Breast Cancer

Each type of cancer has unique characteristics and responds differently when treated. Our highly trained staff and physicians combine their skills with the latest equipment and techniques to treat all forms of cancer. The webpages below contain detailed information about specific types of cancer, related issues and the treatment options available.

Information written by: Constantine Mantz, MD

Breast Cancer

Staging

Medical evaluation of the woman with breast cancer involves physical examination, radiographic studies, and pathology confirmation of disease.

Typically, the woman presents to her primary care physician after having noticed a lump in the breast. Less commonly, the woman is noted on a routine mammogram to have a new mass present but that is not palpable. In the event that a woman first notices a breast mass herself, her primary care physician will then schedule mammography in order to further evaluate the mass. Mammography consists of a set of x-rays taken of both breasts from various angles in order to assess optimally the size and position of the suspicious lesion.

If a suspicious lesion is indeed identified by mammography, then the woman is next referred to a surgeon who may be able to obtain a biopsy of the mass. If the mass is palpable, then the surgeon may easily obtain a biopsy of it using a large-bore needle in the office. If the mass is not palpable, then the surgeon may need to arrange for a biopsy to be performed in an operating room with the assistance of a radiologist.

In this event, the woman is first taken to the radiology department where a radiologist will identify the lesion under x-ray guidance and place a thin wire through it. The woman is then taken to the operating room where the surgeon uses the wire in order to locate the tumor and remove it.

Once a specimen of the tumor is removed, the specimen is sent to the pathology department in order to obtain a reading. A pathologist then makes the determination of whether the tumor represents cancer or not.

Following the diagnosis of cancer, several other tests need to be performed. The tumor specimen will undergo several histologic tests, most common of which is the assessment of estrogen and progesterone receptor status. The assessment of receptor status is important in that it may provide information regarding the prognosis of the tumor, as well as dictate treatment management as will be discussed below. Other tests include a bone scan and radiographic evaluation of the chest and abdomen. These tests are commonly performed for women with advanced stage breast cancer and generally not for women with a small breast tumor.

Following completion of all appropriate tests, a patient is then assigned a stage for her disease. The staging system is intricate but may be simplified as follows:

Stage 1

Disease represents a small breast malignant tumor without spread of the disease to the lymph nodes under the arm.

Stage 2

disease may be generally defined as either a large breast tumor but without evidence of spread of disease to lymph nodes or as a small breast tumor with spread of disease to the lymph nodes.

Stage 3

Disease may be broadly defined as a very large breast tumor invading into the skin or chest wall, or any breast tumor with very large and malignant lymph nodes under the arm.

Stage 4

Disease may be broadly defined as metastatic disease, that is disease that has spread to sites beyond the breast and nearby lymph nodes.

 

Pathology

Breast tumors may be generally broken down into two types: non-invasive and invasive tumors.

Non-invasive tumors are malignant but have not yet progressed to the point where they have broken through the basement membrane of the structure from which they arise. These tumors are typically not palpable and are most frequently identified by routine mammography. These tumors offer the best prognosis for breast cancer, as well over 90% of women diagnosed with non-invasive disease are ultimately cured. The most common form of non-invasive tumor is called ductal carcinoma in situ, in turn, may consist of several subtypes including the following: comedo, cribriform, solid, papillary, and micropapillary. Of these subtypes, comedo ductal carcinoma in situ poses the greatest risk for disease recurrence, although the risk for recurrence is still fairly modest.

Invasive forms of breast cancer include the following: infiltrating ductal carcinoma, infiltrating lobular carcinoma, medullary carcinoma, mucinous carcinoma, tubular carcinoma, among others. Of these, infiltrating ductal carcinoma is by far the most common, accounting for over 90% of all cases.