Step-by-Step: What to Expect After a Breast Cancer Diagnosis
Receiving unexpected news about the possibility of cancer can be very scary. Fortunately, doctors find most cases of breast cancer before symptoms appear. A diagnosis usually comes after a screening mammogram shows a suspicious area, or you or your doctor find a lump during a breast exam. The next step is a series of tests to learn more about the cancer in order to guide your treatment plan.
The first step is diagnostic testing. This can be a diagnostic mammogram, breast ultrasound, breast MRI (magnetic resonance imaging), or other testing. A diagnostic mammogram looks at multiple views of the suspicious area and may include magnified views. Breast ultrasounds and breast MRIs give your doctor different and sometimes more detailed views of the area compared to a screening mammogram.
After diagnostic testing, your doctor may determine the area is not worrisome or the area is likely benign (not cancer) and only requires a follow-up mammogram in four to six months. Alternatively, your doctor may decide the suspicious area needs a biopsy.
At Your Appointment
What to Ask Your Doctor About Breast Cancer
A biopsy is the only way to tell for sure if an area is cancerous or not. The biopsy procedure will depend on the size of the area, where it is in your breast, how many areas need to be biopsied, and other factors. Doctors can take a biopsy with these techniques:
Fine needle aspiration uses a very thin needle to withdraw a small amount of tissue.
Core needle or vacuum-assisted biopsy uses a larger needle to remove a tube-shaped core of tissue.
Surgical or open biopsy is the surgical removal of all or part of the area. This technique is not as common as the others.
Your doctor may perform a lymph node biopsy if you have enlarged lymph nodes to see if the cancer has spread. Otherwise, your doctor will likely do a sentinel node biopsy and remove nearby lymph nodes when you have surgery to remove the tumor. A pathologist analyzes the cells from the breast and lymph node biopsy to determine whether either tissue is cancerous.
Breast Cancer Analysis and Staging
Pathology tests as well as imaging procedures determine the type, grade and stage of breast cancer. This helps identify the best treatment options and develop a prognosis.
Breast cancer types include:
Carcinoma, adenocarcinoma or sarcoma. Most breast cancers are carcinomas or adenocarcinomas.
In situ or invasive. Invasive or infiltrating cancers have invaded other breast tissues or lymph nodes, while in situ (in place) cancers have not.
Ductal, lobular or other. Cancer can arise in the milk ducts (ductal), milk glands (lobular), or stroma (other breast tissues).
Breast cancer tumors also have characteristics, including estrogen and progesterone receptor status and HER2 status. These characteristics influence your treatment choices.
Finally, breast cancers receive a grade from one to three. The grade depends on how closely the cells still look to normal breast tissue cells. The grade also depends on how quickly the cancer cells are dividing. Lower grade cancers look more like normal cells, are slow growing, are less likely to spread, and tend to have a better prognosis.
All of this information helps determine the cancer’s stage from 0, I, II, III or IV. Breast cancer staging helps determine prognosis and guides treatment. Generally, lower stages have better prognoses and survival rates than higher stages.
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