Breast Cancer – An In-depth Insight Into Diagnosis Staging And Treatment Options

Breast Cancer – An In-depth Insight Into Diagnosis Staging And Treatment Options

The severity of breast cancer can be seen in the fact that in every 19 seconds, someone in the world is diagnosed with breast cancer. In India, every year 50,000 women are diagnosed with breast cancer. So when you are given the shocking news that you have breast cancer, the first and foremost aspect you would deal is the practical one. Do I need a surgery? Will I undergo radiation or chemotherapy? How long is the recovery period? These are some of the questions that will be floating around in the mind.

Diagnosis of breast cancer is not a one-step process; there is a lot that goes into making a breast cancer diagnosis. And then accordingly, the treatment is formulated.

How Breast Cancer Is Diagnosed?

If you have been noticing symptoms of breast cancer and the potential risk factors associated with it, it would be wise on your part to consult the physician. If he suspects something serious, he may refer you to an oncologist, who is expert in dealing with cancer. On your first appointment, the breast will be physically examined followed by medical history and several other questions.

If cancer is suspected, you might be ordered mammogram and ultrasound tests to confirm the breast cancer. If both these tests fail to give any conclusive results, the only way to diagnose a breast cancer is to conduct a biopsy. 

During a biopsy, a sample tissue of the affected area is taken and sent for microscopic examination to a pathologist. If cancer cells are found during the examination, the pathologist would then analyze the characteristics of cancer and make a report on the overall findings.

There are different kinds of biopsies which depend on case to case and the size of tumour and location.

  1. Fine needle aspiration - This procedure is conducted either by a radiologist or a breast surgeon. A thin needle with a hollow center will be used to remove a sample of cells from the affected area.
  2. Core Needle Biopsy – During this procedure, a larger hollow needle is used to extract sample tissue.
  3. MRI guided biopsy – This method might be used for a suspicious area that is only visible to MRI.
  4. Surgical biopsy - The surgeon during this procedure uses a scalpel to make a cut through the skin in order to remove a piece of the tissue.

Staging Breast Cancer

Once your doctor has diagnosed the breast cancer, then only the role of establishing the extent or stage of cancer comes into the picture. This will help determine the prognosis and the best possible treatment options. Breast cancer has basically five main stages.

Stage 0

It is the Ductal Carcinoma in situ (DCIS) stage in which cancer cells are confined only to the ducts of the breast and have not spread to the nearby tissues.

Stage 1

This stage is divided into two stages; 1A and 1B.

  • Stage 1A means that the primary tumor is less than 2 cm wide and the lymph nodes (glands) aren’t affected.
  • Stage 1B is when cancer is found in the lymph nodes nearby and either there is no tumor in the breast or the tumor is less than 2 cm in size.

Stage 2

This stage is also divided into two subcategories.

  • Stage 2A is when the tumor is either less than 2 cm in size and has spread to 1-3 nearby lymph nodes, or the tumor is in between 2-5 cm and hasn’t spread to any lymph nodes.
  • Stage 2B denotes that the tumor is either in between 2-5 cm in size and has spread to 1-3 axillary (armpit) nodes, or the tumor is larger than 5 cm and has not spread to any lymph nodes.

Stage 3

This stage constitutes three main types-

    Stage 3A

  • The tumor has either spread to 4-9 lymph nodes or has enlarged the internal mammary lymph nodes.
  • The tumor is larger than 5 cm with a small group of cancer cells in the lymph nodes.
  • The tumors are bigger than 5 cm and cancer has invaded 1-3 axillary (armpit) nodes or breastbone nodes

    Stage 3B

  • The tumor has either intruded the chest wall or the skin and may or may not have spread up to 9 lymph nodes.

    Stage 3C

  • The tumor has spread to 10 or more axillary (armpit) lymph nodes, the nodes near the collarbone or internal mammary nodes.

Stage 4

This stage denotes that the tumor can be of any size. The cancer cells have spread to nearby as well as invaded distant lymph nodes and distant organs. This stage is also known as metastatic breast cancer. This means cancer has spread to organs such as lungs, liver, and bones. This is the most serious stage that needs immediate treatment.

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How Breast Cancer is Treated?

Based on the stage, the doctor will devise an appropriate treatment plan. Usually, a man or woman diagnosed with breast cancer will get more than one treatment. Surgery is the most common treatment while additional treatment includes radiation therapy, chemotherapy, and hormonal therapy.

Surgical Procedures

  1. Lumpectomy – In this method, the suspicious tumor and small margin of the surrounding tissuesare removed.
  2. Mastectomy – Entire breast is removed. In double mastectomy, both the breasts are removed.
  3. Sentinel node biopsy – This procedure removes some of the affected lymph nodes that have received drainage from the cancerous tumor. These lymph nodes will be tested and then only it will be decided whether to remove additional lymph nodes or not.
  4. Axillary lymph node dissection – This option is needed when lymph nodes removed during sentinel node biopsy tests positive. If this is the case, then the additional lymph nodes will be removed.
  5. Contralateral prophylactic mastectomy – Even if cancer is detected in one breast, some women might choose to remove both of her breasts. This procedure is known as contralateral prophylactic mastectomy. The healthy breast is removed due to fear or reducing the risk of developing the breast cancer again.
  6. Radiation therapy – This treatment uses high-powered beams of radiation or energy rays to kill cancer cells. Most of the radiation treatment involves external radiation beams but advanced technologies have enabled doctors to irradiate the patient’s body from inside. This type of radiation is known as brachytherapy.

Drug Therapies

  1. Chemotherapy – This drug treatment procedure is used to kill cancer cells in the region beyond the breast. Chemotherapy might be used to shrink the tumor before surgery. This treatment is given via pills or administered intravenously. Chemotherapy has many unwanted side effect, so it’s important to discuss the treatment with the doctor well in advance.
  2. Hormonal therapy – If you are suffering from breast cancer which is sensitive to hormones, the doctor may give you oral medication that blocks the cancer cells from getting the hormones (estrogen or progesterone) they need for multiplying.
  3. Targeted therapy drugs – Some medications are designed to attack specific abnormalities or mutations within the cancer cells. For instance, Herceptin (trastuzumab) can block the production of a protein HER2 (human epidermal growth factor receptor 2) that helps breast cancer cells grow. Your cancer cells will be tested before giving this treatment.

Why is early detection of breast cancer important?

Early detection is the key to conservatively and effectively treat breast cancer. This has its own benefits such as shorter recovery time and as much as 80 percent chances of cure. So if you are aged above 40 and have a family history of cancer, talking to a physician and going through annual comprehensive examination could help detect breast cancer early.

Mammogram can detect a breast cancer years before the signs and symptoms appear. And in India where the risk of breast cancer is 1 in 30 in the urban area and 1 in 65 in rural, early diagnosis of the disease can be a godsend.