Breast Cancer

BREAST CANCER Diagnosis

The diagnosis of breast cancer is established by the pathological examination of removed breast tissue. Such tissue is generally obtained at the time of surgical treatment. A number of procedures have been devised to obtain tissue or cells prior to the treatment for histological or cytological examination. Such procedures include fine-needle aspiration, nipples aspirates, ductal lavage, core needle biopsy, and local surgical biopsy. Most of these diagnostic steps, however, have some limitations as they may not yield enough tissue or miss the cancer, while the surgical biopsy already becomes an invasive procedure. Imaging tests are used to detect metastasis and include chest x-ray, bone scan, CT, MRI, and PET scanning. Ca 15.3 (carbohydrate antigen 15.3, epithelial mucin) is a tumor marker determined in blood which can be used to follow up disease activity.

Breast cancer is staged. Not only will this allow for better understanding of the disease process, but it will also facilitate interpretation of data, and determine treatment. Prognosis is closely linked to results of staging.

Summary of stages:

Stage 0 - Carcinoma in situ
Stage I - Tumor (T) does not exceed 2 cm, no axillary lymph nodes (N) involved.
Stage IIA – T 2-5 cm, N negative, or T <2 cm and N positive.
Stage IIB – T > 5 cm, N negative, or T 2-5 cm and N positive (< 4 axillary nodes).
Stage IIIA – T > 5 cm, N positive, or T 2-5 cm with 4 or more axillary nodes
Stage IIIB – T has penetrated chest wall or skin, and may have spread to < 10 axillary N
Stage IIIC – T has > 10 axillary N, 1 or more supraclavicular or infraclavicular N, or internal mammary N.
Stage IV – Distant metastasis (M)

Breast lesions are examined for certain markers, notably sex steroid hormone receptors. About two thirds of postmenopausal breast cancers are estrogen receptor positive (ER+) and progesterone receptor positive (PR+). Receptor status modifies the treatment as, for instance, ER+ lesions are more sensitive to hormonal therapy.

The breast lesion will also be tested for the presence of human epidermal growth factor a protein also known as HER2, neu or erbB2. HER2 is a cell-surface protein involved in cell development. In normal cells, HER2 controls aspects of cell growth and division. When activated in cancer cells, HER2 accelerates tumor formation. About 20-30% of breast cancers overexpress HER2. Those patients may be candidates for the drug Herceptin.

INDEX

History of breast cancer
Types of breast cancer
Risk factors and etiology
          Age
          Alcohol
          Environmental causes
          Genes
          Hormones
          Light levels
          Obesity
          Unproven
Prevention in high-risk individuals
Prevention of Environmental Causes
Symptoms
Screening
Diagnosis
Treatment
          Surgery
          Radiation therapy
          Indications for radiation
          Types of radiotherapy
          Side effects of radiation
          Systemic therapy
          Chemotherapy
          Hormonal treatment
          Targeted therapy
          Preclinical
          Flax seeds
          Alternative medicine
Prognosis
Breast cancer in males
Spreading elsewhere
Breast cancer awareness               References