 inches in diameter. The cancer may be spreading to the lymph nodes around the breast and in the shoulder.
Stage 3
A tumor larger than 2 inches which may have invaded the chest wall or skin. It has spread to the lymph nodes.
Stage 4
Cancer has spread to distant sites such as lungs, bone or liver.

2. TNM Staging System

The most commonly accepted staging system is the one created by the American Joint Committee on Cancer. It is based on characteristics of the Tumor, Lymph Nodes, and Metastasis thereby getting its name TNM. If left untreated a cancer tumor will invade the area around the original cancer, spread to the lymph nodes (which are not just under the arm, but in the chest, stomach and all over the body. Not all are operable) and metastasize (spread) to other organs in the body .

  • Clinical Staging: A physical examination by a doctor using visual and touch inspections. Visual changes may be puckering or nipple retraction. The physician then feels the breast to see if he can locate tissue abnormalities and notes the size of the tumor. The area under the arm will be examined to detect enlarged lymph nodes. Several test such as scans may be ordered to determine if the cancer has spread to other organs.
  • Pathologic Staging: microscopic examination of a tissue specimen that has been surgically removed. This is a very important stage because it may effect treatment a patient receives and survival chances. This is explained in the stage section above.
  • Prognosis as a function of TNM staging: Stage I approximately 90% will be alive 5 years after diagnosis. Stage II: about 65% will be alive 5 years after diagnosis. Stage III: about 45% will be alive 5 years after diagnosis. Stage IV: This stage is characterized by the spread of the cancer to other organs and provides the least chance of survival. Less than 10% of patients survive 5 years after diagnosis.
  • There are many other factors which affect the overall prognosis of a patient with breast cancer.

D. Prognosis

There is a difference between prognostic factors and risk factors. Risk factors are indicators associated with an increased chance of developing breast cancer. Prognostic factors are indicators which influence the recurrence rates and ultimate outcomes of patients who have developed breast cancer. The physician notes the different characteristics and uses these to predict the patient's prognosis or chances of survival or recovery. These factors may be clinical or histologic (obtained from the pathology report). Histologic factors are grouped based on where they originated--the primary tumor or metastases.

Regression Analysis is a statistical method used to predict the recurrence and survival chances for the patient. This uses factors relating to clinical presentation, tumor characteristics, and the patient themselves. Clinical prognostic factors are sex and family history. Tumor prognostic factors are lymph node status, tumor size, histologic/nuclear grade, lymphatic/vascular invasion, pathologic stage (TNM) steroid receptor status, DNA content, and extensive intraductal component. Patient factors are age, menopausal status, familial history, previous neoplastic disease, immunosuppression, poor nutrition, prior chemotherapy, and prior radiation.

 

Disclaimer: The information presented on this site should NOT replace the advice of a qualified health care professional
and is NOT presented as qualified advice or council. Please use this information as a guide or reference point
when consulting with your private physician (s).

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