Breast Cancer Diagnosis

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Signs and symptoms of breast cancer

The most common sign of breast cancer is a lump or mass in the breast tissue. The lump could be soft or hard and may have round or irregular edges. Other signs and symptoms may include:

  • Swelling of breasts
  • Breast pain
  • Pain in the nipple
  • Inward turning of nipple
  • Thick, red, and scaly nipples
  • Discharge from nipples other than breast milk
  • Irritation of breast skin
  • Swelling or lump in the armpit

Breast Cancer Diagnosis

Several tests are used to diagnose breast cancer.

  • Breast exam: Regular breast exams are important for detecting any lumps/abnormalities in the breast and lymph nodes in the armpit.
  • Diagnostic mammogram: This procedure is similar to the screening mammogram. The diagnostic type of mammogram captures more images and is more detailed. It will take a bit longer to do than a screening mammogram.
  • Biopsy: This is a surgical procedure (done under anesthesia) in which a doctor removes a small sample of the suspected breast tissue, which is sent to a laboratory for analysis. The pathologist (a doctor who specializes in the study of diseased tissues) will examine the tissue sample and determine if cancer is present or not.
  • Breast ultrasound: This is a painless procedure which uses sound waves to create a picture of the structure of breast tissue. The technician places a gel on the breast and uses a wand-like instrument to move over the breast and surrounding tissues.
  • Magnetic Resonance Imaging (MRI): MRI uses a large machine which scans the breasts using magnetic waves. It is also painless, but some people may be intimidated by the closed chamber in which you must lie for the duration of the procedure. MRI is usually done after a biopsy to gather more information.

Pathology services for breast cancer diagnosis in the public sector are available in ten Caribbean countries: Antigua and Barbuda, Bahamas, Barbados, Dominica, Grenada, Jamaica, St Kitts and Nevis, St Lucia, Suriname, Trinidad and Tobago. This information are based on publicly available data and does not include services that may be available in other countries or in private healthcare facilities.

Stages and grading of breast cancer

Staging is the way health care providers describe breast cancer in terms of size, location in the breast and whether or not it has spread to other areas.
By identifying cancer at a particular stage, the healthcare provider is better able to come up with a treatment plan and make a prognosis for individual patients.
Although your doctor might not be able to tell you the exact stage of the cancer until you have surgery, your scans and tests give some information about it.

Stage 0: This is the non-invasive stage of cancer where the tumor is only confined to the ducts of the breast tissue.

Stage 1: From this stage, cancer becomes invasive, and it attacks the healthy breast tissue outside of the ducts.

  • Stage IA means that cancer is small, invasive, but it has not yet spread to the lymph nodes.
  • Stage IB means that cancer has spread to the lymph nodes. The size of the tumor may range from 0.2m to less than 2mm at this stage.

Stage 2: At this stage, cancer has either spread and/or grown in size; still, it is considered to be in an early stage.

  • Stage IIA means that cancer has spread to 1-3 axillary lymph nodes but not distant parts of the body. There may not be any evidence of tumor in the breast tissue, or there may be a tumor of size up to 50 mm. If the tumor size is larger than 20 mm, yet it has not spread to axillary lymph nodes, it is still considered to be stage IIA.
  • Stage IIB means that the tumor size is larger than 20 mm and smaller than 50 mm and has spread to 1-3 axillary lymph nodes. When the tumor is larger than 50 mm but does not affect the axillary lymph nodes, specialists still call it stage IIB.

Stage 3: At this stage, cancer is considered advanced even though it has not spread to bones and other distant organs in the body. Here, cancer becomes difficult to fight.

  • Stage IIIA means that cancer has not yet spread to other parts of the body, but it has invaded 4-9 axillary lymph nodes. It may also have spread to internal mammary lymph nodes. Stage IIIA is also when the tumor is larger than 50 mm and also affects 1-3 axillary lymph nodes.
  • Stage IIIB means that the tumor has spread from the breast to the skin of the breast or the chest wall. It has not spread to other body organs and may or may not involve axillary or internal mammary lymph nodes.
  • Stage IIIC means that cancer has spread to any of the following lymph nodes:
    • more than 9 axillary lymph nodes
    • Internal mammary lymph nodes
    • lymph nodes around the collarbone

Cancer has not spread to other parts of the body at this stage.

Stage 4 means that cancer has spread to other parts of the body, such as the liver, bones, lungs, and brain. Cancer at this stage is also called advanced cancer, secondary breast cancer, or metastatic breast cancer.

Among breast cancer patients in the UK, 22 percent of Black Caribbean women and 25 percent of Black African women are diagnosed at late stages of cancer (stage III and IV), whereas only 13 percent of British white women are diagnosed at later stages, according to a study by Public Health England.

Grading

Grading is a term used to classify cancer cells based on how they look when compared to normal cells.

Grade Description
1 Cancer cells look similar to normal cells; cells grow slowly and  are less likely to spread
2 Difficulty in determining if there are distinct differences among cells
3 Cells look very different from normal cells; cells grow rapidly and are more likely to spread
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