Breast pits are always cancer
Breast cancer does not cause discomfort or pain in the early stages. However, there are signs that can point to cancer and should be investigated. This does not mean that completely different, harmless causes cannot be concealed behind these symptoms, but the earlier breast cancer is discovered, the better the chances of a cure.
So if you discover one or more of the following symptoms, please consult your gynecologist:
- A lump in the chest, especially if it's painless and won't move
- Changes in the nipples such as nipple retraction, sores, watery or bloody discharge
- New changes in breast size or shape
- New skin abnormalities, for example redness, flaking, inflammation, indentations, punctiform dimples or other changes such as "orange peel"
- Swelling or hardening in the armpit
- unilateral burning pain or chest pulling
As a precaution, you should also consult your gynecologist about other changes that you notice in your breast.
The most important examination to clarify a suspected cancer is still the X-ray mammography. The ultrasound examination (breast sonography) provides additional information. In young women with dense breast tissue, it even comes before the mammography and can even make it superfluous if the result is clearly benign.
The significance of the breast ultrasound depends crucially on the experience of the doctor and the quality of the device used. We therefore carry out this examination with our radiology colleagues who specialize in breast ultrasound and are equipped with particularly high-resolution ultrasound devices.
If an X-ray mammography cannot be carried out or if it does not produce clear results, a magnetic resonance mammography is also carried out today. If the imaging tests confirm the suspicion of cancer, only the targeted removal of small tissue samples from the suspect area provides final certainty. In addition to the classic punch biopsy, we also offer the stereotactic vacuum biopsy in our breast center. A computer evaluates the recordings and guides the biopsy needle directly to the suspect area. The tissue is then sucked in by a vacuum through a side opening of the needle, separated and transported to the outside. Several samples can be taken with one puncture.
Smaller findings can possibly even be completely removed in this way. Our pathologists examine the tissue obtained in the biopsy for changes under the microscope and carry out special biochemical and molecular biological tests to uncover malignant cells.
Important: We do everything we can to provide you with certainty as quickly as possible and to remove an unfounded suspicion of cancer. However, the fine tissue examinations in particular require some time. But that is by no means a reason to panic! Because even if you actually have breast cancer, this diagnosis does not mean a medical emergency that needs to be treated immediately!
Only if the suspicion of cancer is confirmed in the tissue diagnosis, further examinations are added in order to determine the tumor stage and to be able to better assess the spread of the tumor. We speak of so-called staging (staging). We will first ask you more about any complaints, including those outside the chest, and feel your lymph nodes in the armpit area, in the area of the collarbone and on the sternum. In the case of smaller tumors (T1 or T2), no further examinations are usually required. If it is unclear whether the tumor has already spread beyond the breast, we check this, for example, with x-rays of the lungs and chest, an ultrasound examination of the liver and a bone scintigraphy. In order to find out whether the tumor has spread via the lymphatic system, we take the so-called sentinel lymph nodes for a tissue examination if necessary. If a larger tumor is suspected of having spread daughter tumors (metastases) in the main target organs, the lungs, liver and skeleton, we carry out a chest x-ray, an ultrasound examination of the liver and a bone scintigraphy.
All the results together help us to find and pursue the best treatment strategy for you together with you.
After completing the staging examination, the breast cancer is assigned to a specific stage using the so-called TNM system. After the operation, this assignment is checked according to the pTNM system: The preceding letter "p" indicates that the finding is based on the examination of the tissue removed during the operation. The individual letters stand for the tumor size (T), the lymph node status (N) and the absence or presence of metastases (M), “is” stands for “in situ”, a locally limited tumor.
- Tis: carcinoma in situ
- T1mic: a maximum of 0.1 cm ingrown tumor (microinvasion)
- T1: tumor less than two centimeters in size
- T2: tumor between two and five centimeters
- T3: tumor larger than five centimeters
- T4: tumor grown into the chest wall or skin
- N0: no lymph node involvement, cN0: palpation and ultrasound findings
- pN0: histologically confirmed findings, pN0 (sn): no involvement of the sentinel lymph node
- N1-N3: Number of adjacent lymph nodes that were also affected in three groups
- M0: No daughter tumors in other organs
- M1: Daughter tumors present in other organs
The classification of the International Association against Cancer (UICC) groups the TNM stages into new stages, these findings may also appear in your records:
- UICC 0: in situ carcinoma, N0M0 = DCIS
- UICC I: T1N0M0
- UICC IIa: T2N0M0 or T0-1N1M0
- UICC IIb: T2N1M0 or T3N0M0
- UICC IIIa: T0-2N2M0 or T3N1M0
- UICC IIIb: T4N0-2M0
- UICC IIIc: T1-4N3M0
- UICC IV: T1-4N1-3M1
In addition to the tumor stage, so-called grading and the content of certain tissue receptors are important for the selection of treatment methods and the prognosis of the disease. The term grading describes how much the cancer cells differ in appearance and growth from healthy mammary gland cells. The speed at which the tumor cells divide and the deviation of the tumor cells and the milk ducts in the tumor from normal glandular tissue are taken into account. The more aggressively the tumor grows, the higher the grading: "G1" means that the tumor cells are still largely similar to healthy cells and only divide slowly. In “G3” they deviate most from their original shape and divide very quickly. The Ki-67 antigen, which the pathologist also displays by staining the tissue, also provides information about the growth of the tumor cells.
Since breast cancer grows in many women depending on sex hormones, the disease can often be treated with so-called anti-hormone therapy. To find out whether this makes sense in your case, the hormone sensitivity is tested on the biopsy samples if possible. The pathologists examine the removed tissue for special hormone receptors to which the hormones "dock" to the tumor cells. Estrogen receptors are abbreviated to ER (“estrogen receptor”) and progesterone receptors to PR. If the tumor tissue turns out to be hormone-sensitive (ER + or PR +), we will usually recommend anti-hormone therapy. In contrast, this form of therapy would be useless in the case of an "ER- / PR-" finding.
Another important test that is done on the biopsy specimens is HER2 receptor status. "HER2" stands for "Human Epidermal Growth Factor 2". It drives the cancer cells to multiply. The more receptors for this growth factor there are on the tumor cells, the faster they divide and multiply. This is an important indication of a possibly particularly aggressive disease - but at the same time an additional starting point for therapy, because HER2 receptors can be specifically blocked with antibodies. Therefore the question of whether the cells are HER2-positive or not is very important for the subsequent therapy.
A tumor is considered HER2-positive if the immunohistochemistry (IHC) test is triple positive (HER2 +++ / 3+). In this case we recommend antibody therapy. If the result is weakly positive (HER2 ++ / 2+), further examinations, possibly after the operation, are necessary in order to arrive at a meaningful result. In the case of a negative (HER2 + / 1 +) result, antibody therapy directed against HER2 would be ineffective, as there are hardly any receptors on the tumor cells.
We will discuss with you on a case-by-case basis whether further examinations such as the determination of the proteins uPA and PAI-1 on the biopsy samples would make sense. Usually, if at all, these tests are performed on fresh tumor tissue after the operation to assess the risk of relapse. In certain cases, gene expression profiles or multi-gene tests can be helpful in assessing the risk and deciding for or against chemotherapy. We will also decide on this in a joint discussion with you.
As you can see from these diverse examinations and possible findings, there are very many different forms and forms of breast cancer! Medical progress allows an ever more precise analysis of the individual illness and thus an ever more individual, targeted therapy. The result is an ever greater chance of survival with fewer and fewer side effects. At the same time, the demands on the treating doctors and clinics are increasing to keep pace with scientific developments and always provide their patients with the best possible therapy. At the Albertinen Breast Center, we are heavily involved in clinical studies for the further development of breast cancer therapy. For you, this means that you can benefit from new therapy methods at an early stage if it makes sense for you.
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