Breast Cancer Symptoms and Treatment – A DIAGNOSTIC JOURNEY Through Questions

Receiving a Breast Cancer Diagnosis: The Initial Shock!

After a breast cancer diagnosis, patients and families feel sad and bewildered. They also feel anger at their bad luck and fate, often expressing it as “I am stunned; my feelings are all mixed up.” Friends are contacted first, and a known, trusted doctor, if available, is asked what course to follow.

Let us examine together what should be done in such a complex situation that could happen to any of us at any time.

I believe this article will guide many newly diagnosed breast cancer patients and families and hope you share it with friends.

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Is It a Breast Cancer Symptom? What Should I Do?

Breast tissue naturally contains many benign cysts and nodular structures. If you encounter this, first stand before a mirror and look for breast symmetry, skin changes, bloody nipple discharge with gentle touching, indentations or bulges, and nipple retraction. Looking without panic, you can readily notice these potentially breast-cancer-related signs. If none are present, first breathe a sigh of relief.

However, breast cancers, particularly early-stage ones, may occur without these signs. If the nodule you felt is new or a known nodule is growing, you must consult a doctor experienced in breast cancer. .

I Found a Suspicious Breast Lump or Nodule. Which Doctor Should I See?

KETEM centers are among the easiest services to access: a Ministry of Health organization of dedicated, caring physicians. The doctor will examine you and arrange breast ultrasound, mammography if necessary, and even breast MRI.

Among breast cancer imaging methods, ultrasonography - USG is one of the simplest, but is not sufficient alone. If suspicion remains after examination, your doctor will request mammography. Mammographymay not adequately show breast interiors in premenopausal women, particularly under 40, because of breast density. If suspicion persists after ultrasound and mammography, breast MRI - MR must be performed. Breast MRI is over %90 accurate in identifying problems. Of course, none of these methods definitively establishes whether a suspicious lesion is cancer; biopsy is essential if the probability is high.

Besides KETEM, medical faculties, training and research hospitals, private hospital breast cancer clinics and specialist breast physicians can help. Choose by investigating whether the center has a competent breast cancer team. Remember that diagnostic and treatment success results from multiple physicians working harmoniously.

A Suspicious Breast Mass Was Found and Biopsy Recommended. Which Method Should Be Used?

Choosing the method is very important. The right method guides treatment strategies from diagnosis onward and prevents wasted time. Inappropriate methods can waste time and limit surgical choices.

Different breast biopsy methods exist: fine-needle biopsy, core-needle (trucut) biopsy, vacuum biopsy, excisional biopsy—removing the suspicious nodule through local surgery—and wire-localized excisional biopsy.

Of these methods, the most appropriate is trucut , the core-needle biopsy. It obtains more tumor tissue than fine-needle biopsy and allows identification of breast cancer type and biological behavior.

Fine-needle biopsy and direct surgical removal without a specific reason are among the least desirable methods. Fine-needle biopsy generally yields too little tumor material to determine cancer type and characteristics.

After sufficient tissue is obtained and cancer diagnosed, additional stains identify the breast cancer type. Identifying it immediately after biopsy saves time and guides the priority of subsequent treatments.

Except in special circumstances (patients unable to undergo core-needle biopsy), directly removing a suspicious mass through local surgery is inappropriate. This early operation is unplanned and can cosmetically impair subsequent surgical planning. It also makes minimal surgery and axillary lymph node sampling more difficult in early-stage breast cancer.

Unnecessary complete mass removal (excisional biopsy) can affect subsequent imaging methods (for example, PET-CT) and prevent correct decisions.

Unfortunately, this is a common practice. If surgery is proposed for diagnosis, patients should fully ask and understand the reasons. A second medical opinion may be very important and informative in such cases.

I Had a Breast Biopsy and Was Diagnosed with Cancer. What Should I Ask My Doctor?

A patient bringing a pathology report after breast biopsy should ask two appropriate questions:

First, what type is my breast cancer? Second, what stage is it, and how extensively has it spread in my breast and body?

Breast cancer classifications are complex. Discussing four different types understandable to patients is clearest. Knowing subtypes matters for future disease course and treatment options. Not every woman’s breast cancer has the same type and stage. Newly diagnosed patients should therefore not compare themselves with others or draw positive or negative conclusions. Such comparisons may lead to mistaken judgments. Ranking types from the mildest, most manageable medically, to the most aggressive may help understanding.

1. The first is hormone-sensitive, or hormone-positive breast cancer, which biologically benefits, compared with other types, from hormonal drugs. Chemotherapy may not even be necessary if tumor size is small and its genetic structure is low-risk.
2. The second group is less sensitive to hormonal treatment . In this type, hormone receptors may be weakly positive, alongside other adverse and genetic factors.
3. The third type is positive on the targeted-drug test, meaning the tumor receptor called Her2 or Cerb B2 is positive. Chemotherapy and a targeted drug containing trastuzumab are used even when the tumor is very small.
4. The fourth type is triple-negative breast cancer, lacking hormonal and targeted-drug markers, meaning these treatments (hormonal treatment and targeted trastuzumab) do not work. Triple-negative cancers benefit more from chemotherapy than other types, and preventive chemotherapy is preferred even at very early stages with very small tumors. It is more aggressive than other types.

Determining breast cancer type and tumor stage are among the most important steps after biopsy.

How Is Breast Cancer Type Determined?

A pathologist applies special immunohistochemical stains to core-needle biopsy tissue. Hormone receptors (estrogen and progesterone receptors), targeted-drug receptor (Her2), Ki 67 and Grade staining tests readily identify the cancer’s characteristics. These special stains generally take 3-5 days to complete.

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The Biopsy Is Done and Cancer Type Identified. What Should I Ask and Know Next?

The next issue is disease extent, meaning breast cancer stage or degree of tumor spread. Imaging should address its spread and size within the breast, whether it arises from one or multiple foci, whether axillary lymph node metastases exist, whether the opposite breast contains another cancer focus, and whether other organs (bone, liver, lung, etc.) are involved.

A biopsied patient already has some tests partly guiding assessment of spread, often breast ultrasound and mammography. The doctor should examine the patient and record findings, assessing tumor size, breast skin, nipple and axillary nodes. Findings are reviewed alongside any ultrasound and mammography to form an impression of disease extent.

In very early breast cancer, the mass is limited to 1-2 cm and axillary lymph nodes cannot be detected on examination.

With a small hormone-sensitive tumor and no suspicious examination or blood-test findings, we may use simple tests to assess extent without requesting PET-tomography.

However, if the patient is young (particularly under 40), MRI greatly helps identify disease within the breast and assess the other breast. Especially in young women undergoing breast-conserving surgery, breast MRI is more valuable than PET-tomography. Because low-hormone-sensitivity, targeted-drug-test (Her2 receptor)-positive and triple-negative cancers are more aggressive, these groups are more likely to have axillary lymph node metastasis .

Moreover, as tumor size increases in these cancers, spread to other organs (bone, liver, lung) may occur alongside axillary involvement. PET-tomography should be recommended to assess disease extent.

At this stage, tumor stage—extent of spread—and cancer type have been determined. The next step is planning the correct treatment sequence!