Carolinas HealthCare System
Cancer Care
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Diagnosis

Your doctor or practitioner will take a personal and family medical history, and perform a breast exam to check for lumps, thickening, skin changes, and shape. You will be examined in the sitting and lying positions, and will be checked for enlarged lymph nodes in your armpit and around the collarbone. Depending on what your provider finds, they may suggest one or all of the following:

  • Mammogram: The use of X-rays to look at breast tissue. A radiologist will report their findings to your healthcare provider and may recommend regular follow up or additional testing. Only about 90 percent of breast cancer can be seen on mammogram.
  • Breast Ultrasound: The use of sound waves to take pictures of the inside of the breast. Ultrasound is useful to see if a mass is solid or fluid filled. A solid mass is more likely to be cancer.
  • Breast Biopsy: A biopsy, or removal of a piece of tissue from the area of concern, is needed if cancer is suspected. Biopsy is the only way to prove that an abnormality is breast cancer. Most biopsies are negative, or benign. There are various types of biopsies including fine needle aspiration, core needle biopsy, and excisional biopsy. The doctor will numb the area to make the procedure as painless as possible. Mammography or ultrasound may be used to help find where to place the needle. The core needle biopsy is the more common and favored method of biopsy. If a lymph node is felt, or is seen on imaging, it may also be biopsied. At Carolinas Medical Center and Levine Cancer Institute most biopsies are done through the services of Charlotte Radiology.
  • Breast MRI: The use of radio waves and strong magnets to look at breast tissue. This test requires injection of a contrast material to be able to see abnormal areas. MRI results in a higher number of false alarms than mammography. Deciding who needs an MRI involves careful thought. Women with a normal risk for breast cancer should not have an MRI. MRI does not take the place of a mammogram but may be ordered in addition to a mammogram. If you have a pacemaker you cannot have a breast MRI.

What Is Breast Cancer?

What is breast cancer?Breast cancer starts in the tissues of the breast. It is the most common type of cancer in women. Although it is not common, men can also get breast cancer. Like other cancers, breast cancer can invade and grow into the tissue of the breast. It can also travel to other parts of the body and develop into new tumors, a process called metastasis.

In recent years more women have been diagnosed with breast cancer, but fewer women have died from this disease because of early diagnosis and the development of better treatments.

There are two main types of breast cancer:

  • Ductal carcinoma starts in the ducts, or tubes, that carry milk from the breast to the nipple. Most breast cancers are this type.
  • Lobular carcinoma starts in the lobules, the part of the breast which produces milk.
  • In a few cases, breast cancer starts in other areas of the breast.

Breast cancer can be invasive or noninvasive. Invasive means that the cancer cells have grown outside the duct or lobule into the breast tissue. Noninvasive means the cancer cells are still in the duct or lobule. Noninvasive is also called “in-situ.”

  • DCIS or ductal carcinoma in situ is breast cancer in the lining of the milk duct that   has not gone into the breast tissue. DCIS can progress to invasive cancer.
  • LCIS or lobular carcinoma in situ is cancer located in the lobules of the breast. Doctors do not think that LCIS becomes an invasive cancer, but women with this diagnosis are at a high risk of having invasive cancer in either breast.
  • Invasive ductal carcinoma starts in the ducts but invades into the fatty tissue of the breast. About 80 percent of invasive cancers are this type.
  • Invasive lobular carcinoma starts in the lobules and spreads into the fatty tissue of the breast.
  • Inflammatory breast cancer accounts for 1-3 percent of all breast cancers. In this disease, cancer cells have spread into the skin causing redness, warmth, and the skin may look like an orange peel. The effected breast may be larger, firm, tender, or itchy.

Many breast cancers are sensitive to the hormones estrogen and progesterone. This means that estrogen and progesterone will help the breast cancer tumor cells to grow. These types of tumors are called estrogen receptor (ER) positive, progesterone receptor(PR) positive, or both. Hormone receptor positive tumors tend to grow more slowly and are less likely to spread to lymph nodes.

15-20 percent of breast cancer is also HER-2 positive. HER-2 is a gene that normally tells cells to grow and divide. If the gene is overexpressed, if you have more than the normal amount, the growth of the cancer cells can be fast. This causes a higher risk that the cancer will come back or recur. Treatments have been developed to specifically target HER-2 which may positively change the recurrence rate for this type of tumor. 

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