Cancer Information

Breast cancer - Diagnosis and Treatment 


Breast self-examination (BSE): Breast self examination is an effective way to determine early breast cancer. Survival at 5 years was 75% in women performing BSE and 57% in non-performers.

Mammograms- Mammography is a useful adjunctive diagnostic measure when used in patients with clinically suspicious or high-risk breasts. About 25% of breast cancers diagnosed in mass screening programs are detected by mammography alone. A negative mammogram in a patient with a  palpable mass should not dissuade a biopsy or an fine needle aspiration cytology (FNAC) or biopsy.

Breast ultrasound can rapidly and accurately determine if a mass is a simple cyst.  If so, it is benign and no further work up is necessary.

Biopsy: Biopsy is done to provide cells or tissue in order to establish a definitive diagnosis.  Biopsy can be done in several different ways:

  • Needle-directed (guide wire directed) excisional biopsy 

  • Core needle biopsy 

  • Fine needle aspiration 

Treatment for Breast Cancer

Four types of standard treatment are used:


Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells. Type of surgery depends on the stage of the disease and type of tumor.

Lumpectomy: A surgical procedure to remove a tumor (lump) and a small amount of normal tissue around it.

Partial mastectomy: A surgical procedure to remove the part of the breast that contains cancer and some normal tissue around it. This procedure is also called a segmental mastectomy. Patients who are treated with breast-conserving surgery may also have some of the lymph nodes under the arm removed for biopsy.

Total mastectomy: A surgical procedure to remove the whole breast that contains cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.

Modified radical mastectomy: A surgical procedure to remove the whole breast that contains cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.

Radical mastectomy: A surgical procedure to remove the breast that contains cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.

Even if the doctor removes all of the cancer that can be seen at the time of surgery, the patient may be given radiation therapy, chemotherapy, or hormone therapy after surgery to try to kill any cancer cells that may be left. Treatment given after surgery to increase the chances of a cure is called adjuvant therapy.

If a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild a breast?s shape after a mastectomy) may be considered. Breast reconstruction may be done at the time of the mastectomy or at a future time. 

Radiation therapy-

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.


Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. The way the chemotherapy is given depends on the type and stage of the cancer being treated. Mostly chemotherapeutic drugs are given in cycles either alone or in combinations. Some of the common chemotherapeutic drugs include -

Chemotherapy combinations for non-metastatic breast cancer

  • AC T - Adriamycin (chemical name: doxorubicin) with cyclophosphamide (brand name: Cytoxan), with or without Taxol (chemical name: paclitaxel)

  • CMF - cyclophosphamide, methotrexate, and fluorouracil ("5-FU" or 5-fluorouracil)

  • CAF - cyclophosphamide, Adriamycin, and fluorouracil ("5-FU" or 5-fluorouracil)

  • CEF - cyclophosphamide, Epirubicin (similar to Adriamycin), and fluorouracil ("5-FU" or 5-fluorouracil)

  • FAC - fluorouracil ("5-FU" or 5-fluorouracil), Adriamycin, and cyclophosphamide.

All the drugs used for chemotherapy have varying degree of unpleasant side effects.

Hormone therapy  (adjuvant therapy) 

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working. Hormone therapy with tamoxifen is often given to patients with early stages of breast cancer and those with metastatic breast cancer (cancer that has spread to other parts of the body). Hormone therapy with tamoxifen (selective estrogen receptor modulating drug) is most common. Anastrozole (Arimidex), letrozole (Femara), exemestane  (Aromasin)  are aromatase inhibitors which can be used for treatment of homone receptor positive breast cancer specially in post menopausal women . Fulvestrant (Faslodex) an Estrogen receptor downregulators(ERDs) was recently approved by FDA for treatment of breast cancer. Women taking tamoxifen should have a pelvic examination every year to look for any signs of cancer. Any vaginal bleeding, other than menstrual bleeding, should be reported to a doctor as soon as possible.

Immune therapy - Trastuzumabis (Herceptin ) is the only immune treatment currently available for breast cancer. Herceptin works only against breast cancers that make too much of the HER2/neu, or HER2, protein. These cancers are called "HER2 positive." About one out of every four breast cancers is HER2 positive. It is considered an immune treatment because it helps the immune system fight the cancer.

A combination of different therapies is often used for treating breast cancer. For example - Surgery may combined with radiotherapy and chemotherapy or hormone therapy