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COMMON QUESTIONS ABOUT BREAST CANCER: IF THE BIOPSY SHOWS THAT I HAVE CANCER, WHAT IS THE NEXT STEP?
After a lump is diagnosed as cancerous, your doctor may order a variety of tests to make sure the cancer has not already spread to other parts of the body. Chest X-rays, bone scans, and liver function tests may be performed. Ask you doctor how big the tumor is, and whether any lymph nodes are involved. Has the cancer spread? The doctor may tell you the rating of the tumor according to specific definitions of tumor size and degree of spread to the lymph nodes. In general, the lower the numbers, the easier the cancer will be to treat with surgery or chemotherapy.
Ask the doctor what kind of breast cancer you have and how fast this sort of tumor grows. He may tell you that the cancer is in situ, meaning that it is confined to a very small area and has not yet formed a tumor mass. In situ breast cancers are readily treated, and because of their small size, are generally detected by mammography rather than biopsy. The doctor may also use the phrase "infiltrating breast cancer," which means that cancer cells which began growing in a milk duct or lobule have grown through the membrane of that duct or lobule and are now forming a tumor in the surrounding tissues.
You should also ask if estrogen or progesterone receptors were present in the tumor, and if hormonal therapy is an option. The presence of such receptors means that there are proteins inside the cancer cells that bind the estrogen and progesterone. Once these hormones bind, the cell is stimulated to grow. These hormone-sensitive cells are easier to treat than cells that lack hormone receptors (knownas hormone-insensitive cells). If the hormone receptors are present, the doctor is likely to prescribe a hormonal therapy, such as tamoxifen, which blocks the estrogen receptor and prevents the stimulation of cell growth. Ultimately the growth of hormone-sensitive breast cancer cells is thereby retarded.
It is important that a number of other tests be performed on the tumor specimen. The pathologist looks at the primary genetic material, or DNA (deoxyribonucleic acid), of the breast cancer cells to determine if it is abnormal in appearance or quantity and to see how many cells are in the process of dividing or active growth. This determination of how aggressive (or fast growing) the tumor is helps to predict how you as a patient will fare in the long term. It may also aid the doctor in choosing the proper type of chemotherapy and indicate how well you will respond to such treatment.