Breast Cancer Diagnosis

Executive Summary

Different tests are conducted for the diagnosis of breast cancer. Additional reviews helps in checking breast cancer metastasis to other body parts. The biopsy is the most common diagnostic test for identifying the affected body area. Mammography screening or a lump or nodule within the breast’s side at any stage of testing the woman for breast cancer is another diagnostic approach.

The diagnostic approach to breast cancer depends upon the type of cancer, signs and symptoms, age and overall health, and results of previous medical tests. The diagnosis depends on suspicious cancer type, signs and symptoms, age and general condition of the last medical tests results. Imaging tests include diagnostic mammogram, ultrasound, MRI. The physical examination includes surgery, biopsy with analysis of its sample, tumor feature analysis, estrogen receptors and progesterone receptors, human epidermal growth factor receptor 2 (HER2) gene, and grade. Genomic tests are also carried out after the surgery or biopsy, including Oncotype Dx and Mamma Print. Some other additional tests for breast cancer diagnosis include PAM50 (Prosigna TM), EndoPredict, Breast Cancer Index, and uPA/PAI.

Diagnostic Approach of Breast Cancer

Doctors use numerous checks to discover or diagnose Breast Cancer. They may additionally do reviews to test if cancer has spread past the breast and the lymph nodes beneath the arm. If this happens, it is referred to as metastasis. They may also do tests to determine which remedies could be maximum effective.

For most varieties of cancer, a biopsy is the simplest way for the doctor to recognize if an area of the body has cancer. The doctor uses a small tissue sample for biopsy to check out in a laboratory.

Your doctor may analyze these factors when deciding on a particular diagnostic test:

1. Type of cancer
2. Signs and symptoms
3. Age and overall health
4. The results of previous medical tests

A woman or her doctor may also discover a tumor or strange calcifications on screening mammography or a lump or nodule within side the breast at some stage in a medical or self-examination. It further triggers a chain of assessments to decide whether she has breast cancer or not ^​1,2​. A red or puffy breast and a lump or nodule under the arm are much less common symptoms.

The following tests help in the Diagnosis of Breast Cancer or for follow-up testing after a breast cancer diagnosis:

(A) Imaging

Images of the interior of the body are produced via imaging tests. The following breast imaging tests is used to study greater about a suspicious location observed during screening. In addition to these, exceptional new sorts of tests are being investigated, which are given below: –

• Diagnostic mammogram– A mammogram is a form of X-ray used to look at the breast. It corresponds to mammography screening. Besides, it takes more breast pictures ^​3​. It is often used while a female has symptoms like a new lump or nipple discharge. If a screening mammogram reveals something abnormal, diagnostic mammography can be used.

• Ultrasound– Ultrasound imaging creates images of structures deep inside the body through sound waves. An ultrasound can distinguish between a firm tumor that is probably cancer and a fluid-stuffed cyst that isn’t typically malignant ^​4​. It is also used to manually a biopsy needle into a selected location, allowing cells to be extracted and screened for cancer. Swollen lymph nodes under the arm are also treated this way. It is conveniently available, easy to use, and no longer exposes the person to dangerous radiation. It’s also much less costly than numerous different alternatives.
• MRI– A MRI uses magnetic fields, not x-rays, to generate specific body pictures. Before the scan, a particular dye known as a contrast medium is run to aid within the side, creating a clear photo of the suspected cancer. The pigment is injected into the vein of the patient. After a woman is diagnosed with cancer, a breast MRI can be carried out to decide how much cancer has unfolded throughout the breast or to screen the other breast for cancer.

Breast MRI is similar to mammography. It is a screening choice for women who’re at a very excessive threat of developing breast cancer or have a record of breast cancer. MRI is also be practiced if locally superior breast cancer is diagnosed or if chemotherapy or endocrine remedy is administered first. It is further accompanied by a 2nd MRI for surgical planning. Finally, MRI may be utilized as a surveillance technique after a breast cancer diagnosis and treatment.

(B) Biopsy

A biopsy is a process in which a tiny amount of tissue is eliminated and tested under a microscope. Other tests may also indicate the presence of disease. However, a biopsy is the most effective approach to verify breast cancer diagnosis. It is used when your doctor extracts a core of tissue from a suspicious region using a specialized needle tool guided by an X-ray or any other imaging test. A small metal marker is often left at the area inside your breast so that subsequent imaging tests may quickly identify the site.

Biopsy samples are submitted to a laboratory for testing, where experts determine if the cells are malignant. A biopsy sample is likewise examined to set up the sort of cells involved in breast cancer, the disease’s aggressiveness (grade), and whether or not cancer cells have hormone receptors or different receptors that would affect your treatment options.

Analyzing the Biopsy sample 

• Tumor features: The tumor is examined under a microscope to identify whether it is invasive or non-invasive (in situ), whether it is lobular or ductal, or another kind of breast cancer, and whether it has spread to the lymph nodes. The tumor’s margins or edges are inspected, and the distance between the tumor and the excised tissue’s edge is quantified, known as margin width.
• ER and PR: Breast cancers displaying ER, i.e. estrogen receptors and PR, i.e. progesterone receptors, are termed “hormone receptor-positive.” These receptors are proteins that are found in cells. Testing for ER and PR can assist in identifying a patient’s risk of recurrence of cancer. It is the type of treatment that is most likely to reduce that risk ^​5​. Hormonal treatment, commonly known as endocrine therapy, lowers the risk of recurrence of ER-positive and PR-positive malignancies. According to guidelines, everyone newly diagnosed with invasive breast cancer or a breast cancer recurrence should have their ER and PR status evaluated on the region of the spread of cancer and breast tumor.

• HER2: About 20% of breast cancers rely on the human epidermal growth factor receptor 2 (HER2) gene to grow. These cancers are known as “HER2 positive”. It has several copies of the HER2 gene or raised levels of the HER2 protein. These proteins are also known as “receptors.” The HER2 gene produces the HER2 protein, which is located in the cancer cells and is essential for tumor cell growth. Cancer’s HER2 status is used to assess if medicines targeting the HER2 receptor. Such medicines include as trastuzumab (Herceptin) and epratuzumab (Perjeta), which help treat cancer. Only aggressive tumors are subjected to this test. It is recommended that HER2 testing be done when first diagnosed with invasive breast cancer ^​6​. Furthermore, if cancer has migrated to another region of your body or returns after treatment, it is essential to do the tests again.
• Grade: A biopsy is also used to identify the tumor grade. The grade describes how cancer cells vary from healthy cells and whether they develop slower or quicker. The cancer is considered “well-differentiated” or a “low-grade tumor” if it resembles healthy tissue and has distinct cell groupings. A “poorly differentiated” or “high-grade tumor” is defined as malignant tissue that looks substantially different from healthy tissue. There are three levels of differentiation. It involves grade 1 (highly differentiated), grade 2 (moderately differentiated), and grade 3 (poorly differentiated). 

(C) Genomic test

Doctors employ genomic testing to check for specific genes or proteins, molecules produced by genes present in or on cancer cells. These tests aid clinicians in gaining a better understanding of the characteristics of each patient’s breast cancer ^​7​. Genomic testing also predict the likelihood of cancer returning following therapy. Knowing this information can assist doctors and patients in making treatment decisions and help some people avoid undesirable side effects from medicines that aren’t required.

The genetic assays described below can be performed on a tumor sample that has already been removed via a biopsy or surgery:

• Oncotype Dx: This test is available to patients who have ER-positive and PR-positive, HER2-negative breast cancer that is not progressed to the lymph nodes and specific situations where cancer has spread to the lymph nodes ^​8​. Patients and their doctors use this test to determine if chemotherapy should be added to hormonal treatment.
• Mamma Print: This test is an alternative for people with ER-positive and PR-positive, HER2-negative or HER2-positive breast cancer that has not reached the lymph nodes or has only spread to 1 to 3 lymph nodes ^​9​. This test estimates the probability of recurrence for early-stage breast cancer using information from 70 genes. This test can assist patients and their doctors to decide if chemotherapy should be added to hormonal treatment if they have a high chance of the disease recurrence. This test is not advised for those with a low risk of cancer recurrence.

Also Read: Best known foods that kill breast cancer cells

Additional tests 

Other tests may be available for patients with ER-positive and PR-positive, HER2-negative breast cancer that has not progressed to the lymph nodes. PAM50 (Prosigna TM), EndoPredict, Breast Cancer Index, and uPA/PAI are some available tests ^​10​. It is used to predict the likelihood of cancer spreading to other body regions.

Your doctor will undergo all the outcomes with you when the diagnostic tests are done. These records can help the doctor describe cancer if the analysis is cancer, known as staging. If a suspicious region is detected outside of the breast and adjacent lymph nodes, a biopsy of different parts of the body can be required to decide whether or not it is cancer.

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