Breast Cancer

Breast cancer staging is the process of checking to see how far the cancer has gone. Is the cancer just in the breast, the local area, or has it spread as far as the lymph nodes in the axilla or armpit which is the regional area? Or perhaps it has gone a stage further to give rise to secondary cancers or metastases somewhere else in the body? These are commonly known as distant metastases as they are now far away from the primary cancer in the local area.

The primary cancer in the breast is detected and confirmed by the Triple Assessment. You will also remember from the videos on pathology that it is the pathologist who says whether there is any cancer in the lymph nodes in the armpit and stages the armpit or axilla by looking at the lymph nodes under the microscope. Staging of the axillary lymph nodes by the pathologist is mandatory for all patients who have breast cancer.

secondary cancer

But how does one tell if there is any cancer in the rest of the body? How does one stage the rest of the body?

Scans
Staging of the body is accomplished by a performing a combination of scans and blood tests to look for any evidence of cancer.

The brain, the lungs and the abdomen and pelvis - which includes the liver, can be examined with a combination of x-rays, ultrasound scans, CT scans or MRI scans. If CT scanning is used and the scanner is fast enough, the whole body can be scanned at one sitting.

Checking the bones requires a completely different type of scan called a bone scan.

This scan is performed by injecting some weakly radioactive dye into a vein and then detecting the dye which is concentrated in the bones using a large camera which records radioactivity.

The radioactive dye concentrates particularly in secondary cancers or metastases and so these show up on the scan as ‘dark’ or ‘hot-spots’ in the bones.

Blood tests:
It is common for some blood tests to be performed as part of the staging process but really no blood test is capable of telling you accurately whether there is any cancer in the body or not.

However, as it is still important to check you fully, the following blood tests are commonly taken.

1.       Firstly, Full blood count - to check for anaemia

2.       Additionally an ESR –  which stands for erythrocyte sedimentation rate – a simple, inexpensive but non-specific test which can be elevated in some cases of breast cancer

3.       A Liver function test should be performed, which if abnormal could alert the surgeon to the possible presence of a secondary cancer in the liver.

4.       Serum biochemistry tests check the kidney function and calcium levels.

5.       And the tumour markers – CA15-3, CA125 – are checked. These are proteins released from some breast cancers and which are covered separately in the video on the Follow Up phase.

The Timing of Staging:
Staging can be done either after the diagnosis and before surgery or after surgery when the cancer and lymph nodes have been removed and have been sent to the pathologist for microscopic analysis.

So when will your surgeon ask for these tests to check the rest of your body?

Well, in a routine case where there is no suspicion that there is any cancer in the lymph nodes or anywhere else in the body, surgery can proceed. The pathologist then examines the lymph nodes removed at surgery under the microscope.

If the cancer has not spread to the lymph nodes then there is little chance that there are secondary cancers further on in the rest of the body, certainly of a sufficient size to show up on scans. These scans and tests are costly and so staging should only be performed if there is a real and reasonable chance of finding something. So if the lymph nodes are negative or clear of cancer it is not even logical to do the scans in the first place unless of course the cancer has some particularly aggressive features about it and the surgeon really thinks that it is wise to check everything just in case.

The other approach of course is the approach taken by many breast cancer units, which is to stage each and every patient who has been newly diagnosed with breast cancer either before or after surgery.

All patients with positive lymph nodes should as a matter of routine – undergo full staging. For if there is cancer in the lymph nodes there might be cancer further on – somewhere else in the body and it is of course essential to check for the presence of any such secondary cancers which will require prompt treatment.

During the Triple Assessment, the radiologist might see a suspicious or enlarged lymph node in the adjacent armpit and sample it. So the surgeon might then receive a report from the pathologist that confirms not only the diagnosis of the cancer in the breast, but also that there is a positive lymph node or a lymph node metastasis present in the axilla.

If the patient is suspected or known to have positive lymph nodes either by the surgeon or the radiologist prior to surgery, or it is the unit’s routine to do it at this time, staging can be performed before the surgery.

If the staging tests are clear or negative for cancer then surgery can proceed as normal.

If the staging tests do show secondary cancer in the body then chemotherapy is required NOT surgery.

Your surgeon will inform you if staging investigations are necessary and how and when they will be performed.

So let’s recap:

1.       Staging is the process of finding out how far a cancer has gone. Is it only in the breast or has it gone as far as to form a secondary cancer or metastasis in the lymph nodes in the armpit. Has it gone a stage further and now there is a secondary cancer or distant metastasis somewhere else in the body?

2.       The axillary lymph nodes are staged by the pathologist under the microscope. This is mandatory for all patients with breast cancer.

3.       The body is staged by performing a combination of scans and blood tests and these can be carried out either before or after surgery.

4.       Staging is often performed routinely

5.       But it is not always necessary to stage the body for every woman with breast cancer.

Breast Cancer

 

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