The importance of Breast Cancer Diagnostics

The diagnosis determines the type of treatment

Most breast tissue changes are benign and easy to treat: for example, benign breast lumps may be cysts filled with fluid or a thickening of the tissue caused by menstruation. However, any abnormal change could also be caused by a malignant cancer.

Determining exactly what kind of tumor it is (benign or malignant) is essential to selecting the best possible treatment.

 

Negative results in most cases
If your doctor has detected a lump, thickening or any other change in your breast tissue during a physical exam, he/she will refer you for a mammography or an ultrasound. The radiographic images taken during the examination will primarily identify so-called “microcalcifications”, which are tiny calcium deposits.

In the majority of women, these deposits are caused by harmless inflammation. But they can also be a marker of a growing, malignant tumor.

Additional imaging procedures are performed if there is any doubt. A tissue sample (biopsy) is taken if these images are inconclusive as well, or if a reliable diagnosis cannot be confirmed. The result of the biopsy will show whether the change in the breast tissue is benign or malignant. Innovative methods such as 3D digital mammography and 3D proton MRI spectroscopy are available to obtain additional information.
 

Benign or malignant?

The majority of breast tumors are benign – such tumors hardly change at all and do not spread. Malignant tumors, however, do change in their advanced stage.


Malignant tumors almost always develop inside the breast’s glandular tissue. So-called lobular carcinomas develop inside the glandular lobes (lobuli) and ductal carcinomas develop inside the mammary ducts (ductuli). Tumors that have not spread any further than the glandular lobes and mammary ducts are in their early stages and are also called carcinoma in situ (in situ = “in its place”). We speak of invasive (tissue-damaging) carcinoma only if it has already spread to one of the other surrounding layers of tissue or further. These types of carcinoma may spread metastases via lymph and blood vessels into lymph nodes and other organs.
 

Tumor classification provides information

There are a number of different approaches to determining how far the cancer has spread:

  • the physical examination,
  • imaging techniques,
  • biopsy and
  • surgical examination (operation for the purpose of examination).


The individual treatment plan that follows is based on the results of these procedures.

Tumors are generally classified into different stages. The most common classification method is the so-called TNM staging system. This international system uses specific categories as one globally recognized standard for classifying the extent to which the cancer has spread. A code system consisting of letters and numbers describes the following:

  • the size of the tumor (T),
  • regional lymph nodes that are involved (N) and
  • distant metastasis (M).


With this method, treating physicians receive the most important information about the spread of the cancer quickly and conclusively.

Physicians often use additional test results to supplement information from the TNM staging system: Grading of tumors provides information about their progression in terms of their abnormality compared to healthy tissue. In addition, modern molecular methods allow the identification of particular tumor-specific markers. The overall picture of the combined results makes it easier to predict the grade and severity of the disease and therefore serves as an important guideline for treating each patient individually. 
 


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