A series of tests are conducted before breast cancer surgery to gather comprehensive information about the cancer. These evaluations are important for understanding the specific characteristics of the disease and its extent. The information collected from these tests guides the medical team in planning the most effective surgical approach and ensuring the patient’s well-being throughout the treatment process. This assessment helps tailor the treatment strategy to each individual’s needs.
Confirming Diagnosis and Characterizing the Tumor
The initial phase of pre-surgical assessment focuses on confirming the presence of breast cancer and gathering detailed information about the tumor itself. Imaging tests help identify suspicious areas within the breast. Diagnostic mammograms provide detailed X-ray images, while breast ultrasounds use sound waves to create images, often distinguishing between fluid-filled cysts and solid masses. Breast MRIs, using magnetic fields and radio waves, offer detailed views of breast tissue, useful for assessing the full extent of the disease.
Once a suspicious area is identified, a biopsy is performed to obtain tissue for microscopic examination. A core needle biopsy is the most common method, using a hollow needle to extract tissue samples from the suspicious area. These samples are then sent to a pathologist, a doctor who specializes in diagnosing diseases by examining tissues and cells. The pathologist’s report provides the definitive diagnosis and crucial details about the cancer.
The pathology report outlines several important characteristics of the tumor. It specifies the type of breast cancer, such as invasive ductal carcinoma, which originates in the milk ducts, or invasive lobular carcinoma, which begins in the milk-producing glands. The report also includes the tumor grade, indicating how aggressive the cancer cells appear under a microscope, with higher grades suggesting faster growth. Additionally, the report details the receptor status, identifying whether the cancer cells have receptors for estrogen (ER), progesterone (PR), or a protein called HER2, as these factors influence treatment decisions, including the use of hormone therapy or targeted drugs.
Assessing Cancer Spread
After diagnosis and tumor characterization, tests determine if the cancer has spread beyond the breast. Evaluating the lymph nodes, particularly axillary lymph nodes in the armpit, is important. Ultrasound is often used to assess these nodes for involvement. The presence of cancer cells in the lymph nodes indicates spread and influences the surgical plan, often leading to a sentinel lymph node biopsy during surgery.
For large or aggressive tumors, or if symptoms suggest spread, systemic imaging checks for distant metastasis. A CT scan of the chest, abdomen, and pelvis can reveal if the cancer has spread to organs like the lungs or liver. A bone scan uses radioactive material to detect cancer in the bones. PET scans, using radioactive sugar, make cancer cells visible as they absorb it more actively. These tests determine the overall stage of the cancer and guide treatment decisions.
Evaluating Overall Health for Surgery
Before breast cancer surgery, a patient’s overall health is evaluated to ensure tolerance of the procedure and anesthesia. Blood tests provide insights into bodily functions. A complete blood count (CBC) assesses the levels of red blood cells, white blood cells, and platelets, which can indicate conditions like anemia or infection. Blood chemistry panels evaluate kidney and liver function, while coagulation studies measure the blood’s ability to clot properly, important for preventing excessive bleeding during surgery.
A cardiac evaluation assesses heart health. An electrocardiogram (ECG or EKG) records heart electrical activity, checking for rhythm or structure abnormalities. This ensures the heart can withstand surgery and anesthesia stress. A chest X-ray examines the lungs, ensuring they are clear and healthy for anesthesia.
Patients consult with an anesthesiologist. The anesthesiologist reviews medical history, current medications, and pre-operative test results. This discussion helps plan the safest anesthesia for surgery, addressing potential risks or concerns.
Genetic Testing and Counseling
Genetic testing is an additional consideration for many individuals diagnosed with breast cancer, as it can influence surgical decisions. This testing aims to identify inherited gene mutations, such as those in the BRCA1 and BRCA2 genes, which significantly increase an individual’s lifetime risk of developing breast cancer and other cancers. Knowing about these mutations can help predict the likelihood of future cancer development.
A positive genetic test result impacts surgical planning. For instance, a patient with a BRCA1 or BRCA2 mutation might opt for a bilateral mastectomy (removing both breasts), even if cancer is only in one. This proactive measure reduces the risk of new cancers in the unaffected breast. Results also inform decisions about risk-reducing surgeries for other cancers, such as ovarian cancer.
Genetic counselors explain genetic testing complexities and implications. They help patients understand test results, discuss risks and benefits of surgical and screening options, and provide information on potential impact on family members. This counseling ensures informed decisions tailored to their genetic profile and circumstances.