Part two of our Breast Cancer Awareness Month information picks up right where we left off last time, with symptoms and diagnosis. How do you find out you have it, and what treatments are available?

  • 1


    When breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause the following changes:

    • A lump or thickening in or near the breast or in the underarm area or in the neck
    • A change in the size or shape of the breast
    • Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast
    • Ridges or pitting of the breast skin (like the skin of an orange)
    • A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly)

    Note: These symptoms may also be caused by other, less serious health conditions. Anyone experiencing these should see a doctor.

  • 2


    The doctor will ask about your symptoms and medical history. A physical exam will be done.

    Tests may include:

    • Clinical breast exam—the size and texture of the lump is manually examined to determines whether the lump moves easily
    • Mammography —x-rays of the breast used to see lumps or other changes in breast tissue
    • Ultrasonography—the use of high-frequency sound waves to see whether a lump is a fluid-filled cyst or a solid mass
    • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body
    • PET/CT scan —a type of imaging test that combines positron emission tomography (PET) and CT techniques
    • Biopsy —removal of tumor tissue to be tested for cancer cells, types of biopsies for breast cancer include:
      • Fine-needle aspiration—removal of fluid and/or cells from a breast lump using a thin needle
      • Needle biopsy —removal of tissue with a needle from an area that looks suspicious on a mammogram but cannot be felt
      • Surgical biopsy:
        • Incisional biopsy—cutting out a sample of a lump or suspicious area
        • Excisional biopsy—cutting out all of a lump or suspicious area and an area of healthy tissue around the edges
    • Tissue evaluation—breast cancer tissue is tested for the presence of estrogen and progesterone receptors, as well as the presence of HER2/neu; these are used to help plan therapy
    • Genetic testing—blood is evaluated for the presence of specific gene mutations in certain patients

  • 3


    Once breast cancer is found, staging tests are done. This will help to find out if the cancer has spread and, if so, to what extent.

    Treatments include:

    • Lumpectomy —removal of the breast cancer and some normal tissue around it. Often, some of the lymph nodes under the arm are also removed.
      • May also be called tylectomy or quadrantectomy
    • Segmentectomy—removal of the cancer and a larger area of normal breast tissue around it.
    • Simple mastectomy —removal of the breast, or as much of the breast as possible. The surgeon will try not to remove lymph nodes.
    • Radical mastectomy—removal of the breast, both chest muscles, the lymph nodes under the arm, and some additional fat and skin. This procedure is only considered in rare cases. It is done if the cancer has spread to the chest muscles. This procedure is rarely done in the US at this time.
    • Modified radical mastectomy—removal of the whole breast, the lymph nodes under the arm and, often, the lining over the chest muscles.
    • Sentinel lymph node biopsy —a small amount of blue dye and/or a radioactive tracer is placed in the area where the tumor was located. The dye or tracer is then followed into the armpit. The lymph nodes that pick up the substance are removed. The accuracy rate for this procedure exceeds 95% in experienced hands. It reliably identifies those lymph nodes that may contain cancer. Presently, those remaining lymph nodes should be removed if any sentinel nodes contain cancer. This method is usually done in women who do not have lymph nodes that can be felt in the armpit. The potential side effects are far less than seen after a standard lymph node dissection.
    • Axillary lymph node dissection—removal of the lymph nodes under the arm. This is done to help determine whether cancer cells have entered the lymphatic system.
    Radiation Therapy

    This is the use of radiation to kill cancer cells and shrink tumors. Two main types of radiation may be used:

    • External radiation therapy—radiation directed at the breast from a source outside the body
    • Internal radiation therapy—radioactive materials placed into the breast in or near the cancer cells

    Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms including pill, injection, and via a catheter. The drugs enter the bloodstream. They travel through the body killing mostly cancer cells. Some healthy cells are killed as well.

    Biologic Therapy

    Biologic therapy is the use of medicines or substances made by the body. They can increase or restore the body's natural defenses against cancer. It is also called biologic response modifier (BRM) therapy.

    Hormonal Therapy

    Hormonal therapy is designed to take advantage of the fact that many breast cancers are "estrogen sensitive." Estrogen binds to the "estrogen sensitive" cells and stimulates them to grow and divide. Anti-estrogen drugs prevent the binding of estrogen. This stops the cells from growing and, in doing so, prevents or delays breast cancer recurrence.