Breast cancer is not one distinct disease. There are several different types and each type of breast cancer can be identified by examining some of the cells from the tumour under a microscope and by other means.
Normal breast tissue contains special cells called hormone recepters, which are sensitive to certain chemicals [hormones] naturally present in the body. One of the most important of these hormones is oestrogen which is produced by the ovaries. These hormones stimulate breast cells and are essential for their normal functioning as well as changes that occur during the menstrual cycle and pregnancy
A large number of tumors and their growth can be stimulated by oestrogen. Other types of tumors contain fewer hormone receptor cells and are called oestrogen negative [or ER negative ] tumors. Identification 'of different tumors have important implications for their treatment
In addition to this, tumors can be classified in
a number of different ways relating to the rate of growth and make-up
of the cells. Your doctor will explain more about this if you wish
to know.
As a result of this there are a number of different treatments which
will be explained in more detail and to undergo a test to discover
whether or not the lump is cancerous
Biopsy
This is the most reliable way of discovering whether a breast lump
is cancerous and is performed in patients where an abnormality is
found but importantly nine out of ten biopsies discover breast problems
other than cancer. In this procedure a sample
of tissue is removed by the doctor or surgeon and examined under a
microscope by a pathologist. The tissue can be obtained either by
the use of a needle or by surgery.
The choice of which technique is used depends upon the nature and
location of the lump as well as the woman’s' general health
as not all lumps or mammographic changes merit a biopsy. Nearly all
lumps that look smooth and have a clear outline are benign. Your doctor
will carefully compare the findings from your physical examination
and mammogram and take your medical history into consideration before
recommending a biopsy. In some instances, the doctor may suggest merely
watching the susoicious area for a month or two. Many lumps may be
the result of normal hormonal changes taking place during the menstrual
cycle so this waiting period is needed for additional information.
Needle biopsy
Fine needle biopsy (sometimes
called aspiration) uses a very thin needle and syringes to remove
either fluid from a cyst or clusters of cells from a solid lump. This
technique requires a high level of skill and experience on the part
of the doctor.
Core needle biopsy uses a somewhat large needle with a cutting edge. In the procedure the needle is inserted under local anesthesia through a small incision in the skin and a small core of the suspect tissue is removed. This procedure may cause some bruising, but rarely leaves a scar and is over within a few minutes.
Localization biopsy
This produce (also known as needle localization) uses mammography
to locate the abnormality before taking a sample with a needle.
Surgical biopsy
Using a mammogram (or sonogram) as a guide, the radiologist
inserts a fine needle to pinpoint the suspicious area. Under general
anesthetic, the surgeon can locate and remove the tissue targeted
by the needle. The more precisely the needle is placed, the less tissue
needs to be removed.
Examination of tissues
The tissue sample removed by any of these techniques is then examined
by a pathologist. If the excised lump is large enough, it is frozen
and sliced into razor-thin section which can then be examined under
a microscope. This is known as a frozen section and it provides an
immediate, if provisional, diagnosis and surgeon may be able to given
you the results before you go home.
A more thorough assessment of the sample takes several days and involves
the pathologist preparing and examined in greater detail.
What does the pathologist look for?
The pathologist looks for abnormal cell types and growth patterns.
In many cases the diagnosis will be clear cut. However, sometimes
the distinction between benign and malignant cells can be subtle.
When there is any doubt the pathologist will seek a second opinion.
What happens after biopsy?
Not all breast cancer treatments involve surgery. It is a common belief
that if you have breast cancer you will need to have your breast removed.
This is rarely true. Even if some form of surgery is required the
results of the biopsy and diagnosis are separated from any further
treatment by several weeks.
Why are there so many different
treatments?
Each type of breast cancer may respond to a different treatment. Also,
the treatment for premenopausal women usually differs to that offered
to post menopausal women. All women are different, so the treatment
given to them will be the best possible for their individual circumstances.
How is a treatment decided?
There are many different factors to consider and often a combination
of treatments are used. Major consideration include your age, the
type of breast cancer, the actual size and position of the tumor and
also if there has been any spread to the lymbh glands. The hormone
receptor status of the tumor is also taken into consideration.
Treatment options
There are four main types of treatment for breast cancer:
* Surgery
* Radiotherapy
* Hormonal (endocrine) treatment
* Chemotheraphy
Whatever treatment is given the chances
of success are always greater the earlier it is given.
In early breast cancer primary treatment is almost invariably surgery,
often accompanied by radiotherapy and increasingly followed by adjuvant
hormonal therapy or chemotheraphy.
Four steps to
follow for Good Breast Health
