Breast Cancer Diagnosis
A woman’s journey through diagnosis, treatment, and recovery.
Diagnosing Breast Disease
Breast lumps are usually found by a woman during her monthly breast self-exam, by a medical provider during a physical exam, or by an annual mammogram. A mammogram may find lumps that are not palpable, in other words, that cannot be felt by hand. Some changes in breast tissue are normal with puberty, pregnancy, menopause, and even during the monthly menstrual cycle.
Breast lumps can be harmless (benign) or cancerous (malignant). Although the doctor may be able to evaluate the lump by its feel and its appearance on the mammogram, there are several common biopsies that are also used to determine what kind of lump is present.
If the lump is palpable, and depending on your ultrasound and mammogram findings, the doctor may perform a needle biopsy during your office visit. The doctor will withdraw fluid from the lump to determine whether it is just a cyst (filled with watery clear fluid), or a lump that needs further study. If the withdrawn fluid is bloody, the doctor will send a sample to the lab where it will be examined for cancer cells.
If the results of the biopsy are inconclusive, if it shows malignant cells, or if the doctor feels it is in your best interest, you will need a surgical biopsy, or a lumpectomy, to remove the lump.
During a lumpectomy, which is performed under general anesthesia, the surgeon removes the entire lump and some of the surrounding tissue, which is called a margin. The tissue is sent to pathology, where the margins are examined to make sure the surgeon has removed the entire lump.
It will take a few days for a complete analysis of the tissue. If the analysis of the lump shows cancerous cells, you and the doctor will discuss the next steps in your treatment.
When Cancer Is Found
When cancer is found, the pathologist can tell what kind of cancer it is (whether it began in a duct or a lobule) and whether it is invasive (has invaded nearby tissues in the breast).
Special lab tests of the tissue help the doctor learn more about the cancer. For example, hormone receptor tests (estrogen and progesterone receptor tests) can help predict whether the cancer is sensitive to hormones. Positive test results mean hormones help the cancer grow, and the cancer is likely to respond to hormonal therapy. More information about hormonal therapy can be found in the Treatment section. Other lab tests are sometimes done to help the doctor predict whether the cancer is likely to grow slowly or quickly. The doctor may order x-rays and blood tests. The doctor may also do special exams of the bones, liver, or lungs because breast cancer may spread to these areas.
If the diagnosis is cancer, the patient may want to ask these questions:
- What kind of breast cancer do I have? Is it invasive?
- What did the hormone receptor test show? What other lab tests were done on the tumor tissue, and what did they show?
- How will this information help in deciding what type of treatment or further tests to recommend?
Treatment generally begins within a few weeks after the diagnosis. There will be time for the woman to talk with the doctor about her treatment choices, to get a second opinion, and to prepare herself and her loved ones.