Diagnosis (Finding out)

Breast Biopsy

When you discover a lump or other changes in your breast, it is important to find out what it is. It is normal to be alarmed, but you have reasons to be reassured:

• Most women, at sometime in their lives, will develop lumps in their breasts.
• Most lumps are NOT breast cancer. In fact, 8 out of 10 lumps are harmless.
• To be sure that a lump or other change is not breast cancer, you need to have the lump partially or entirely removed (a biopsy). A diagnosis can then be made by a pathologist – a doctor who looks at the cells under a microscope – to find out if the tissue is normal or cancerous.

When Your Lump Can Be Felt

If your lump can be felt, you will most likely have one of the following types of biopsies:

A. Fine Needle Aspiration Biopsy (FNAB). A thin needle is placed into the lump. If fluid comes out, and the lump disappears, it means that the lump is a cyst and is usually not cancer.

• Advantage: You can avoid scar and surgery. If cancer is found, you can start to plan your treatment.
• Disadvantage: If the needle removes only normal cells, and the lump does not go away, then you may need more tests to make sure that the lump is not cancer.

B. Core Biopsy. A larger needle is used to remove a small piece of tissue from the lump.

• Advantage: Your scar will barely be noticeable. Even if the lump is cancer, you will have avoided the stress of one surgery.
• Disadvantage: If this biopsy finds cancer, you will need more surgery to remove the part of the cancer that is still in your breast. If this biopsy does not find cancer, you may still need a surgical biopsy to make sure that the lump that is still in you breast does not contain any cancer cells.

C. Surgical Biopsies. A surgical biopsy is the surgical removal of tissue for microscopic examination and diagnosis. There are a number of types of surgical biopsies:

An incisional biopsy removes only a portion of the lump. An excisional biopsy removes the entire lump.

• Advantage: Excision biopsies are definitive. You will know with certainty if your lump is harmless or cancerous.
• Disadvantage: You will have a scar on your breast, which will heal with time. There may be some changes in the shape or size of your breast. If an incisional biopsy does not find cancer, you may still need further surgery to determine if the remaining lump in the breast does not contain any cancer cells.

Frozen Section Biopsy. In frozen section biopsy, doctors cut a portion of a woman’s lump and the tissue is immediately sent to the pathologist for examination. If breast cancer is found, the doctors remove the patient’s breast in the same operation while the woman is still under general anesthesia. A woman goes into the operation giving consent that if cancer is found during biopsy, the doctors should proceed to remove the breast.

• Advantage: If cancer is found, the woman only undergoes one operation for both biopsy and surgical treatment (removal of the affected breast).
• Disadvantage: Although the patient already gave consent prior to surgery for the procedure, a woman found to have breast cancer wakes up in the recovery room without the affected breast. This may lead to emotional stress or self-doubt about earlier decisions made. Even if the biopsy does not find cancer, the woman will have already exposed herself to general anesthesia and its after-effects.

When Your Lump Can Be Seen But Not Felt

Sometimes you can have an area of concern that cannot be felt in the breast but shows up on pictures of the inside of the breast. These pictures are taken by either mammography (a type of x-ray) or ultrasound, a process that shows harmless soundwaves as they travel through a breast. In these cases you may have:

A. Needle Localization Biopsy. Using a mammogram or an ultrasound as guide, a doctor places a needle or fine wire into the suspicious area. The area is then removed with a surgical biopsy. A second picture of the biopsy area may be taken later to make sure that the area of concern was entirely removed.

Studies show that it is safe to start treatment within several weeks after your biopsy. This two-step procedure gives you time to:

• Read more and think through the information.
• Get a second opinion.
• Talk to other women who have had breast cancer.
• Talk to other women who have had breast cancer.
• Have a complete study of your breast tissue, and, if needed, of other parts of your body.
• Prepare yourself and loved ones for your treatment.

Ask your doctor the following questions:

• Do you think I need to have a biopsy? If not, why?
• What type of biopsy do you recommend? Why?
• How soon will I know the results?
• What will the scar look like after the biopsy and after it heals?
• Do you suggest local or general anesthesia? What are the advantages of each?

Second opinions are your right and are commonly asked for today. Get a second opinion if you:

• Want to confirm your diagnosis or treatment.
• Have concerns about your treatment plan.
• Feel uncomfortable with your doctor.

Classification of Tissue

After your biopsy, it can now be determined whether the tissue extracted is benign or malignant. Benign means that your lump or other problem was NOT cancer; malignant means that your tissue DOES contain cancer cells and may either be:

In Situ Cancer – Today, fifteen to twenty percent of breast cancers fall into this category.
Two types exist:

• Ductal carcinoma in situ (DCIS) is noninvasive, which means it is limited to the milk ducts of the breast. It has NOT spread beyond the breast, to the lymph nodes in the armpit, or to other parts of the body. However, there are several types of DCIS. If it is not removed, some types may in time change and develop into an invasive cancer. Some may never progress to an invasive cancer.
• Lobular carcinoma situ (LCIS) is a noninvasive growth limited to the milk lobules of the breast. It is NOT cancer – only a warning sign of increased risk of developing cancer, according to the National Cancer Institute. Women with LCIS have about a 1% risk of developing invasive breast cancer equally in either breast per year. After 20 years, this risk is about 18%.

Invasive Cancer HAS SPREAD to surrounding tissue in the breast and MAY HAVE SPREAD to the lymph nodes in the armpit or to other parts of the body. All breast cancers, except in situ, are invasive.

Metastasized cancer HAS SPREAD to other parts of the body, such as the bones, lungs, liver,
or brain.

Stages of Breast Cancer

Breast cancer is a complex disease so there is no right treatment for all women. Your breast cancer will be placed into one of 5 stages. How your cancer is staged and your treatment choices will depend on:

• How small or large your tumor is and where it is found in your breast.
• If cancer is found in the lymph nodes in your armpit.
• If cancer is found in other parts of your body.