Diagnosis for Breast Cancer

What is breast cancer?

Breast cancer is a disorder that develops when the cells multiply uncontrollably in the breast. There are various types of breast cancer, and the subtype of breast cancer is determined by which breast cells turn malignant. Breast cancer can develop in several places in the breast. Lobules, connective tissues, and ducts are the three essential parts of a breast. The milk-producing glands are known as lobules. To reach the nipple, milk passes through ducts. Everything is contained within a breast and kept in place by the connective tissue, which is composed of fatty as well as fibrous tissue. Most breast cancers start inside the lobules or ducts. Breast cancer can spread beyond the breast through the lymphatic and blood arteries.

Breast cancer diagnosis

To identify or diagnose breast cancer, breast cancer specialists employ a variety of tests. In addition to inspecting the lymph nodes underneath the arm and the breast, they may perform tests to see if cancer has progressed to other areas of the body. The progression of cancer to other body parts is known as metastasis. The only reliable way for a breast cancer specialist to determine if a region of the human body has cancer is by performing a biopsy. During a biopsy, the breast cancer specialist removes a small piece of tissues to be examined in a lab. In the absence of a biopsy, the physician may recommend other tests to aid in diagnosis.

Breast cancer is evaluated by conducting a variety of examinations. When selecting a diagnostic test, your breast cancer specialist may take these things into account:

• Type of cancer expected
• Symptoms you are exhibiting
• Your age as well as your overall well-being
• Outcomes of previous medical tests

When an individual or their breast cancer specialist notices a breast tumour, abnormal calcium deposits on mammography screening, or cysts in the breast during a diagnostic examination, a series of examinations, which is normally needed to determine a potential breast cancer, starts. Very frequently, someone may detect a lump or cyst beneath the arm or a red or inflamed breast.

Imaging tests for breast cancer diagnosis

The images of the interior of a body are produced during imaging exams. They can indicate the progression of cancer. To gather more data about a problematic region inside the breast discovered during screening, some imaging studies of the breast might be performed. Such imaging techniques can include:

Ultrasound – During an ultrasound, sound waves are used to produce an image of the breast tissue. Cysts in the breast filled with a fluid, which is typically not cancerous, can be distinguished from solid breast tumours that may be cancerous by using an ultrasound.
Mammography – Diagnostic mammography is identical to mammography screening, with the exception that additional breast images are captured during the former. When a person exhibits symptoms, such as fresh cysts in the breast, Diagnostic mammography is utilised. If screening mammography reveals anything unusual, a mammogram can be used.

Magnetic resonance imaging (MRI) – Instead of using x-rays, an MRI is employed to generate the precise pictures of the human body by using magnetic properties. Before the scan, a dye known as a ‘contrast medium’ is administered to visualise potential cancer efficiently. The patient receives this dye through an injection into the vein. After receiving cancer diagnosis, an MRI may be performed to determine the extent of the disease inside the breast and to screen the other parts of the breast for tumours. For those with an elevated probability of acquiring breast cancer as well as for certain women with a family history of cancer, a breast MRI might be a screening choice in addition to mammography.

Furthermore, MRI can be utilised if a patient is found to have ‘locally advanced breast cancer’ or if endocrine treatment/chemotherapy is being administered to the patient first, which can be followed by another MRI for preoperative planning. The last possibility is to employ MRI as a monitoring technique after breast cancer detection and therapy.

Biopsy for breast cancer diagnosis

A biopsy refers to the extraction of a tiny tissue sample for microscopic analyses. Only a biopsy can confirm a cancer diagnosis; other tests can only indicate that cancer may be present. The specimen is examined by a pathologist. A pathologist is a medical professional who focuses on analysing lab results and analysing cells, organs, and tissues to identify diseases. The methodology and size of the needle being used to obtain the sample of a tissue serve to distinguish the various types of biopsies. These types include:
Fine needle aspiration biopsy – When performing this type of biopsy, a tiny cell specimen is taken using a thin needle.

Surgical biopsy – The largest portion of the tissue is removed in this type of biopsy. The optimal time to have surgery is following a cancer diagnosis; hence, a surgical biopsy is typically not advised for the diagnosis of breast cancer. Most frequently, non-invasive core needle biopsies are advised for breast cancer diagnosis to minimise tissue removal. The use of needle biopsies for diagnosis lowers the number of people who undergo unnecessary surgery because many individuals who are advised to get a breast biopsy are not diagnosed with cancer.

Core needle biopsy – To obtain a large tissue sample during this sort of biopsy, a broader needle is used. Typically, this is the preferred technique for a biopsy. Cancer biomarkers, like hormone receptor status (ER as well as PR) and HER2 status, can be examined if a tumour is found to help determine the best course of treatment. The tumour cells contain these biomarkers. Although other kinds of biomarkers can be discovered in the bloodstream or other body fluids, they are not frequently utilised to confirm a diagnosis of breast cancer. In reaction to malignancy, both the body and the tumour produce them. The doctor will use this information to create a treatment plan. To minimise the patient’s suffering during the process, local anaesthetic, a painkilling drug, is utilised.

Sentinel lymph node biopsy – The sentinel lymph node is primary the lymph nodes that a cancerous tumour  penetrates when spreading through the lymphatic system. They are typically the axillary lymph nodes underneath the arms, which are commonly seen in breast cancer. Determining the presence of cancer in the lymph nodes close to the breast is possible through the sentinel lymph node biopsy.

Image-guided biopsy – Using an imaging method, such as mammogram, ultrasonography, or MRI, a needle is directed towards the site of the breast tumour during this process. In a particular kind of image-guided biopsy called a stereotactic biopsy, mammograms are used to direct the needle. Your breast cancer specialist will explain to make you understand what form of biopsy is suitable for your condition. When a breast is being biopsied, a tiny metal clip is typically inserted to indicate the location of the biopsy sample in the event the tissue turns out to be cancerous and additional surgery is required.

Analysing the biopsy sample for breast cancer diagnosis

Your doctor can learn about the specific characteristics of a cancerous tumour by analysing the samples taken at the time of biopsy, which can assist them to decide on your therapeutic approaches. The doctor can obtain information regarding the following with a biopsy:

Tumour features – The subtype of breast cancer (whether it’s lobular, ductal or some other type) and whether it has progressed to the lymph nodes are determined by microscopically examining the tumour.

Oestrogen receptors (ER) and progesterone receptors (PR) – An individual’s probability of breast cancer relapse and the kind of treatment that will most likely minimise the risk can both be determined with the aid of ER and PR studies. In general, hormonal therapy, commonly referred to as endocrine therapy, lowers the likelihood of PR-positive or ER-positive malignancies relapsing.

HER2 test – The HER2 position of a breast tumour helps doctors decide if medications, which bind the HER2 receptor, would be effective in treating breast cancer. When the patient is initially told that they have advanced breast cancer, HER2 tests should be performed.

Grade – A biopsy can also be used to identify the tumour grade. Grading describes how distinct cancerous cells are from normal cells and whether they seem to be spreading slowly or rapidly. If the tumour contains various cellular groups and resembles normal tissue in appearance, it is referred to as a low-grade tumour. The tumour is referred to as a high-grade tumour if the malignant tissue differs significantly from healthy tissue in appearance.

Genetic tests to estimate the chance of recurrence

Clinicians examine tumours by using genomic assays to check for particular proteins or genes that are present within or around cancerous cells. These examinations assist medical professionals in understanding the specific details of each patient’s breast cancer. Genetic tests can also be used to assess the probability that cancer will return following a therapy plan.

The tumour sample that is extracted during biopsy/surgery can be used for the genetic testing described here. For the majority of individuals, these tests won’t necessitate additional surgery/biopsy.

Oncotype Dx – For those who have breast cancer that is HER2-negative, ER-positive, or PR-positive but has not progressed towards the lymph nodes, this test is an option. It can also be the choice in some circumstances if cancer has progressed to one to three lymph nodes, like in menopausal women. This examination can aid in the decision-making process for patients and doctors regarding whether chemotherapy should be started or hormonal treatments can be opted.

MammaPrint – This is a diagnostic test, which is employed to estimate the likelihood that breast cancer will return or progress to other body parts.
EndoPredict – With hormonal treatment for a minimum of 5 years, the EndoPredict test can be performed to estimate the likelihood of breast cancer spreading to another part of the body.