STAGE OF BREAST CANCER AND DIAGNOSIS

9. STAGE OF BREAST CANCER.

For the breast cancer, there are 5 stages:
Stage 0: There are two kinds of stage 0 breast cancer:
Duct carcinoma in situ [DCIS]: Abnormal cells are in the lining of a milk duct and have not spread outside of the duct.
Lobular [lobe] carcinoma in situ [LCIS] : Abnormal cells are in the living of a lobe, non invasive cancer.

Stage 1: Cancer is 2 cm or smaller and the cancer has not spread outside the breast.

Fig. 5: Diagram showing a stage T1 breast cancer

Stage 2: Cancer is 2 to 5 cm, or has spread to the lymph nodes, or both.

Stage 3: Cancer is larger than 5 cm and it has spread to the lymph nodes and may have
spread to nearby tissue such as muscle, ribs or the skin.

Fig. 6: Diagram showing a stage 3 breast cancer, where the cancer is greater than 5 cm and has spread to the lymph node and nearby tissue.

Stage 4: Cancer has spread to distant parts of the body, or other organs—usually the lung,
liver, bone or brain.

10. DIAGNOSTIC AND TEST OF BREAST CANCER.

Whether you discover a lump or one is found during a routine breast exam or mammogram, the doctor has a few of diagnostic tests to choose for the further examination.
The following technique that diagnose and gather more information about invasive cancer:
Test for diagnosing cancer.
Test for staging of cancer.
Test to gather more information about cancer.

TEST FOR DIAGNOSING CANCER.
Diagnosing invasive cancer usually involved a combination of procedures, including a physical examination and imaging tests:
Physical examination of the breasts
Mammography
Ultrasound bounces sound waves of the breasts
Breast magnetic resonance imaging [MRI].
Biopsy: If the patient has a suspicious mammogram or other imaging test result, the doctor will probably want the patient to have a biopsy. Highly suggestive of malignancy [cancer] from imaging tests- means that are findings that look like and probably are cancer, require biopsy. Known biopsy-proven malignancy- means that any findings on the imaging tests have already proven to be cancer through a biopsy.

Fig.7: Sentinel node biopsy from the left breast

TEST FOR STAGING
Staging is the process used to detect how far invasive cancer may have spread from its original location.
The stage of the cancer is based on 3 kinds of information:
The size of the cancer.
Whether the cancer has spread to any lymph nodes, and if so, how many.
Whether the cancer has spread to other organs of the body.
Test that could be done include:
An x-ray of the chest to check the lungs.
Bone scan.
CT [Computerized tomography] scan, ultrasound, or MRI are used to create images of the abdomen, pelvis, the stomach area, or other areas of the body.

TESTS TO GATHER MORE INFORMATION ABOUT CANCER.
Grade: A pathologist examines the cancer cells under the microscope and determines how abnormal they appear and behave when compared with healthy breast cells. There are 3 grades of invasive cancer: low or grade 1, moderate or grade 2, and high or grade 3. Low grade- slow growing, less likely to spread. Grade 3, high grade- tend to grow quickly, more likely to spread.
Surgical margin: A pathologist examines the cancer cells and the outer edge of the tissues. The tissue around the very edge of what was removed is called the margin of the resection.
Hormone receptor assay: This tissue test determines whether or not the breast cancer has receptors for the hormones estrogen and progesterone. A positive result means that estrogen or progesterone [or both] has the ability to fuel the cancer cells’ growth. If the cancer is hormone-receptor-positive, the doctor likely will recommend hormonal therapies that block the effects of estrogen or lower estrogen levels in the body. [cont.]