Breast Cancer

Breast Investigations
A lump, other changes in the breast, or an abnormal area on a mammogram may be caused by breast cancer. To determine if the symptoms are associated with breast cancer, a doctor will take a complete medical history and perform a physical examination that includes one or more of the following breast investigations:

• Diagnostic Mammogram – An X-ray of the breast to detect a mass or calcification
• Breast Ultrasound – An imaging technique using high-frequency sound waves to produce an image of the breast area
• Nipple Discharge Examination – An examination to detect any fluid produced by the nipple
• Magnetic Resonance Imaging (MRI) – An imaging technique using a powerful magnet linked to a computer to produce detailed pictures of the breast area

Biopsy
Based on the results of one or more of the above examinations, a doctor may determine that fluid or tissue from the breast should be removed and sent to a laboratory for
further examination. This procedure is called a biopsy and there are several types, including:

• Image-Guided Biopsy – An imaging technique using an ultrasound or X-ray in the removal of a tissue sample
• Fine Needle Biopsy Aspiration – Removal of a tissue sample using a very thin needle guided into the area of abnormal tissue
• Core Needle Biopsy – Removal of a cylinder of tissue using a large needle guided into the area of abnormal tissue
• Surgical Biopsy – Removal of part or all of a lump or abnormal tissue through an incision in the breast
• Sentinel Lymph Node Biopsy – A procedure using a dye to locate the lymph node closest to the tumor (sentinel node) to determine if the cancer has spread

Staging
The process used to find out whether the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. 

These are the stages used to describe female breast cancer:

Stage 0 (carcinoma in situ): A noninvasive, precancerous condition in which abnormal cells are found in the lining of a breast duct or in the lobules of the breast.

Stage I: The tumor is 2 centimeters (about 4/5 of an inch) or smaller and has not spread outside the breast.

Stage IIA: Cancer has not spread to distant sites, but is:

• not found in the breast but it is in one to three axillary lymph nodes (the lymph nodes under the arm)
• 2 centimeters or smaller and is found in the axillary lymph nodes; or
• the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes; or
• detected by sentinel node biopsy as microscopic disease in internal mammary nodes but not yet on imaging studies or by clinical exam; or
• larger than 2 cm and less than 5 cm but has not spread to axillary nodes.

Stage IIB: Cancer has not spread to distant sites, but is:

• larger than 2 centimeters but not larger than 5 centimeters and has spread to the axillary lymph nodes; or
• larger than 5 centimeters but has not spread to the axillary lymph nodes.

Stage IIIA: Cancer has not spread to distant sites, but is:

• not found in the breast, but in axillary lymph nodes that are attached to each other or to other structures; or
• 5 centimeters or smaller and has spread to axillary lymph nodes that are attached to each other or to other structures; or
• larger than 5 centimeters and has spread to axillary lymph nodes that may be attached to each other or to other structures.

Stage IIIB: Cancer has not spread to distant sites, but may be any size and:

• has spread to tissues near the breast (the skin or chest wall, including the ribs and muscles in the chest); and
• may have spread to lymph nodes within the breast or under the arm.

Stage IIIC: Cancer has not spread to distant sites, but:

• has spread to lymph nodes beneath the collarbone and near the neck; and
• may have spread to lymph nodes within the breast or under the arm and to tissues near the breast.

Stage IV: The cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.

These are the stages used to describe male breast cancer:

Stage 0: The earliest form of breast cancer where cancer cells are located within a duct and have not invaded the surrounding fatty breast tissue. 

Stage I: The tumor is 2 cm (about 4/5 of an inch) or less in diameter.  The cancer has not spread outside the breast. 

Stage II: Cancer has not spread to distant sites, but is:

• larger than 2 cm in diameter and less than 5 cm and has spread to one to three axillary lymph nodes; or
• the tumor is larger than 5 cm and does not grow into the chest wall and has not spread to lymph nodes.

Stage III: Cancer has not spread to distant sites, but is:

• smaller than 5 cm in diameter and has spread to 4 to 9 axillary lymph nodes; or
• the tumor is larger than 5 cm and has spread to 1 to 9 axillary nodes, or to internal mammary nodes; or
• the tumor has grown into the chest wall or skin and may have spread to no lymph nodes; or
• the tumor is any size, has spread to 10 or more nodes in the axilla or to one or more lymph nodes under the clavicle (infraclavicular) or above the clavicle (supraclavicular) or to internal mammary lymph nodes.

Stage IV: The cancer, regardless of its size, has spread to distant organs such as bone, liver, or lung, or to lymph nodes far from the breast. 

Source: American Cancer Society