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Breast Cancer Diagnosis and Stages
At UT Southwestern, our breast cancer pathologists are uniquely trained experts who focus solely on determining whether someone has breast cancer. In North Texas, this degree of subspecialty is unique to UT Southwestern.
Diagnosing Breast Cancer
An accurate breast cancer diagnosis is the first step toward the most effective treatment.
If our doctors detect a suspicious change in the breast during an examination or on a mammogram, they’ll use one or more methods to determine if the disease is present.
First, additional imaging, such as an ultrasound or breast magnetic resonance imaging (MRI), might be required. The breast cancer team at UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center offers the latest in these technologies.
The next step to confirm a diagnosis is typically a biopsy. Using a needle, we will remove a sample of the suspicious tissue and examine it under a microscope to determine whether it’s cancerous.
Methods of Diagnosis
Our team uses several advanced types of biopsies to diagnose breast cancer, depending on the situation. These include:
- Fine needle aspiration biopsy, in which a small amount of breast tissue or fluid is collected through a thin needle
- Core needle biopsy, which uses a hollow needle to remove breast tissue (more tissue than a fine needle biopsy)
- Vacuum-assisted needle biopsy, a procedure that uses a vacuum-powered instrument to remove multiple tissue samples
- Image-guided biopsy, which uses imaging technology such as a mammogram, ultrasound, or MRI to locate abnormalities
- Surgical (open) biopsy, in which part of the breast mass is removed for examination
- Lymph node biopsy, which removes lymph node tissue for examination
Evaluating a cancerous tumor’s microscopic characteristics is important in determining if it’s likely to metastasize (spread) and what treatment or therapy is most appropriate. These characteristics help determine the type of breast cancer (invasive or noninvasive), the grade (how quickly an invasive cancer is growing), and the classification.
After examining the cancerous tissue, the breast pathologist produces a report. A pathology report might include information about the size of the tumor, the type of cancer cells, the grade of the tumor, and tumor markers to determine how best to treat the cancer.
Types of Breast Cancer
Treatment can vary depending on the type of breast cancer, so it’s important for our team to identify the type of breast cancer early. Most breast cancers are either invasive ductal carcinoma, the most invasive form of breast cancer, or invasive lobular cancer, which accounts for only 10 to 15% of breast cancers.
Human epidermal growth factor receptor 2-positive (HER2) cancer is an aggressive form of breast cancer that’s more likely to spread and recur.
Hormone Receptor-Positive/Estrogen Receptor-Positive
Hormone receptor-positive/estrogen receptor-positive (HR+) is the most common type of breast cancer. HR+ means that cells are stimulated by the hormone estrogen.
Triple Negative Breast Cancer
Triple negative breast cancer is an aggressive form of breast cancer that is estrogen receptor-negative, HER2-negative, and progesterone receptor-negative. Triple negative breast cancer has a poorer prognosis than other forms of breast cancer.
Stages of Breast Cancer
Staging is a measure of how extensively the cancer has spread within and outside the breast. It's determined by the cancer's characteristics such as tumor size and hormone receptor status.
- Stage 0 is non-invasive and often described as pre-carcinoma. Stage 0 diseases include ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). Though not life-threatening, DCIS and LCIS can develop into breast cancer if not appropriately treated.
- Stage I involves a tumor two centimeters or smaller (IA) that has not spread or cancer cells found in lymph nodes (IB).
- Stage II involves a tumor two to five centimeters that has not spread to lymph nodes (IIA) or a tumor larger than five centimeters that still has not spread to lymph nodes (IIB).
- Stage III involves a tumor larger than five centimeters that has spread to one to three lymph nodes near the breastbone (IIIA), or a tumor of any size that spread to up to nine lymph nodes (IIIB), or cancer that has spread to 10 or more lymph nodes (IIIC).
- Stage IV is an invasive cancer that has spread beyond the breast and nearby lymph nodes.
Tests for staging a breast cancer include:
- Chest X-rays, imaging technology that uses radiation to produce images of the chest
- Blood tests, such as a complete blood count
- Bone scans, nuclear imaging tests to see if the cancer has spread to the bones
- Computed tomography (CT), specialized X-ray technology that takes cross-sectional images to produce detailed 3-D images
- Positron emission tomography (PET), an imaging test that uses small amounts of radioactive medicine to create detailed images of structures in the body
- MRI, large magnet and radio waves that produces detailed images to check for soft tissue changes
Not all women will require each of these tests to determine the stage. This is when our doctors’ experience and collaboration with members of the breast cancer team matter most. Identifying the exact type of breast cancer and its stage determines how the cancer will be treated. Our pathologists and oncologists will work together closely to customize a treatment plan for patients and start treatment as soon as possible.