Why Does My Provider Need To Test The Metastatic Tumor
Your care team will test the metastases to figure out the biology of the tumor, which can help guide your treatment plan. Providers may test tumors for:
- Hormone receptor status: If the cancer is hormone receptor-positive, hormonal therapy may be your first treatment.
- HER2 status: Human epidermal growth factor receptor 2 is a protein that is overexpressed on some breast cancer cells. HER2-positive cancer responds to specific HER2-targeted therapies.
- PIK3CA gene mutation: If a tumor is hormone receptor-positive and HER2-negative, your provider may test for this gene mutation. Specific targeted therapies can be used to treat tumors with this mutation.
- PD-L1 status: Tumors that are hormone receptive-negative and HER2-negative may be tested for PD-L1 status. If the PD-L1 test is positive, you may be recommended to receive a combination of immunotherapy and chemotherapy.
Surgery For Invasive Ductal Carcinoma
Breast cancer treatment has evolved to offer patients more options. In addition to removing breast cancer, new aesthetic surgical approaches can enhance well-being and lessen the emotional impact of losing all or part of a breast to cancer. Comprehensive breast centers with coordinated teams of oncologic and plastic surgery practitioners can offer a wider array of options.
Surgery for IDC may include one of these procedures:
- Lumpectomy is removal of part of the breast. It is also known as breast-conserving surgery. Lumpectomy may be followed by radiation treatments to treat any remaining cancer cells.
- Mastectomy is removal of the breast. Mastectomy is a treatment for patients with multiple, very aggressive, or large invasive ductal tumors. It can be followed by breast reconstruction.
What Is Stage Iii Breast Cancer
In stage III breast cancer, the cancer has spread further into the breast or the tumor is a larger size than earlier stages. It is divided into three subcategories.
Stage IIIA is based on one of the following:
- With or without a tumor in the breast, cancer is found in four to nine nearby lymph nodes.
- A breast tumor is larger than 50 millimeters, and the cancer has spread to between one and three nearby lymph nodes.
In stage IIIB, a tumor has spread to the chest wall behind the breast. In addition, these factors contribute to assigning this stage:
- Cancer may also have spread to the skin, causing swelling or inflammation.
- It may have broken through the skin, causing an ulcerated area or wound.
- It may have spread to as many as nine underarm lymph nodes or to nodes near the breastbone.
In stage IIIC, there may be a tumor of any size in the breast, or no tumor present at all. But either way, the cancer has spread to one of the following places:
- ten or more underarm lymph nodes
- lymph nodes near the collarbone
- some underarm lymph nodes and lymph nodes near the breastbone
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What Is Cancer Staging
Staging is a way of describing how extensive the breast cancer is, including the size of the tumor, whether it has spread to lymph nodes, whether it has spread to distant parts of the body, and what its biomarkers are.
Staging can be done either before or after a patient undergoes surgery. Staging done before surgery is called the clinical stage, and staging done after surgery is called the pathologic stage. Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor recommend the best kind of treatment and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.
This page provides detailed information about the system used to find the stage of breast cancer and the stage groups for breast cancer, such as stage IIA or stage IV.
Breast Cancer Stage Groups
In breast cancer, stage is based on the size and location of the primary tumor, the spread of cancer to nearby lymph nodes or other parts of the body, tumor grade, and whether certain biomarkers are present. To plan the best treatment and understand your prognosis, it is important to know the breast cancer stage.
There are 3 types of breast cancer stage groups:
- Clinical Prognostic Stage is used first to assign a stage for all patients based on health history, physical exam, imaging tests , and biopsies. The Clinical Prognostic Stage is described by the TNM system, tumor grade, and biomarker status . In clinical staging, mammography or ultrasound is used to check the lymph nodes for signs of cancer.
- Pathological Prognostic Stage is then used for patients who have surgery as their first treatment. The Pathological Prognostic Stage is based on all clinical information, biomarker status, and laboratory test results from breast tissue and lymph nodes removed during surgery.
- Anatomic Stage is based on the size and the spread of cancer as described by the TNM system. The Anatomic Stage is used in parts of the world where biomarker testing is not available. It is not used in the United States.
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What To Expect During Surgery
You will receive general anesthesia before your surgery, so youll be asleep during the procedure. Unless youve decided on a nipple-sparing surgery, the surgeon will remove as much of the tissue as possible from both your breasts. This includes the skin, nipple and areola.
Sometimes that also includes the lymph nodes from under the arm. The doctor may also remove the pectoral muscles, located under the breasts.
As part of the surgery, the surgeon will remove breast tissue and insert one or two tubes for fluid to drain into from an attached soft-rubber ball.
Sometimes breast reconstruction is performed at the same time as a mastectomy. Choices for reconstruction include breast reconstruction using breast implants or whats known as tissue flap surgery, which reconstructs the breast by using muscle, fat and skin taken from other parts of the body.
At the end of the surgery, the area is closed with stitches.
A woman who has undergone a mastectomy typically stays in the hospital for one or two nights.
What Are The Pros And Cons Of Bilateral Mastectomy
Bilateral mastectomy has some benefits. For example, with this surgery there is:
- A lower future risk of cancer in the breast.
- No need for follow-up mammograms or breast MRIs.
- A better chance that the breasts will match if both are reconstructed at the same time.
The surgery also has some downsides. Bilateral mastectomy:
- Has no effect on the risk of cancer somewhere else in your body.
- Is more complex than lumpectomy. It takes longer to recover. And there’s a higher risk of problems, such as infection.
- Causes a loss of feeling in the chest. Usually the feeling doesn’t come back. And the surgery leaves scars that are permanent.
- May mean that you need one or more other surgeries if you want breast reconstruction. Each surgery has risks and requires recovery time.
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Surgical Management And Cosmesis
Considerable controversy has existed regarding the surgical management of patients with synchronous bilateral breast cancer. Traditionally, most clinicians have approached bilateral breast cancer more aggressively than unilateral disease. Most studies have shown a disproportionately higher incidence of bilateral mastectomy for bilateral breast cancer. This aggressive approach was employed to treat what was once thought to be a disease with a worse prognosis and outcome. However, several studies have shown that the prognosis of patients with bilateral breast cancer seems similar to unilateral disease. Gollamudi et al. retrospectively reviewed patients with SBBC and showed that they do not have a worse prognosis and can be safely treated with bilateral breast conservation. The cosmetic outcome was comparable to patients who underwent unilateral breast conservation. Heron et al. also demonstrated that bilateral breast conservation treatment does not compromise cosmesis, outcome or overall survival in this group of patients . Currently, the overall consensus is that bilateral breast cancer is amenable to bilateral breast conservation treatment without compromising survival and maintaining patient cosmesis .
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Treatment Of Breast Cancer By Stage
This information is based on AJCC Staging systems prior to 2018 which were primarily based on tumor size and lymph node status. Since the updated staging system for breast cancer now also includes estrogen receptor , progesterone receptor , and HER2 status, the stages may be higher or lower than previous staging systems. Whether or not treatment strategies will change with this new staging system are yet to be determined. You should discuss your stage and treatment options with your doctor.
The stage of your breast cancer is an important factor in making decisions about your treatment options. In general, the more the breast cancer has spread, the more treatment you will likely need. But other factors can also be important, such as:
- If the cancer cells have hormone receptors
- If the cancer cells have large amounts of the HER2 protein
- If the cancer cells have a certain gene mutation
- Your overall health and personal preferences
- If you have gone through menopause or not
- How fast the cancer is growing and if it is affecting major organs like the lungs or liver
Talk with your doctor about how these factors can affect your treatment options.
Stage 0 cancers are limited to the inside of the milk duct and are non-invasive .
Ductal carcinoma in situ is a stage 0 breast tumor.
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Checking The Lymph Nodes
The usual treatment is surgery to remove the cancer. Before your surgery you have an ultrasound scan to check the lymph nodes in the armpit close to the breast. This is to see if they contain cancer cells. If breast cancer spreads, it usually first spreads to the lymph nodes close to the breast.
Depending on the results of your scan you might have:
- a sentinel lymph node biopsy during your breast cancer operation
- surgery to remove your lymph nodes
You may have other treatments after surgery.
Breast Cancer Support And Resources
There are many resources and support groups for breast cancer survivors. Theres no obligation to stick with a group. You can try it out and move on whenever youre ready. You might be surprised to learn that you have a lot to offer others as well.
The American Cancer Society has a variety of support services and programs. You can call the 24/7 helpline at 800-227-2345, visit the
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What Do Experts Say About Bilateral Mastectomy
Most experts do not recommend bilateral mastectomy for early-stage breast cancer. This is because:
- Women who have both breasts removed don’t live longer than women who have lumpectomy plus radiation treatments.footnote 1
- Bilateral mastectomy reduces only the risk of a new cancer in the breast. It doesn’t reduce the risk of a new cancer in another part of the body.
The risk of a new cancer in the breast is already small. If a new cancer occurs, it’s more likely to appear somewhere else in the body.
Hyperplasia Of The Breast
Hyperplasia is an overgrowth of the cells that line the lobules or ducts inside the breast. It is not cancer, but some types of hyperplasia are linked with a higher risk of developing breast cancer .
Hyperplasia can be described as either usual or atypical, based on how the cells look under a microscope.
- In usual ductal hyperplasia, there is an overgrowth of cells lining the ducts in the breast, but the cells look very close to normal.
- In atypical hyperplasia , the cells look more distorted and abnormal. This can be either atypical ductal hyperplasia or atypical lobular hyperplasia .
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Rare Types Of Invasive Ductal Carcinoma
Medullary ductal carcinoma accounts for only 3%5% of breast cancers. It may appear on a mammogram, and it does not always feel like a lump rather, it can feel like an abnormally spongy area in the breast tissue.
Mucinous ductal carcinoma is also called colloid breast cancer. It occurs when cancer cells within the milk duct of the breast produce mucous, which also contains breast cancer cells. The cells and mucous combine to form a tumor. Pure mucinous ductal carcinoma tends to grow slowly, and has a better prognosis than some other types of IDCs.
Papillary carcinoma forms finger-like projections that can be seen under a microscope. Many papillary tumors are benign, but even those that become cancerous are usually very treatable with a good prognosis. Papillary carcinoma most commonly occurs in people older than 60.
Tubular ductal carcinoma is a rare diagnosis of IDC, comprising only 2% of breast cancer diagnoses. The name comes from how the cancer looks under the microscope like hundreds of tiny tubes. Tubular breast cancer has an excellent prognosis.
Where Do These Numbers Come From
The American Cancer Society relies on information from the Surveillance, Epidemiology, and End Results database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for breast cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread outside of the breast.
- Regional: The cancer has spread outside the breast to nearby structures or lymph nodes.
- Distant: The cancer has spread to distant parts of the body such as the lungs, liver or bones.
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Immunohistochemistry For Steroid Receptor Status And Cerbb
For immunohistochemistry , deparaffinized sections were immunostained with primary antibodies to estrogen receptor, progesterone receptor , and cerbB-2 oncoprotein . In negative controls, distilled water was applied as a substitute for primary antibodies. Sections were subjected to heat-induced epitope retrieval for 20 min in a citrate buffer , using a microwave and a pressure cooker. Antigens were localized using a labeled streptavidin method with 3,3-diaminobenzidine as a chromogen .
In estrogen and progesterone receptor stain, a 20% nuclear positivity rate was regarded as receptor positive . Distinct membrane staining was considered to be specific for cerbB-2 gene expression . Two positive and three positive were regarded as cerbB-2 expression positive.
M Categories For Breast Cancer
M followed by a 0 or 1 indicates whether the cancer has spread to distant organs — for example, the lungs, liver, or bones.
M0: No distant spread is found on x-rays or by physical exam.
cM0: Small numbers of cancer cells are found in blood or bone marrow , or tiny areas of cancer spread are found in lymph nodes away from the underarm, collarbone, or internal mammary areas.
M1: Cancer has spread to distant organs as seen on imaging tests or by physical exam, and/or a biopsy of one of these areas proves cancer has spread and is larger than 0.2mm.
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A Clinicopathological Study Of Early
- Jia-jian Chen ,
Contributed equally to this work with: Jia-jian Chen, Yan Wang
Affiliation Department of Breast Surgery, Fudan University Shanghai Cancer Center Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Yan Wang ,
Contributed equally to this work with: Jia-jian Chen, Yan Wang
Affiliation Department of Breast Surgery, Fudan University Shanghai Cancer Center Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Affiliation Department of Breast Surgery, Fudan University Shanghai Cancer Center Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Affiliation Department of Breast Surgery, Fudan University Shanghai Cancer Center Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Affiliation Department of Ultrasound, Fudan University Shanghai Cancer Center Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Affiliation Department of Diagnostic Radiology, Fudan University Shanghai Cancer Center Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Affiliation Department of Pathology, Fudan University Shanghai Cancer Center Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Affiliation Department of Breast Surgery, Fudan University Shanghai Cancer Center Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Inoperable Breast Cancer Is Often Still Treatable
Stage 3C breast cancer is divided into operable and inoperable stage 3C breast cancer. However, the term inoperable is not the same as untreatable.
If your physician uses the word inoperable, it may simply mean that a simple surgery at this time would not be enough to get rid of all the breast cancer that is within the breast and the tissue around the breast. There must be healthy tissue at all of the margins of the breast when it is removed. Keep in mind that the breast tissue goes beyond the breast mound it goes up to the clavicle and down to a few inches below the breast mound. There must also be tissue to close the chest wound after the surgery is performed.
Another treatment method may be used first to shrink the breast cancer as much as possible before surgery is considered.
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How Do I Prevent Bilateral Breast Cancer
Well, this disease may happen to anyone, even to people who are not exposed to the risk factors. But if you have it in your genetic history or want to take precautions against it, you can try the prevention tips I am stating below.
- Consult a doctor for breast screening and ask them to perform mammograms or other clinical breast exams to determine if anything is wrong.
- Discuss with your doctor about various breast screening process to figure out the most suitable one for yourself.
- Learn everything about self-exam so you can perform breast screening by yourself at home. If you find anything out of the book, consult your doctor immediately.
- Restrain your alcohol intake or put an end to it if possible.
- Maintain a healthy lifestyle by exercising, eating healthy foods, and live a green life.
- If you feel the necessity of going through hormonal therapy after therapy, discuss the advantage or disadvantages of it with your doctor.
- Maintain a proper weight as obesity can lead you to breast cancer.
- Eat healthy foods and superfoods that can help you to prevent harmful health conditions.