When a lump is discovered in the breast, either by the woman or her physician, tests will be ordered to determine whether or not the lump is cancerous. These tests can be used to ‘stage’ and ‘grade’ the cancer. These tests will most likely include:
Imaging Studies: This allows tissues, organs and/or bones to be studied in detail. X-rays, ultrasounds, CT scans and/or bone scans give healthcare professionals the opportunity to study pictures of the size of the tumor and to see if it has spread.
Biopsy: This is usually necessary to make a definite diagnosis of cancer; cells are removed and checked under a microscope. These cells can also be studied to determine how fast the cancerous cells are growing. A biopsy can be done by:
• Fine needle aspiration: this uses a thin needle to remove fluid/cells from the lump.
• Core needle biopsy: a needle is inserted through a small incision in the breast to remove samples of tissue.
• Surgical biopsy: local anesthetic is used and part or the entire lump will be removed.
Laboratory Tests: If cancerous cells are found in the biopsy sample these tests can help the physician learn more about the cancer to determine which treatment options are best suited. The hormone receptor status test shows whether the cells have certain hormone receptors. This can help predict how the tumor will behave and whether or not it will respond to hormonal therapy; this is more common in post-menopausal women. The Her2 test looks for the cancer gene that controls the Her2 protein. Her2 positive breast cancers behave differently than other breast cancers and need specific treatment.
Once a definite diagnosis of cancer has been made the cancer will be given a stage and a grade. The cancer stage describes the tumor size as well as whether or not it has spread beyond the place where it began to grow. In the earliest stage of breast cancer the cells are found only in the milk ducts or lobules and are called in situ cancer. If this is diagnosed before these cells have spread to the surrounding tissue there is no risk of them spreading once they have been removed. When breast cancer spreads of the duct or lobule it is called invasive cancer; this is still effectively treated especially if diagnosed early. The five stages of breast cancer are:
Stage 0: There are 2 kinds of stage 0 breast cancer: ductal carcinoma in situ (DCIS), where abnormal cells are in the lining of the milk duct and have not spread outside of the duct. Lobular carcinoma in situ (LCIS), where abnormal cells are in the lining of a lobule.
Stage 1: Where the tumor is 2 cm or smaller and the cancer has not spread outside of the breast.
Stage 2: Where the tumor is 2 to 5 cm, or the cancer has spread to the lymph nodes, or both.
Stage 3: Where the cancer has spread to the lymph nodes and may have also spread to surrounding tissues i.e. the muscle or the skin.
Stage 4: Where the cancer has spread to distant parts of the body.
The biopsy sample is studied to determine the grade of the tumor which is based on how the cancer cells look and behave when compared to the normal cells. There are 3 grades:
Grade 1: This is a low grade; slow growing and less likely to spread.
Grade 2: This is a moderate grade.
Grade 3: This is a high grade that tends to grow quickly and is more likely to spread.
Along with the stage and grade of the breast cancer, the healthcare team will factor in the woman’s age, health status and whether or not she has been through menopause in order to determine the best treatment options. The most common treatment methods are:
Surgery: The type of surgery will depend on the size and location of the tumor. A lumpectomy involves the removal of a lump as well as some tissue, but not the whole breast. A mastectomy involves the removal of the whole breast. Many times the doctor will also remove some lymph nodes from the armpit in order to determine whether or not the cancer has spread.
Radiation Therapy: External beam radiation therapy involves a large machine that is used to aim a beam of radiation at the tumor. The radiation damages the cancerous cells as well as healthy cells that are in the path of the beam. This type of radiation therapy is almost always given after breast-conserving therapy (lumpectomy) and is sometimes used after a mastectomy. In certain cases, the lymph node area will also be treated with this therapy. Internal radiation therapy (brachytherapy) involves radioactive material being placed directly into or near the tumor.
Chemotherapy: This treatment is given either orally (pills) or by injection. Chemotherapy drugs interfere with the ability of cancerous cells to grow and spread; however this treatment does damage healthy cells as well. Side effects from chemotherapy generally include nausea, vomiting, fatigue, hair loss, decreased appetite as well as increased risk of infection. Some chemotherapy drugs can affect the ability to become pregnant as well.
Hormone Therapy: This treatment removes hormones from the body and/or blocks their actions which can stop cancer cells from growing. Tumors that are hormone receptor positive can be treated with this therapy. Drugs, surgery or radiation therapy can be used to change hormone levels. Hormonal drugs are given as either injections or oral medications. This can cause menopause-like symptoms, i.e. irregular periods, hot flashes. These side effects can be reduced and/or controlled and usually go away once treatment has been concluded; however menopause may be permanent. Surgically removing the ovaries from pre-menopausal women is also a treatment option. This causes immediate onset of menopause.
Biological Therapy: This method of treatment uses drugs to interfere with how the cancer cells grow as well as using the body’s immune system to destroy the cancerous cells. This treatment is often used for women whose breast cancer has too much of the Her2 protein.
Early detection plays a large role in the successful treatment of breast cancer. Women aged 40-49 should have a clinical breast examination at least every 2 years. Women aged 50-69 should have a clinical breast examination every 2 years as well as a mammogram during the same time period. Women over this age should talk to their physician regarding how often testing should occur. For more information regarding breast cancer, please visit the Canadian Cancer Society.