A breast cancer diagnosis is less frightening when you have all the information you need. Getting basic information allows you to understand all your treatment options at each stage of your evaluation and treatment.
Breast cancer is most prevalent in women, but for every 100 women diagnosed with this disease, one man is diagnosed as well. Therefore, a lump in a man’s breast also requires evaluation.
Evaluating your imaging studies
A palpable mass in your breast or an abnormality on your mammogram will require further evaluation. You will likely need an ultrasound to see if the mass is solid and requires biopsy, or cystic and may require aspiration.
Microscopic findings on mammograms, called microcalcifications, may also require a second look. Depending on the findings of your radiologic studies, you may be referred to a surgeon or radiologist for a biopsy.
Most breast biopsies can be performed minimally invasively in an outpatient setting. Often, your surgeon will use your ultrasound or mammogram as a guide, leading to the abnormal area of your breast.
If the lump is not apparent on any imaging study, it still needs to be evaluated and will likely require a biopsy to determine whether or not it is cancerous. About 20 percent of all cancers are not seen on mammograms or ultrasounds, so you need a tissue biopsy to know whether the mass is benign (not cancer) or malignant (cancer).
Understanding your pathology report
After your breast biopsy, your physician will receive your initial pathology report. It may include some of the following terms.
- Benign: Benign breast lesions do not need to be removed, nor do they increase your risk of developing breast cancer. Lesions that fall into this category include fibroadenomas, papillomas, fibrous mastopathy, sclerosing adenosis, PASH (pseudoangiomatous stromal hyperplasia) and various other noncancerous growths.
- Atypical or high-risk lesions: These types of lesions are not cancer, but do require surgical removal because they increase your chances of developing breast cancer. Lesions that fall into this category include ADH (atypical ductal hyperplasia), LCIS (lobular carcinoma in situ or lobular neoplasia), FEA (flat epithelial atypia), atypical papillary lesions, radial sclerosing lesions and phyllodes tumors. Some high-risk lesions are “precursors to cancer” or can turn into cancer if they are not removed completely and your doctor will discuss those specifically when they are identified.
- Lobular carcinoma in situ (LCIS): LCIS or lobular neoplasia is NOT CANCER. In LCIS the cells are growing faster than normal in the lobules of the breast. Even though it is not cancer this lesion increases your risk of breast cancer in the future. LCIS requires surgical excision.
- Ductal carcinoma in situ (DCIS): This is the very earliest stage of breast cancer where the cancer cells are confined to the ducts of the breast. The grade (how fast the cells divide) of the DCIS is extremely important when determining the treatment.
- Invasive breast cancer: Breast cancer is called invasive ductal carcinoma when it originates in the ducts and invasive lobular carcinoma when it begins in the lobules. When left untreated, breast cancer can spread to lymph nodes and other organs.
The stage of a tumor goes from 0 to IV and is determined by the tumor’s size, whether it has spread to the lymph nodes or other areas of the body. The clinical stage is determined by the information that is available at the time of diagnosis. The pathologic stage is determined after definitive surgery has been performed.
For more about tumor staging and other important clinical information about breast cancer, visit http://comprehensivebreastcare.com/resources/breast-cancer/.
The grade of a tumor is determined by how aggressive it appears under the microscope.
- Grade I: Low grade or slow dividing cells
- Grade II: Intermediate grade moderate cell division
- Grade III: High grade or rapidly dividing cells
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