Breast Cancer Diagnosis
In the majority of cases, breast cancer at early stages is asymptomatic. In the early diagnosis of breast cancer, a manual breast examination and mammography play key roles in identifying unusual signs of the breast tissue.
If the results of preliminary tests mark a suspicious presence of a malignant tumor, the patient is required to undergo an in-depth diagnosis.
Diagnosis of breast cancer is conducted at the private hospital of Herzliya Medical Center at the Mammary Gland Health Center, which is equipped with the latest equipment. The necessary procedures are carried out as soon as possible, and research results are ready within 48 hours.
Diagnosis of Breast Cancer
Mammography forms a central role in screening and diagnosis of breast cancer. Diagnostic mammograms - diagnostic mammography differs from a screening mammography - diagnostic mammography requires more X-ray scans. A suspicious area can be examined in multi-view and high magnification, to give an outlook on the nature of the detected changes. If the test results indicate the presence of benign tumors in the breast, the patient is asked to undergo another mammogram in 4-6 months. X-rays of possible malignant tumors require a biopsy for conformational diagnosis.
Breast ultrasound – ultrasound (US) allows the specialist to explore the breast tissue, which has a high density (for example, in young patients), and to differentiate solid from cystic neoplasms. At the same time, US is a less informative test, (compared with mammography), and it cannot be considered a complete test. Most often, breast ultrasound is assigned in addition to mammography, not instead of it.
Breast MRI - the advantage of MRI compared to mammography is the lack of X-ray irradiation. Indications for MRI of the breast:
- In-depth investigation of suspicious areas on a mammogram detected
- Accurate assessment of the size and location of the (diagnosed) cancer
Galactography (galactogram) or ductography (ductogram) - x-ray technique to visualize the ducts, allowing to examine the presence of discharge from the nipple and visualizing possible tumors of the breast ducts, called ductal carcinoma. A small amount of contrast agent is inserted into the (discharging) duct of the breast, using a cannula (thin tube). This technique precedes a mammogram.
A biopsy is the process of obtaining biological material - a sample of tissue from a suspicious area. The tissue sample is subjected to histological examination in a laboratory. Most biopsies are conducted to determine malignancies – but can also be used to identify other non-cancer related conditions. Numerous types of biopsy procedures exist, biopsies include minimally invasive and surgical techniques.
All biopsy procedures at Herzliya Medical Center are performed under local anesthesia. If in the histopathology sample cancer cells are detected, the diagnosis of breast cancer considered definitively confirmed. Sometimes at the site of the biopsy, the doctor may leave a small metal tag. It is located deep in the breast tissue and is not determined by feel. This label is distinguishable on mammography and can be used in the future as a guide if the patient required surgical treatment of breast cancer.
Sentinel Node Biopsy in Breast Cancer
This procedure is used to detect cancer cells in the lymphatic system. Using radioactive contrast agent to mark lymph nodes under the arm. During a surgical procedure, the nodes 1-3 are removed and sent for a pathological analysis. The method determines whether cancer has spread beyond its origin, as well as cancer staging, the oncologist may appoint a more accurate and effective treatment plan.
The Classification of Breast Cancer
During the histological analysis of tissue removed during a biopsy, the type of tumor is determined. Breast cancer is divided into invasive and non-invasive (in situ), lobular and ductal carcinoma. In addition, there are more rare forms of breast cancer: Inflammatory, medullary, colloid (Mucinous) and other. The histological tumor type is important for determining a patient’s prognosis and treatment plan.
Grading of cancer determines the size and location of a tumor, as well as whether or not it has spread. The degree of a malignancy is determined within histopathological analysis. The higher the grade the more aggressive cancer growth and the poorer the prognosis of its treatment. For invasive and non-invasive forms of cancer different evaluation system grading is used.
In addition, differentiation describes how the tumor cells compare to normal healthy cells, well differentiated cancer cells resemble normal cells, and are slower growing (low grade), conversely poorly differentiated cells do not resemble healthy cells and grow at a faster rate (high grade).
Hormone Receptor Status
Breast cancer cells contain receptors (proteins) displayed on and within, this indicates the cancer cells are responsive to the hormones estrogen and/ or progesterone. Such tumors are called hormone-dependent and tend to grow quickly
Hormone-dependent tumors are referred to as ER+ (estrogen receptor positive) and PR+ (progesterone receptor positive). These types of tumors respond more effectively to hormone therapy treatment than non-hormone dependent tumors.
About 20% of malignant breast tumors contain cells that synthesize large quantities of the protein human epidermal growth factor receptor 2 (HER2). This protein has been actively involved in the process of tumor cell growths; its more intense synthesis is caused by amplification of the HER2/neu gene.
Tumors that are HER2/neu positive tumors are characterized by rapid, aggressive growth. Currently, targeted drugs have been developed, which identify HER2 / neu - positive cells and destroy them.
Following a biopsy or surgical mastectomy / lumpectomy, estrogen receptor and / or progesterone, and HER2/neu status (positive or negative) are determined.
In recent years, a system classification of tumors has become popular, based on molecular characteristics. There are 4 molecular subtypes of breast tumors:
- Luminal A: ER+, low-grade
- Luminal B: ER+, a high grade
- HER2: ER-, PR-, HER2+
- Basal-like/ Triple negative: ER-, PR-, HER2/neu -
Aggressive growth and resistance to hormonal and targeted therapy characterize tumors of the basal subtype.
The Mammary Gland Health Center
Herzliya Medical Center has a special division of the health of the breast, which performs imaging diagnosis, biopsy and pathologic analysis of tumors, breast surgeon consultation and services, as well as providing moral and psychological support to patients diagnosed with breast cancer. The best specialists of the country work together, creating individualized treatment plans and monitoring treatment of each patient. All the necessary procedures and consultations are carried out as soon as possible.