How is breast cancer diagnosed?

During the examination of the patient, the scale of the tumor (how far it has already spread, or whether it has spread) must be ascertained. Thus, the mammary region, and all the appropriate regional, axillary and supraclavicular lymph nodes must be thoroughly examined. It is important to conduct a thorough examination of both breasts as well.

In addition to a clinical examination, other special examinations are performed in the diagnosis of breast cancer.

Differential Diagnosis

One must keep in mind that not all nodules in the breast are breast cancer. Differential diagnosis is conducted against the following conditions:

  1. Fibrocystic mastopathy: the breast becomes enlarged and painful during menstruation. Following the end of menstruation, the condition improves.
  2. Galactocele: a cyst forming as a result of previous non-cancerous infections.
  3. Lipoma: the presence of a lipid based nodule in the breast which poses no risk.
  4. Chronic mastitis: as a result of chronic infection a nodule forms in the breast in the shape of a dangerous infiltrate.
  5. Tuberculosis of the mammary gland.

The performed examinations include:

  1. Mammography or a breast ultra sound are the basic routine examinations used in order to set a diagnosis. In cases of uncertainty, or lack of clarity, an additional MRI may be ordered. Both of these examinations consist in determining the presence or absence of a nodule in the breast, as well as other important characteristics, such as its size, content, and texture.
  2. Biopsy of the nodule, where tissue material is extracted from the nodule. The cells extracted are analyzed and used to determine if the nodule is cancerous. Tissue material may be extracted from the axillary nodes to check if they have been affected. In cases of serous secreting cancer, material is extracted and examined via cytology, in order to check if cancer cells can be isolated.

In certain age groups periodical mammography controls, or breast ultra sounds are recommended. For the 50 to 70 years old, these controls are recommended to be performed once a year. In even higher risk groups, they are recommended to be performed even more often.

Spreading of cancer cells

The spreading occurs in the following ways:

  1. Via lymphatic pathways. The lymph nodes circulate lymph, and through this circulatory pathway cancerous cells can pass from the breast into axillary, supra and intra clavicular, or sternal lymph nodes to any other place in the body.
  2. Hematogenous pathways. The cancer cells may travel via the blood and become implanted in various other organs, such as the lungs, liver, bones etc.

It is worth noting that in younger ages, breast cancer is manifested more aggressively that in older women. In older ages, the progress of the disease is more gradual, and can last for up to several years.

Cancers developed during pregnancy or lactation are prone to having a very malignant predisposition, usually progressing precipitously and causing a swift death. This is one of the reasons why the hormone balance is thought to heavily affect the growth of tumors. 

Medically Reviewed by a doctor on 26 Oct 2017
Medical Author: Dr. med. Diana Hysi