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Breast Cancer Diagnosis

If you have symptoms that may signal breast cancer, your doctor will examine you and ask you questions about your health, your lifestyle, including smoking and drinking habits, and your family history. One or more of the following tests may be used to find out if you have breast cancer and if it has spread.

Biopsy: A small sample of the suspicious area of the breast is removed for examination under a microscope. Biopsies for breast cancer may be done in one of the following ways:

Surgical biopsy: An incision (small cut) is made in the breast. Surgeons find the tumor by touch or with a CT (or CAT, computed axial tomography) scan, ultrasound or mammogram. In an excisional biopsy, the entire mass is removed. In an incisional biopsy, part of the tumor is removed.

Fine needle aspiration (FNA): A thin, hollow needle is inserted into the breast. Fluid and cells are removed from the tumor and looked at with a microscope. While this test can help to determine if breast cancer is present, it cannot determine if the cancer is invasive. Additional biopsies may be needed if breast cancer is found.

Core biopsy: A thicker needle is used to remove one or more small cylinder-shaped tissue samples from the tumor.

Sentinel lymph node biopsy: Lymph nodes are olive-sized glands that are part of the lymphatic system that circulates lymph fluid throughout the body. The lymphatic system also can carry cancer cells from the tumor site to other areas of the body. In breast cancer, the first nodes to be affected are under the arms.

In a sentinel lymph node biopsy, a radioactive blue dye is injected into the area before surgery. The dye shows up in cancerous lymph nodes. The node with the highest amount of blue dye is the “sentinel” node. The surgeon removes all nodes with blue dye.

Sentinel node biopsy can spare healthy lymph nodes, which results in fewer side effects such as lymphedema. MD Anderson has special expertise in this type of biopsy for breast cancer, which often helps preserve function and health.

Imaging tests, which may include:

CT or CAT (computed tomography) scan
Mammogram or MRI (magnetic resonance imaging) scan
Ultrasound

Breast Cancer Staging

Staging is a way of determining how much disease is in the body and where it has spread. This information is important because it helps your doctor decide the best type of treatment for you and the outlook for your recovery (prognosis).

Breast Cancer Stages

(source: National Cancer Institute)

Stage 0 (carcinoma in situ): Cancer has not spread from the site of origin. There are two types of breast carcinoma in situ:

Ductal carcinoma in situ (DCIS) is a noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive breast cancer and spread to other tissues.

Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are found in the lobules of the breast (where milk is made). This condition seldom becomes invasive cancer. However, having LCIS in one breast increases the risk of developing breast cancer in either breast.

Stage IA: The breast tumor is no more than 2 centimeters (no more than 3/4 of an inch) across. Cancer has not spread to the lymph nodes.

Stage IB: The tumor is no more than 2 centimeters across. Cancer cells are found in lymph nodes.

Stage IIA

The tumor is no more than 2 centimeters across, and the cancer has spread to underarm lymph nodes; or
The tumor is between 2 and 5 centimeters across, but the cancer hasn't spread to underarm lymph nodes

Stage IIB

The breast cancer tumor is larger than 2 centimeters but not larger than 5 centimeters and has spread to the axillary lymph nodes; or
The tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes.

Stage IIIA: Breast cancer is found in axillary lymph nodes that are attached to each other or to other structures. Cancer may be found in lymph nodes near the breastbone; or

The tumor is 2 centimeters or smaller. Breast cancer has spread to axillary lymph nodes that are attached to each other or to other structures. Cancer may have spread to lymph nodes near the breastbone; or
The tumor is larger than 2 centimeters but not larger than 5 centimeters. Breast cancer has spread to axillary lymph nodes that are attached to each other or to other structures. Cancer may have spread to lymph nodes near the breastbone; or
The tumor is larger than 5 centimeters. Breast cancer has spread to axillary lymph nodes that may be attached to each other or to other structures. Cancer may have spread to lymph nodes behind the breastbone.

Stage IIIB: The tumor may be any size and breast cancer:

Has spread to the chest wall and/or the skin of the breast
May have spread to axillary lymph nodes that may be attached to each other or to nearby tissue
May have spread to lymph nodes near the breastbone

Stage IIIC: The breast cancer can be any size, and:

Cancer has spread to lymph nodes behind the breastbone and under the arm, or;
Cancer has spread to lymph nodes above or below the collarbone

Stage IV: The tumor can be any size, and cancer has spread to other organs of the body, most often to the bones, lungs, liver or brain.

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