Breast Cancer Diagnostics
Pune Breast Care
The first step in making a sound treatment strategy for breast cancer, involves accurate diagnostic tests and complete information gathering. At Pune Breast care, we help you expedite the diagnostic process, but ensuring accuracy at every step. We take the time to explain your diagnosis in detail to to help you make a better treatment plan and feel prepared and confident in the journey.
Investigations for Breast Cancer
A diagnostic mammography is different from a screening mammogram done for healthy women. Special magnification and compression views may be used in this mammogram to study the affected area in detail. The mammogram helps the surgeon to determine if there is one tumor or more and also whether the opposite breast is normal. It can show suspicious calcifications that may indicate pre-cancerous tissue (DCIS) in surround tissue.
Dr Pranjali Gadgil performs her own ultrasounds to evaluate the tumour and plan the surgical approach. The ultrasound confirms whether the remaining breast tissue is healthy. A detailed evaluation of th the nodes in the armpit give an idea of stage of the cancer and helps treatment planning.
Diagnostic Breast Ultrasound
Core Needle Biopsy
A core needle biopsy is the most appropriate way to biopsy a suspected tumor. We perform most of our biopsies under ultrasound guidance for higher accuracy. If there are other abnormal areas on ultrasound, these can also be biopsied even if they are not felt by hand. If the nodes in the armpit appear suspicious, we may biopsy them at the same time as the tumor biopsy, so we can get additional information about the stage of the cancer and plan treatments accordingly.
PET- CT Scan
PET CT:: In late stages breast cancers can spread to bones, liver, lung, brain and other organs. A PET CT scan evaluates the body for spread of breast cancer into these organs. A PET CT scan is performed in a nuclear medicine lab. A glucose containing contrast agent is given intravenously. Areas of the body that show a high uptake of glucose, light up on PET scan, suggesting possible involvement with breast cancer. A PET CT scan is not recommended in staging early breast cancer. Probability of this distant spread in such cases is low and PET CT can show “false positive” findings.
Breast MRI: MRI is performed using specialised equipment in breast-imaging centres. We use this test selectively in cases where mammography may not be adequate for surgical planning. This is particularly helpful in young women with breast cancer, dense breasts and women with BRCA gene mutations.
Types of Breast Cancer
The pathology reports obtained at biopsy can be used to classify the breast cancer based on different criteria
Cell of Origin of the Breast Cancer
80% of breast cancer originates from milk ducts- small tubules that carry milk from milk glands to the nipple. When cancer cells are limited to the inside of the ducts, it is called DCIS or "Ductal Carcinoma in situ". When they are present outside the ducts, it is called "Invasive Ductal Carcinoma" or IDC.
This 2nd most common type arises from lobules of the milk producing glands. It accounts for 10-15 % of all breast cancer.
Less Common Types
Others: Mucinous, papillary, tubular carcinomas, phyllodes tumors, breast sarcomas, breast lymphomas.
Grade of the tumor
Grade indicates how different a tumor cell looks from a normal cell and indicates growth rate. Grade of a tumor does not refer to stage.
Grade I or low grade tumors
These are usually slow-growing and resemble normal breast cells.
Grade II or intermediate grade tumors
These are the most common type
Grade III or high grade tumors
These tend to have a faster growth rate
Molecular Subtype (ER/PR/HER2)
Molecular (IHC) tests done on the biopsy sample include ER, PR, HER2. Prognosis and Treatment of Breast cancer is largely determined by these molecular markers.
Hormone Receptor Positive breast cancer
ER and/or PR positive ( ER+ PR+) tumors are sensitive to and grow under influence of estrogen and progesterone hormones. These tumors can be treated by blocking in the influence of the these hormones with endocrine therapy. ER + PR + HER2 -ve Tumors can be further described as "Luminal A" or "Luminal B"
HER-2 positive breast cancer
HER 2 is a growth promoting protein, seen on lining of this type of tumor. Tumors overexpressing HER2 tend to be aggressive. However treatments available that specifically block this protein to inhibit growth of these tumors. This is called HER-2 targeted or anti-HER2 therapy.
Triple Negative breast cancer
This type of tumor shows neither the ER PR hormone receptors, nor the HER 2 protein on the cell linings, hence it is called ‘triple negative’. Triple negative breast cancer is usually treated with chemotherapy.