Breast Cancer Diagnosis
The diagnosis of breast cancer is based upon a thorough clinical examination along with a detailed history of the patient and is confirmed by carrying out a few tests.
CLINICAL EXAMINATION & HISTORY:
It helps the doctor to pick up subtle signs in the early phases. A palpable lump is measured and the location is duly noted. The opposite breast, both armpits and the areas above the collar bones are also examined to look for any lumps.
A detailed History is essential to rule out any significant family history as well as to note the presence of other comorbid conditions such as hypertension, diabetes, heart disease, asthma, allergies, etc which may interfere with treatment.
Bilateral breast mammography is carried out to look for lesions in the suspected breast and to rule out a problem in the other breast. Quite often, a routine screening mammogram may be able to pick up a suspicious lesion before it is even palpable.
It is done along with a mammogram and is especially useful in younger women who have denser breasts. A lesion deemed suspicious on the mammogram is further studied using ultrasound before coming to a probable diagnosis.
Mammography and ultrasonography have a staging system called BIRADS, which adheres to international standards set for radiologists worldwide.
Breast MRIs are increasingly being used in younger patients, women with breast implants, those with symptoms of abnormal nipple discharge and a few other select conditions where the doctor deems it necessary.
FNAC (Fine Needle Aspiration Cytology)
A thin needle is used to draw out a few cells from the lump and these are then examined by the pathologist under a microscope. A positive test indicates that the lump may be cancerous. However we confirm the diagnosis by performing a core biopsy.
In this test, a slightly thicker needle is used to draw out cores of tissue from the lump.
This test gives a confirmative diagnosis in the majority of patients. This test is of even greater value in patients who will require neoadjuvant chemotherapy (i.e. chemotherapy before surgery) as it provides us with information regarding the type of the carcinoma and the specific targets available for therapy.
A PET CT gives us information about the size, activity and location of the primary tumour as well as any metastatic spread. It is currently a precise tool for assessment of the stage of the disease before commencing treatment. In patients with metastatic disease, a PET CT is used to assess response to therapy.