Diagnosis and Staging

BREAST CANCER

Diagnosing Breast Cancer

To determine the cause of any signs or symptoms, your doctor will perform a careful exam that includes:

Personal and family medical history
Current overall health status
Breast exams, including feeling the lump, diagnostic mammogram or ultrasound

It is important to remember that a lump or other changes in the breast, or an abnormal area on a mammogram, may be caused by cancer or by other less serious problems. Not all lumps are cancerous.

If imaging shows an abnormality in the breast, your doctor will follow up with a series of tests to determine whether cancer is present. Lumps that might be malignant (cancerous) may be found by imaging studies or felt as masses during a physical exam, but they still must be sampled and studied under a microscope for accurate diagnosis. The procedure that takes a sample for this testing is called a biopsy. Before diagnosing cancer, at Woman’s, a second expert will always review the sample. Waiting for a diagnosis can be stressful. To reduce your anxiety, we strive to present a cancer or non-cancer diagnosis within seven days of finding an abnormality in mammography.

A breast surgeon serves many roles in detecting and treating a cancer.

It is important to note that being referred to a surgeon does necessarily mean you have cancer. Breast surgeons help determine if an abnormality is cancer.

In general, a breast surgeon or a surgeon specializing in breast care is trained to evaluate and manage patients with breast pain, benign lumps and cysts and abnormal mammograms, in addition to breast cancer.

Understanding Breast Cancer Diagnosis

If you are diagnosed with breast cancer, your doctor will determine how far along the tumor has advanced. This is done through a process called staging.

The stage of a cancer is the most important factor in choosing treatment options. Your healthcare team will usually know the stage after surgery to remove the tumor in the breast and lymph nodes under the arm. The stage is based on whether the cancer is invasive or non-invasive, the size of the tumor, how many lymph nodes are involved and whether it has spread to other parts of the body.

Breast cancer staging can be complex. Your doctor will explain your stage and will answer any questions that you may have. This will help you both decide on the best treatment for you.

Breast cancer is categorized into five stages:

Stage 0

Stage 0 cancer is also referred to as carcinoma in situ. The cancer has not invaded the nearby breast tissue in this stage, but it can become invasive if not treated.

Stage I

Stage I is an early stage of invasive breast cancer. The tumor is no more than 2 centimeters wide and the cancer cells have not spread beyond the breast.

Stage II

Stage II is an early detection of a locally advanced cancer.

The tumor is no larger than 2 centimeters but has spread to the lymph nodes under the arm.
The tumor is between 2 and 5 centimeters and may or may not have spread to the lymph nodes.
The tumor is larger than 5 centimeters but has not spread to the lymph nodes.

Stage III

Stage III cancer is a locally advanced cancer discovered at a later period than Stage II. It is divided into three subunits.

Stage IIIA

The tumor is no more than five centimeters and has spread to lymph nodes behind the breastbone or lymph nodes under the arm that are attached to each other or to other structures.
The tumor is more than five centimeters wide and has spread to lymph nodes behind the breastbone or underarm lymph nodes that are alone or attached to each other or to other structures.

Stage IIIB

In Stage IIIB cancer, the tumor has grown into the chest wall or skin of the breast. It may be associated with swelling of the breast or with lumps in the breast. Stage IIIB cancer may also have spread to lymph nodes behind the breastbone or underarm lymph nodes that are alone or attached to each other or to other structures.
Inflammatory breast cancer is a rare type of cancer in which the breast appears red and swollen due to blocked lymph vessels in the skin of the breast. This cancer is at least Stage IIIB but could be more advanced.

Stage IIIC

Stage IIIC is a tumor of any size in which:

The cancer has spread to the lymph nodes behind the breastbone and under the arm.
The cancer has spread to the lymph nodes above or below the collarbone.

Stage IV

Stage IV cancer is the most advanced state. This stage is defined by either:

The cancer has spread to other organs of the body, most often the bones, lungs, liver or brain.
The cancer has spread locally to the skin and lymph nodes inside the neck, near the collarbone.

Know for Sure

A breast biopsy is a test that removes tissue from the suspicious area. These cells are examined and tested to check for the presence of breast cancer. Many women who have a breast biopsy do not have breast cancer.

Biopsy