Breast cancer is cancer that is found in the cells of the breast. It is reassuring to note that most of these breast abnormalities are benign (non-cancerous), and require only monitoring. When an abnormality is found to be breast cancer (malignancy), our doctors will take a multidisciplinary approach to include pathologists, radiologists, radiation therapists, and oncologists. The complexity of diagnosing and treating breast cancer requires that all physicians work together to create a unique plan tailored to each patient’s individual situation and desires. It is important to note that while most commonly found in women, breast cancer can affect men as well.
Breast abnormalities can first be discovered either through physical examination, or through radiological testing such as mammogram or ultrasound.
A breast lump may be found by the patient on his or her own through breast self-exam or through a physical examination by a physician. In either case, further diagnostic testing will most likely follow this initial finding. The patient will be instructed to have a mammogram or ultrasound (or rarely, MRI) of the affected breast, as well as to visit a surgeon for consultation or biopsy.
If the lump is found as a palpable mass, your surgeon may begin by aspirating the mass to either collapse it if it is a cyst (a fluid-filled sac), or to obtain cells if it is solid, to send to pathology for further evaluation. Your surgeon may also decide to perform a core needle biopsy, a biopsy using a larger needle for a larger tissue sampling. Based on the pathological findings, your surgeon may decide to repeat radiological testing, or perform an open biopsy under local anesthesia and sedation.
If a breast abnormality is found radiologically, sometimes an abnormality can be conclusively determined to be non-cancerous due to its specific radiologic distinctions. Other abnormalities may be determined to be suspicious for cancer or undetermined, and will require further testing. This additional testing includes core biopsy, stereotactic biopsy (core biopsy with mammographic guidance), or open biopsy under sedation and local anesthesia. Your surgeon and radiologist will determine which technique is best suited to your situation.
Pathology findings will show the lump is either benign, a non-invasive cancer or an invasive cancer.
Most breast abnormalities are determined to be benign. The most common types of benign lesions include fibrocystic changes, simple cysts, fibroadenomas, intraductal papillomas, or traumatic fat necrosis due to injury.
Non-invasive tumors are cancerous and while they can spread in the breast through the ductal system, they do not travel through lymph channels or the blood stream. This means that these cancerous cells can spread through the breast through the milk ducts, but are unlikely to invade the rest of the body. The two most common types of non-invasive breast cancer are Ductal Carcinoma In Situ (DCIS) and Lobular Carcinoma In Situ (LCIS)—a type of cancer associated with future increased risk of breast cancer.
Invasive tumors are cancers that can spread to the lymph nodes or through the bloodstream. In treating patients with these types of tumors, treatment is not limited to the breast. Attention is necessary to the body as a whole, to prevent or treat any spread of cancer.
Treatment of breast cancer depends on a number of factors including type and size of tumor, whether the cancer is invasive, and patient preference. There are basically two approaches: breast conservation and oncoplastic surgery, which involves removing the cancerous area and slightly beyond it, as well as radiation therapy or a total mastectomy which is complete removal of the affected breast without the need for additional radiation.
Breast conservation therapy may not be appropriate in all cases, for example, in cases where there are multiple areas of cancer, where there is a very large tumor, where the patient has very small breasts, where there has been previous radiation therapy to the breast, or simply the patient has a preference for total mastectomy.
Some women may choose total mastectomy due to fear or the inconvenience of radiation, for cost considerations, or for personal reasons. Oftentimes, women who choose mastectomy opt for reconstructive breast surgery which involves the use of implants. Women often consult with a reconstructive surgeon prior to the mastectomy in order to have both procedures scheduled together.
When dealing with invasive breast cancer, your doctor will need to determine if the lymph nodes in the armpit (axilla) contain breast cancer cells. This may be done using a newer technique called sentinel lymph node biopsy. This technique reduces the incidence of complications to the patient. A combination of radioactive material and blue dye is injected prior to the surgery to allow your surgeon to view which lymph node(s) catch material coming from the breast, including cancer cells. If these cells are found to be clear of cancer, it is rather certain that the others do not as well.
If there is a finding of cancerous cells in these lymph nodes, your surgeon will want to remove them to prevent these cells from invading surrounding tissues. Additionally, if the lymph nodes have indeed been affected, chemotherapy is typically recommended to help reduce the chance of metastases.
Even if cancer is not found in the lymph nodes, your oncologist my advise chemotherapy, or other additional treatments including hormone treatments. Factors involved in this decision include tumor size, grade, and location, the patient’s estrogen, progesterone, and Her2Neu receptor status, as well as the her menopausal status and overall health.
Most breast abnormalities are determined to be non-cancerous. If you are facing a breast cancer diagnosis, it is important to note that breast cancer is a highly treatable disease, and that most women diagnosed with breast cancer are long-term survivors. Additionally, survival rates continue to rise each year. We have very good treatments and surgical techniques to treat breast cancer; these approached will be tailored for your individual case by our team of physicians. You may schedule your initial consultation with Progressive Surgical Associates’ Laura Ragauskaite, M.D., who also serves as Medical Director of The Breast Center at Silver Cross Hospital, by calling our office at (815) 717-8730.
Progressive Surgical Associates’ general surgeon Laura Ragauskaite, M.D., F.A.C.S. also serves as Medical Director for The Breast Center at Silver Cross Hospital, providing surgical services in the treatment of breast diseases and cancer. Here she works as part of an interdisciplinary team to provide holistic care for breast patients.