Staging
The initial reaction to being diagnosed with breast cancer is one filled with fear. Fear of dying, fear of loss of your hair, fear of loss of your breasts and the fear that you have lost control of your life. Knowledge is how you release fear and regain your power.
Once your cancer has been proven by a biopsy, you may go through a series of tests that are meant to define the extent of the breast cancer and help to tailor your treatment plan. The initial tests are called a metastatic survey and are intended to prove that the cancer is only in your breast and nowhere else in your body. This process is important in allowing you to let one of the" black clouds" that hang over you to float away once it is determined that the tumor has not spread beyond your breast.
Your doctors will determine which of the following tests you will receive. If one or more are not ordered for you, that may be due to information about your tumor that your doctor is using to specialize your treatment plan. He or she may not feel a particular test is necessary. (Non-invasive cancers do not require many tests befoe surgery, where as some invasive cancers require many tests) Do not be afraid to ask your doctor specific questions about your diagnosis or treatment plan. If your doctor is unwilling to answer your questions, then you may want to find a physician team that is willing to partner with you.
Bone scan- A radioactive tracer is injected into your body and allowed to circulate for several hours. The whole body is then imaged and the scans are interpreted by the radiologist. Areas of previous trauma to the bones, arthritis and degenerative changes are often found, so do not panic if you see black spots in the films. The kidneys also light up on the scan. Additional plain x-ray films or an MRI may be needed to determine the cause of the tracer uptake.
Chest x-ray- CXR is a two view regular x-ray of yourchest cavity looking for lung nodules and abnormal shadows in your chest. If something is not normal in the study, often times a CT (Comuterized Axial Tomography) scan of the chest is required.
Liver function tests-A blood test that is a screening study for abnormalities of the liver. If the liver functions are elevated, a CT scan of the abdomen may be indicated.
PET scan-Positron emission tomography uses glucose (sugar) that is tagged or so called labeled with a radioactive substance to identify areas of the body that have a love ( or affinity) for glucose. Since cancers are fast dividing cells, they tend to take up glucose very rapidly and therefore this test can potentially identify regions of the body that have fast dividing cells. A positive finding on this type of scan may prompt a further study.
CAT scan- Computerized axial tomography is a study that is performed with or without an injection of contrast (be certain to tell the technologist if you are allergic to iodine or shell fish). It evaluates the body for areas of abnormal growth and compares the normal tissue to what may appear abnormal.
Pet–CT- A PET CT scan that is the combination scan of the PET and the CT that utilizes the best of both imaging techniques and allows specific organ systems to be viewed with more precision then either technology alone.
Breast MRI-Magnetic resonance imaging uses powerful magnetic fields to create images that allow for the evaluation of the breasts and to look for the extent of the cancer and to look for second cancers in the same breast and abnormal areas in the other breast. There are many arguments for and against the routine use if breast MRI in the pre-op evaluation of breast cancer patients.
MRI of specific body regions- An MRI may be ordered of the spine, hip, liver etc to determine if a finding on another study is real of represents a normal finding.
The scans that we use to look for disease outside of the breast are highly sensitive and sometime pick up findings that are not cancer but normal variations found in the body. Our goal is not to create more tests and more fear, but to make certain that if cancer has spread outside of the breast at diagnosis, that we are aware of its presence and treat it appropriately
