Diagnosing Breast Cancer: Evaluating the Tumor

The evaluation of the tissue removed by biopsy or surgery is a key determinant of prognosis and the breast cancer treatment your oncologist advises. It is therefore important that the breast tissue is evaluated by a pathologist knowledgeable in the field of breast cancer.

The pathologist performs a detailed analysis of breast cancer tissue to:

Determine the type of cancer cells and whether the cancer is the cancer is in situ (noninvasive) or invasive.
Determine the size of the cancer.
Determine microscopic and hormonal characteristics of the cells.
Help predict how the cancer is likely to behave.
Help guide the choice of therapy that is most likely to provide the desired outcome. The analysis of the cancer cells can help direct physicians to select specific treatments that have a higher probability of being effective.
Determine whether the surgical removal of the breast lump was complete; or whether a so called re-excision (re-removal) is indicated. The pathologist can do this by evaluating the margins of the removed lump for the presence or absence of cancer cells. If removal is incomplete, re-excision and removal of additional breast tissue is indicated.

Spread beyond the breast?
Evaluation of the breast tissue specimen by the pathologist to see if cancer cells have invaded any tiny blood or lymphatic vessels is especially important. The presence or absence of invasion helps predict if the cancer has spread beyond the breast.

Cancer cells have the potential to leave the breast (egress) by traveling inside the linings of small lymphatic channels or blood vessels. The pathologist will determine whether this has happened. Some experts feel that if there is the presence of cancer cells within the the channel (lumen) of a blood vessel or lymphatic channel, there is a greater chance that cancer spread may have occurred.

Your doctor may recommend sampling of the lymph nodes in the axilla (the area under the arm pit) on the side where the breast cancer was found. The recommendation might be made at the time of your biopsy or shortly thereafter. If the lymph nodes are able to be felt by the doctor (palpated or palpable) there will definitely be an examination to determine whether these tissues contain cancer.

Sampling of the lymph nodes is done to help determine whether the cancer cells have escaped from the breast. The lymph system is one of the body's first defenses in trying to keep the cancer contained. The lymph nodes act like small filters that trap and in some instances neutralize cancer cells.

Your treatment program and outlook is affected by the presence of absence of cancer cells in one or more of the axillary lymph nodes.

Next >> Tumor Staging and Tumor Margins

In This Article:
Diagnosing Breast Cancer
Tumor Staging and Tumor Margins
Invasive Cancer Grading
Receptors: Estrogen, Progesterone & HER2/neu

From the Harvard Health Publications Special Health Report, Breast Cancer: Strategies for Living. Copyright 2004 by the President and Fellows of Harvard College. Illustrations by Harriet Greenfield, M.A., and Jesse Tarantino. All rights reserved. Used with permission of StayWell. Harvard Medical School does not endorse products.
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