Evaluating The Tumor Spread Beyond The Breast - Making The Diagnosis: Breast Cancer

Content provided by the Faculty of the Harvard Medical School

Evaluating the tumor: 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.

While the most common lymph nodes that are involved with breast cancer are generally located under the arm pit or axilla, other sets of lymph nodes can be affected, These are located both above and below the collar bone and along the central portion of the chest, very close to the ribs. These lymph nodes may be sampled as well. Involvement of these lymph nodes may be associated with a poorer prognosis compared to breast cancers that involve only the axillary lymph nodes.

Your oncologist will use the pathologist's report of the breast tissue and lymph node samples in designing a treatment plan and to offer a general prognosis. The multiple components of the detailed pathology evaluation help predict whether the cancer has already metastasized or is likely to metastasize in the future. There is no single characteristic that alone determines prognosis and guides therapy. Rather a group of characteristics, taken collectively, is used to predict the potential of the cancer's spread to other areas of the body.

The pathology results often are not enough. You may require some x ray studies such as a CT scan of the abdomen and pelvis and chest, a bone scan, and on occasion, a CT scan or MRI of the head and brain. These studies will help determine whether the cancer has advanced beyond the breast and lymph node area of the breast.

Last updated:	April 23, 2007