Breast Cancer

Screening and Diagnostics tests in Breast Cancer

Screening tests (such as clinical breast examinations & ) are routine tests for healthy individuals to identify breast cancer early before any symptoms have developed.
Diagnostic tests are for those suspected to have breast cancer, based on symptoms or a screening test result.
Monitoring tests are used during and after treatment to monitor how well therapies are working and to check for signs of recurrence.
For screening and diagnosis your specialist for breast cancer will go through the following steps:

• Clinical History & Examination: They will ask you about a family history of breast and other cancers, menstrual status and will examine the breasts and the lymph nodes. A clinical breast examination will be conducted as well during which the doctor will carefully feel the tissue in the breast. Breast cancer differs from benign lumps and normal tissue in size, texture, and movement. They may also take a blood sample for routine blood tests.
• Imaging: Mammography is a type of low-dose x-ray that looks for early breast cancers. The breasts are placed on the x-ray machine and pressed between two plates to produce a clear image. If there is a suspicion of cancer in the report, a doctor will investigate further. Some women may have dense breasts which are those with a lot of glandular and connective tissue and not much fatty tissue. On a mammogram, it is harder to detect an underlying cancer in women with dense breasts and further testing may be required. Ultrasound scans let radiologists examine the breasts and the lymph nodes in the armpit. It can help visualize a lump and determine its characteristics. MRI scan: MRI uses magnetic fields and radio waves to produce detailed images of the breast. This is not a routine investigation and maybe used in patients such as those with a family history of breast cancer or specific genetic mutations. Other radiological scans sometimes indicated include CT scan, PET scan and Bone scan to assess the spread of cancer.

• Biopsy: Imaging studies (mammogram and MRI), often along with physical examinations, can lead doctors to suspect breast cancer. However, the confirmatory test is to take a sample of tissue and examine it under a microscope. A biopsy is essential to plan a patient’s treatment. There are various types of biopsy, such as fine needle aspiration biopsy, core biopsy, incisional and excisional biopsies. The biopsy by the pathologist provides essential information on the type of breast cancer.

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Treatment for Breast Cancer

The choice of treatment in breast cancer is on a number of complex clinical principles which will be explained by the doctor. These include: Staging (size, position and spread of cancer), Histology (classify the tumour based on cells and tissue), Grade (how do the cells look and how fast do they grow), Hormone receptor status and HER2 gene expression.

• Surgery: Breast cancer operation is done to remove as much of the cancer as possible, identify whether the cancer has spread to the lymph nodes (also known as sentinel lymph node biopsy or axillary lymph node dissection/biopsy), restore the breast’s shape after tumour removal (breast reconstruction) or relieve symptoms of advanced cancer. There are two types of surgery to remove the tumour – Conserving surgery (removes the tumour but tries to conserve as much of the breast as possible), or Mastectomy (removal of the entire breast). A lumpectomy is a form of breast conserving surgery where only a portion of the breast is removed, sometimes referred to as an excisional biopsy, where the tumour is removed along with a margin of normal tissue.

• Radiotherapy: It is the use of ionising radiation which kills cancerous cells by damaging the DNA. The decision of the medical oncologist to administer radio is based on the type of surgery performed, the spread of cancer to the lymph nodes or elsewhere in the body, and the patient’s age. There are two types of radiotherapy, external beam radiation (radiation comes from a machine outside the body) and internal radiation or brachytherapy (radioactive source is put inside the body for a short time). Side effects: Swelling in the breast, skin changes such as redness, skin peeling, darkening of the skin, fatigue, nerve damage (neuropathy). In the case of brachytherapy (local radiotherapy delivered only to the tumour) it may lead to redness or bruising at the treatment site, breast pain, infection, weakness and fracture of the ribs in rare cases and fluid collecting in the breast.

• Endocrine (Hormone Therapy): Endocrine therapies are used in estrogen or progesterone receptor positive tumours. These are called hormone-dependent tumours. The therapy may be taken orally or as an injection. This form of therapy is often used after surgery to reduce the risk of recurrence of cancer or may sometimes be administered before surgery as well. Side effects: Depending on the agent used, the side effects may include: Hot flashes, vaginal dryness, vaginal discharge, mood swings, headache, nausea, bone pain, injection site pain, muscle pain and joint stiffness and/or pain and bone thinning.
• Chemotherapy: Chemotherapy uses anti-cancer drugs or simply explained medicine of breast cancer that may be injected into the vein or given orally and reach the cancer cells through the bloodstream. These agents may be used before surgery, after surgery or for advanced breast cancer. Not all patients with breast cancer will need chemotherapy. Side effects: Hair loss, nail changes, mouth sores, loss of appetite or weight changes, nausea and vomiting, diarrhoea, increased chance of infections, easy bruising or bleeding, fatigue, changes in menstrual periods, cardiomyopathy (heart damage), nerve damage (neuropathy).

• Immunotherapy: Immunotherapy is a method to stimulate a person’s immune system to recognize and destroy cancer cells and can be used to treat some types of breast cancer. The immune system avoids attacking normal cells in the body by proteins called “checkpoints”. Breast cancer cells occasionally use these checkpoints to avoid being attacked by the immune system. By targeting these checkpoints, an immune response is mounted against the cancer cells. Side effects: Fatigue, cough, nausea, loss of appetite, constipation, diarrhoea. A rare side effect includes the turning of the immune system on healthy cells in the body.
• Targeted therapy: These are drugs or medicine of breast cancer designed to block the growth and spread of cancer cells, but unlike chemotherapy drugs, which attack all cells that multiply quickly, these drugs work only against cancer cells. Side effects: Heart damage, severe diarrhoea, hand-foot syndrome (the hands and feet become sore and red with blisters and peeling).

• Palliative care & End of life Care: It involves a number of interventions for those patients with advanced disease, and includes management of symptoms, support for coping with prognosis and diagnosis of advanced cancer, and preparation for end-of-life care. End-of-life care is for patients with incurable cancer and involves keeping the patient comfortable and providing relief from physical and psychological symptoms.

Sources: Breastcancer.org; Cleveland Clinic; European Society for Medical Oncology (ESMO); Radiologyinfo.org; American Cancer Society; Mayo Clinic

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