Cancer of the Breast Evaluation
- New breast lump
- Changes in breast shape or size
- Dimpling in the skin of the breast
- New lump in the armpit that does not go away
- Nipple discharge from one breast
- Orange-peel color of the skin overlying the breast
- Retracted (pointing inward) nipple or changes in the nipple
Testing is required to evaluate breast cancer.
Tests that may be used to evaluate breast cancer include:
- Breast biopsy
- Miraluma breast scan
- Bone scan:
- To look for cancer that has spread)
- Breast ultrasound:
- Sentinel node biopsy
- Breast tissue hormone status
- This is a special x-ray that can reveal close to 90% of all breast cancers.
- Enhanced MRI of breast
Cancer of the Breast Hormone Receptors
Part of the evaluation of breast cancer will involve special blood tests that determine whether or not the tumor is estrogen-receptor sensitive. Estrogen receptor sensitive tumors are the type that grows when exposed to the female sex hormone estrogen. They are more common in postmenopausal women. Hormone receptor status is important because it is an important factor in determining the best drug treatment.
Cancer of the Breast Miraluma
In situations where the mammogram reading is unclear, additional breast imaging methods may be used. One technology, called Miraluma, uses a weakly radioactive substance known as technetium.
The weakly radioactive compound is injected into the bloodstream. The drug will concentrate up to nine times higher in cancer cells than in normal cells. A gamma camera can detect very low levels of radiation, far below the level that would be harmful to the human body. A computer receives information from the gamma camera and builds an image of the breast.
Cancer of the Breast Sentinel Node Biopsy
Sentinel Node Biopsy
A biopsy of axillary lymph nodes is an important diagnostic test in staging the spread of breast cancer. If a cancerous breast lump is detected, it becomes essential to determine if the cancer has spread to the surrounding lymph nodes. If breast cancer is going to spread, it usually spreads first to the lymph glands under the armpit. The first node that develops cancer is known as the sentinel node.
To perform sentinel node biopsy, physicians inject the area of the breast cancer with a blue or radioactive dye that slowly leaks into the lymph glands of the armpit. After making an incision in the armpit, the physician can identify the sentinel node by the color or radiation output. If the sentinel node testing does not reveal cancer, then the rest of the lymph nodes are usually cancer free.
Sentinel node biopsy can save the patient from undergoing lymph node resection when it is not necessary. About 10 to 20% of women who undergo aggressive lymph node resection under the arm suffer from chronic arm swelling and pain.
Cancer of the Breast Staging
Breast Cancer Staging
Cancer staging refers to a classification that is used to describe the extent to which a cancer has spread.
If breast cancer is detected, a number of tests will be needed to determine the tumor's size, location, and possible spread to other parts of the body. The staging evaluation may include a chest x-ray, CT scanning of the chest or abdomen, ultrasound and bone scan.
Breast cancer stages:
Cancer of the Breast Recurrent
Cancer of the Breast Stage 0
Breast Cancer Stage 0
Stage 0 disease is also referred to as carcinoma in situ.
There are two forms:
- Ductal carcinoma in situ: a pre-cancerous condition in which the abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues of the breast.
- Lobular carcinoma in situ: a less commonly pre-cancerous condition in which the abnormal cells are found in the lobules of the breast. This condition can increase the risk of developing breast cancer in either breast.
Cancer of the Breast Stage 1
Breast Cancer Stage 1
The tumor is less than 2 centimeters and has not spread outside of the breast.
Cancer of the Breast Stage 2a
Breast Cancer Stage 2A
Any one of the following qualifies as stage 2A disease:
- No tumor is found in the breast, but cancer is found in the axillary lymph nodes, under the arm
- Breast tumor is no larger than 2 centimeters and has spread to the axillary lymph nodes
- Breast tumor is between 2 and 5 centimeters, but has not spread to the axillary lymph nodes
Cancer of the Breast Stage 2b
Breast Cancer Stage 2B
Any one of the following qualifies as stage 2B disease:
- Breast tumor is larger than 5 centimeters, but has not spread to the axillary lymph nodes
- Breast tumor is between 2 and 5 centimeters and spread to the axillary lymph nodes
Cancer of the Breast Stage 3a
Breast Cancer Stage 3A
Any one of the following qualifies:
- No tumor is found in the breast, but cancer is found in the lymph nodes under the arm, which are attached to each other or to other structures
- Breast tumor is no larger than 5 centimeters and is found in the lymph nodes under the arm, which are attached to each other or to other structures
- Breast tumor is larger than 5 centimeters and is found in the lymph nodes under the arm, which are attached to each other or to other structures
Cancer of the Breast Stage 3b
Breast Cancer Stage 3B
Cancer may be any size and must have both of the following:
Cancer of the Breast Stage 3c
Breast Cancer Stage 3C
Stage 3C cancers have both of the following characteristics:
- Cancer has spread to lymph nodes beneath the collarbone and near the neck
- Cancer may have spread to lymph nodes under the arm and to tissues near the breast
Stage 3C cancers are further divided into the following two groups:
- Stage 3C operable Any one of the following qualifies as being 3C operable:
- Cancer is found in 10 or more lymph nodes under the arm.
- Cancer is found in the lymph nodes beneath the collarbone and near the neck on the same side of the body as the breast with the cancer.
- Cancer is found in lymph nodes within the breast itself and in lymph nodes under the arm.
- Stage 3C inoperable In this stage, the cancer has spread to the lymph nodes above the collarbone and near the neck on the same side of the body as the breast with cancer.
Cancer of the Breast Stage 4
Breast Cancer Stage 4
In this stage, cancer has spread to other organs of the body such as the bones, lungs, liver, or brain.
Continue to Cancer of the Breast Treatment
- Aiello EJ, Buist DS, White E, Seger D, Taplin SH. Rate of breast cancer diagnoses among postmenopausal women with self-reported breast symptoms. J Am Board Fam Pract. 2004 Nov-Dec;17(6):408-15. 
- Collaborative Group on Hormonal Factors in Breast Cancer: Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. Collaborative Group on Hormonal Factors in Breast Cancer. Lancet 1997 Oct 11; 350(9084): 1047-59. 
- Giordano SH. A review of the diagnosis and management of male breast cancer. Oncologist. 2005 Aug;10(7):471-9.