Diagnosis of Breast Cancer

Diagnosis of breast cancer is an ongoing procedure. The test for the presence of breast cancer usually falls into three categories: screening, diagnostic and monitoring test.

The following test are used to determine whether someone has breast cancer and also to follow up the treatment. The method of diagnosis will depend on the following:

• Type of cancer suspected
• Sign and symptoms
• Age and medical condition
•  Previous test and results

1.Biopsy

A biopsy is the removal of small amount of tissue for examination under a microscope. Different techniques are used to carry out a biopsy.

•  Fine needle aspiration: this uses a needle to remove small samples of cells can be used.

fine needle aspiration (photo credit: medicinenet.com)

• Larger samples of cells can be gotten using a wider needle. This is referred to as core needle biopsy.
• Image guided biopsy is used when a lump cannot be felt but it can be seen on a mammogram or any other imaging test. The needle that is used to collect the sample is guided to the tumour with the aid of an imaging technique such as ultrasound, MRI or mammography.
• Biopsy can be gotten through surgery. It could be incisional surgical biopsy (where part of the lump is removed) or excisional (where the entire lump is removed). However, surgical biopsy is not the recommended way to diagnose breast cancer. This is usually done after fine needle aspiration or core needle biopsy and other test have confirmed the presence of a tumour.

Image source: drmathewlubin.com

The examination of a biopsy will reveal the following:

• The features of the tumour. Analysis of the biopsy will determine if the tumour is invasive or insitu, ductal or lobular and if it has spread to the lymph nodes.

• The grades of the tumour. The tumour is graded with respect to its difference from normal cells. There are three grades: grade 1 is well differentiated, grade 2 is moderately differentiated and grade 3 is poorly differentiated.

2 imaging test

Imaging test can be used to further confirm the diagnosis of cancer. The imaging test that are commonly used are:

• Ultrasound. It uses high frequency sound waves to create an image of the entire breast. It can distinguish between a solid mass and a fluid filled mass.  this is because solid masses are usually tumours while fluid filled masses are usually cysts.
• Mammography: Diagnostic  mammography is used when a woman is experiencing the signs of breast cancer, such as a lump in the breast or if the breast is swollen and painful. Diagnostic mammography is also used if there is an abnormality in the breast after screening mammography has taken place. 

(image source: ladycarehealth.com)

• MRI (Magnetic Resonance Imaging). It uses magnetic fields to produce images of the breast or body. It is used for screening, and it is also used to check the size of a breast tumour.

3 Blood test

A pathologist may order blood test to learn more about the cancer. The following blood test are usually ordered.

• Complete blood count
• Serum test: this test examines minerals in blood (for example calcium and potassium) and enzymes. If cancer is present, they will be abnormal. For example blood calcium levels can be high if cancer has spread to the bone.  Total bilirubin count is able to test the functioning of the liver. A high level of bilirubin can mean that the liver is damaged and signify that cancer may have spread to the liver. It important to note that other diseases can make these values go up.

4 supplementary imaging test

These additional test are done for women who are at a later stage of breast cancer. it is not used for people at early stages of breast cancer. Majority of this test will be done after surgery to determine if cancer has spread.

• Computerized tomography (CT scan)

This is used to determine if tumours have spread to other organs such as the bone, liver, brain and lymph nodes. It can also be used to measure tumour size and if the tumour is responding to treatment.

• X-rays: x-rays use radiation to get a picture of structures inside the body
• Bone scan: this is done to determine if cancer has bread to the bones.