Diagnosis

Symptoms

Signs and symptoms of breast cancer may include:

 

A breast lump or thickening that feels different from the surrounding tissue

 

Bloody discharge from the nipple

 

Change in the size or shape of a breast

 

Changes to the skin over the breast, such as dimpling

 

Inverted nipple

 

Peeling, scaling or flaking of the nipple or breast skin

 

Redness or pitting of the skin over your breast, like the skin of an orange

 

When to see a doctor

 

Although the majority of breast changes don't turn out to be cancer, make an appointment to see your doctor if you find a lump or other change in your breast. Even if you've just had a mammogram with normal results, it's still important to have your doctor evaluate any changes.

 

Diagnosing breast cancer

Tests and procedures used to diagnose breast cancer include:

 

Breast exam. Your doctor will check both of your breasts, feeling for any lumps or other abnormalities. Your doctor will likely check your breasts in varying positions, such as with your arms above your head and at your side.

 

Mammogram. A mammogram is an X-ray of the breast. Mammograms are commonly used to screen for breast cancer. If an abnormality is detected on a screening mammogram, your doctor may recommend a diagnostic mammogram to further evaluate that abnormality.

 

Breast ultrasound. Ultrasound uses sound waves to produce images of structures deep within the body. Your doctor may recommend an ultrasound to help determine whether a breast abnormality is likely to be a fluid-filled cyst or a solid mass, which may be either benign or cancerous. Breast ultrasound is helpful to guide radiologic biopsy to get a sample of breast tissue if a solid mass is found.

 

Removing a sample of breast cells for testing (biopsy). A biopsy to remove a sample of the suspicious breast cells helps determine whether cells are cancerous. The sample is sent to a laboratory for testing. A biopsy sample is also analyzed to determine the type of cells involved in the breast cancer, the aggressiveness (grade) of the cancer and whether the cancer cells have hormone receptors.

 

Breast magnetic resonance imaging (MRI). An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast. Before a breast MRI, you receive an injection of dye. This test may be ordered after a breast biopsy confirms cancer, but before surgery to give your doctor an idea of the extent of the cancer and to see if there's any evidence of cancer in the other breast.

 

Other tests and procedures may be used depending on your situation.

 

What you can do to prepare

 

Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

 

Write down key personal information, including any major stresses or recent life changes.

 

Write down your family history of cancer. Note any family members who have had cancer, including how each member is related to you, the type of cancer, the age at diagnosis and whether each person survived.

 

Make a list of all medications, as well as any vitamins or supplements, that you're taking.

 

Keep all of your records that relate to your cancer diagnosis and treatment. Organize your records in a binder or folder that you can take to your appointments.

 

Consider taking a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.

 

Write down questions to ask your doctor.

 

Questions to ask your doctor

 

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For breast cancer, some basic questions to ask your doctor include:

 

What type of breast cancer do I have?

 

What is the stage of my cancer?

Can you explain my pathology report to me? Can I have a copy for my records?

 

Do I need any more tests?

 

What treatment options are available for me?

 

What are the benefits from each treatment you recommend?

 

What are the side effects of each treatment option?

 

Will treatment cause menopause?

 

How will each treatment affect my daily life? Can I continue working?

Is there one treatment you recommend over the others?

 

How do you know that these treatments will benefit me?

 

What would you recommend to a friend or family member in my situation?

 

How quickly do I need to make a decision about cancer treatment?

 

What happens if I don't want cancer treatment?

 

What will cancer treatment cost?

 

Does my insurance plan cover the tests and treatment you're recommending?

 

Should I seek a second opinion? Will my insurance cover it?

 

Are there any brochures or other printed material that I can take with me? What websites or books do you recommend?

 

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions that may occur to you during your appointment.

Treatment

Treatments and Drugs

 

Your doctor determines your breast cancer treatment options based on your type of breast cancer, its stage, whether the cancer cells are sensitive to hormones, your overall health and your own preferences. Most women undergo surgery for breast cancer and also receive additional treatment, such as chemotherapy, hormone therapy or radiation.

 

There are many options for breast cancer treatment, and you may feel overwhelmed as you make complex decisions about your treatment. Consider seeking a second opinion from a breast specialist in a breast center or clinic. Talk to other women who have faced the same decision.

 

Radiation Therapy

 

Radiation therapy uses high-powered beams of energy, such as X-rays, to kill cancer cells. Radiation therapy is typically done using a large machine that aims the energy beams at your body (external beam radiation). But radiation can also be done by placing radioactive material inside your body (brachytherapy).

 

External beam radiation is commonly used after lumpectomy for early-stage breast cancer. Doctors may also recommend radiation therapy after mastectomy for larger breast cancers. When external beam radiation is used after a woman has tested negative on a sentinel node biopsy, there is evidence that the chance of cancer occurring in other lymph nodes is significantly reduced.

 

Side effects of radiation therapy include fatigue and a red, sunburn-like rash where the radiation is aimed. Breast tissue may also appear swollen or more firm. Rarely, more-serious problems may occur, including arm swelling (lymphedema), broken ribs, and damage to the lungs or nerves.

Chemotherapy

 

Chemotherapy uses drugs to destroy cancer cells. If your cancer has a high chance of returning or spreading to another part of your body, your doctor may recommend chemotherapy to decrease the chance that the cancer will recur. This is known as adjuvant systemic chemotherapy.

 

Chemotherapy is sometimes given before surgery in women with larger breast tumors. Doctors call this neoadjuvant chemotherapy. The goal is to shrink a tumor to a size that makes it easier to remove with surgery. This may also increase the chance of a cure. Research is ongoing into neoadjuvant chemotherapy to determine who may benefit from this treatment.

 

Chemotherapy is also used in women whose cancer has already spread to other parts of the body. Chemotherapy may be recommended to try to control the cancer and decrease any symptoms the cancer is causing.

 

Chemotherapy side effects depend on the drugs you receive. Common side effects include hair loss, nausea, vomiting, fatigue and a small increased risk of developing infection.

Hormone therapy

 

Hormone therapy — perhaps more properly termed hormone-blocking therapy — is often used to treat breast cancers that are sensitive to hormones. Doctors sometimes refer to these cancers as estrogen receptor positive (ER positive) and progesterone receptor positive (PR positive) cancers.

 

Hormone therapy can be used after surgery or other treatments to decrease the chance of your cancer returning. If the cancer has already spread, hormone therapy may shrink and control it.

 

Surgery

Breast cancer surgery

Operations used to treat breast cancer include:

 

Removing the breast cancer (lumpectomy). During lumpectomy, which may be referred to as breast-sparing surgery or wide local excision, the surgeon removes the tumor and a small margin of surrounding healthy tissue. Lumpectomy is typically reserved for smaller tumors that are easily separated from the surrounding tissue.

 

Removing the entire breast (mastectomy). Mastectomy is surgery to remove all of your breast tissue. Mastectomy can be simple, meaning the surgeon removes all of the breast tissue — the lobules, ducts, fatty tissue and some skin, including the nipple and areola. Or mastectomy can be radical, meaning the underlying muscle of the chest wall is removed along with breast tissue and surrounding lymph nodes in the armpit. Radical mastectomies are less commonly done today. Some women may be able to undergo a skin-sparing mastectomy, which leaves the skin overlying the breast intact and may help with reconstruction options.

 

Removing one lymph node (sentinel node biopsy). Breast cancer that spreads to the lymph nodes may spread to other areas of the body. Your surgeon determines which lymph node near your breast tumor receives the lymph drainage from your cancer. This lymph node is removed using a procedure called sentinel node biopsy and tested for breast cancer cells. If no cancer is found, the chance of finding cancer in any of the remaining lymph nodes is small and no other nodes need to be removed.

 

Removing several lymph nodes (axillary lymph node dissection). If cancer is found in the sentinel node, your surgeon may remove additional lymph nodes in your armpit. However, there is good evidence that removal of additional affected lymph nodes does not improve survival in cases of early breast cancer following a lumpectomy, chemotherapy and whole-breast irradiation for tumors less than 2 inches (5 centimeters) in size, and where the cancer has spread to just a few lymph nodes in the armpit. In such cases, chemotherapy and radiation treatment after the lumpectomy have proved to be equally effective. This avoids the serious side effects, including chronic swelling of the arm (lymphedema), that often occur after lymph node removal. However, axillary lymph node dissection may still be performed if the sentinel lymph node contains cancer following a mastectomy, in the case of larger breast tumors or when a lymph node is large enough to be felt on physical exam. It may also be performed in situations when a woman elects to receive partial breast irradiation.

 

Complications of breast cancer surgery depend on the procedures you choose. Surgery carries a risk of bleeding and infection.

 

Some women choose to have breast reconstruction after surgery. Discuss your options and preferences with your surgeon. Consider a referral to a plastic surgeon before your breast cancer surgery. Your options may include reconstruction with a synthetic breast implant or reconstruction using your own tissue. These operations can be performed at the time of your mastectomy or at a later date.

 

Ask your doctor about breast cancer screening. Ask your doctor at what age you should begin breast cancer screening exams and tests, such as clinical breast exams and mammograms. Talk to your doctor about the benefits and risks of screening. Together you can decide what breast cancer screening strategies are right for you.

Become familiar with your breasts through breast self-exams. Ask your doctor to show you how to do a breast self-exam to check for any lumps or other unusual signs in your breasts. A breast self-exam can't prevent breast cancer, but it may help you to better understand the normal changes that your breasts undergo and identify any unusual signs and symptoms.

BREAST CANCER

Breast cancer is cancer that forms in the cells of the breasts. There are numerous types of breast cancer, but cancer that begins in the milk ducts (ductal carcinoma) is the most common type. Breast cancer survival rates have increased and the number of deaths has been declining, thanks to a number of factors such as earlier detection, new treatments and a better understanding of the disease.