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When the tumour and surrounding tissue (for breast conserving
treatment) or the whole breast (for mastectomy) is taken out,
it will be sent to the pathologist for tests. Any lymph nodes
which are taken out will also be sent for tests. These tests
will give more information about the likely spread of the
cancer and also confirm or change the information you received
from the biopsy.
You may be told the results of your tests while you are in
hospital (depending how long you stay and what day of the
week you have your operation). If not, you will be told the
results the week following the operation at the surgeon's
office.
Key points
- The results will now be more conclusive than after the
biopsy and will enable your doctor to discuss alternative
treatments.
- You'll need to understand as much as possible about your
diagnosis and the choices you have for your particular circumstances.
- You should understand the future implications of the treatments
you choose and how to manage them.
- If you have had breast conserving treatment, your tests
may indicate that your cancer has spread to the margins.
Sometimes extra work needs to be done to establish whether
this indicates that you need to have a further operation
(sometimes a mastectomy) to ensure that sufficient tissue
has been taken to ensure there is not spread beyond the
margins.
Staging
The pathologist will now be able to group your cancer on
a 'staging' system. The most common staging system used is
called the TNM system.
T - refers to the size of the cancer
N - refers to whether the lymph nodes under your arm contain
cancer cells
M - refers to whether the cancer has spread to other parts
of your body
All this information is then combined into stage numbers
(I, II, III and IV). Your doctor needs to know the stage of
your cancer to plan your treatment. Women with Stage I or
II cancer are said to have early
breast cancer. Women with Stage III or IV cancer are
said to have more advanced breast
cancer or metastatic breast cancer. They may need different
treatment to women with early breast cancer.
The tests used to "stage" breast cancer which has
spread to the lymph nodes to establish whether it has spread
further include one or more of the following:
- blood tests
- a chest X-ray to check for spread to the lungs
- a bone scan to check for spread to the bones ( radioactive
isotope is injected. This will be absorbed by any secondary
cancer and show up on the gamma camera when scanned a few
hours later).
- a liver ultrasound scan (to check for metastases in the
liver).
Spread (Margins)
In breast conserving treatment, cancer may have spread from
the tumour close to or right to the edge of the margins of
the tissue which has been removed. During your operation,
your surgeon will check the edges of the tissue that is removed
to make sure it is free of cancer. The pathologist will conduct
more tests around the margins of the tissue taken to establish
how close the cancer is to the edges. If there is any sign
of cancer at the edges of your breast, it may mean that some
cancer cells are still in your breast. Note that even if this
is not the case, there may be some risk, which is what the
follow up radiation treatment is intended to deal with. The
surgeon will probably recommend another operation, if there
are cells at the margins to ensure all cells are removed,
possibly a mastectomy.
Spread (Lymph Nodes )
If cancer cells move into the lymph system, they are carried
to the lymph nodes. The closest lymph nodes to the breasts
are under the arms in the axilla. This is usually the first
place breast cancer spreads outside the breast.
Unless you have a sentinel node biopsy (or have no nodes
removed) your surgeon will usually remove some or all of your
lymph nodes to see if they are affected by cancer. The number
of nodes with cancer will tell the surgeon how likely it is
that the cancer has spread to the rest of the body. If no
lymph nodes have cancer, then the risk of the cancer having
spread is low. If all the lymph nodes are affected, the chance
of the cancer having spread is higher. If there is spread
it is more likely that the specialist will recommend chemotherapy.
Where you have a sentinel node biopsy, if the sentinel node
is clear during the breast cancer surgery, no further nodes
will be removed. If not, all nodes will be removed.
Tumour Grade
The tests will confirm the grade of your cancer. Grade refers
to the similarity of cancer cells to normal cells. The more
similar cancer cells are to normal cells, the more likely
it is that treatment will be successful. There are three grades
of tumours:
- Grade 1 cancers are similar to normal cells and able to
be successfully treated.
- Grade 2 cancers are somewhat similar to normal cells and
are associated with moderately successful treatment.
- Grade 3 cancers are not similar to normal cells and less
able to be treated successfully.
Number and size
Sometimes the tests will identify the presence of other cancer
tumours in the part of the breast removed. The results from
the operation will also confirm the size of the tumour.
Websites on tests for breast cancer
| Topic |
Stages
and Grades of Breast Cancer:
Diagnosing and Staging Breast Cancer - What are the types
of Breast Cancer |
| National
Cancer Institute - Breast Cancer Stage Explanation |
| CancerNet
- Stages of Breast Cancer |
| Oncology
Channel - Breast Cancer Staging |
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