Breast Cancer

Lesson 2: Diagnosis, Tests & Staging

Biopsies

Biopsies have gotten a bad rap over the years. When your doctor suggests a biopsy, it does not necessarily mean that you have cancer. If you do have cancer, it is vital that you and your medical team know how large the tumor is, where it is and if and where it has spread. A biopsy is a surgical procedure where they take out a piece of tissue, or a section of a cyst, or an entire lump or cluster of cells, to be sent to the pathologist for further analysis via staining, microscopic examination and a slew of other scientific screening tests.

Many a pesky, benign cyst has been found on biopsy. Biopsies are not extremely painful and for the most part, are outpatient procedures, or surgeries. Please remember that the pain levels cited are my own opinion. I am neither a martyr nor a total wimp. http://www.bccancer.bc.ca/PPI/TypesofCan...

Fine needle biopsy – They dab some anesthetic on the area of the breast to be biopsied, and then insert a very fine needle into the breast. The surgeon removes the needle, deposits the cells on a slide and that’s it. The doctor can’t tell anything at this point. The slide has to be sent to cytology to be examined. Pain level: about the same as an injection, perhaps less, since the area is numb. http://www.cancersupportivecare.com/fna....

Large needle biopsy – Your breast gets anesthetized and the surgeon makes a small cut and inserts a bigger needle to take out a sampling of the lump. Sample is sent to pathology. Pain level: With the anesthetic, like an annoying paper cut and then an injection. http://www.medbroadcast.com/health_topic...

Stereotactic biopsy –

Sometimes the lump only shows up on the mammogram and can not be felt from the outside. I’ve never had this type of biopsy. A mammogram is done. You lie face down on the table. Your breast hangs down below the table through a cut-out in the surface. A computer calculates where to insert the needle. Again, your breast area is numb and except for the fact that you are face down, the pain level should be comparable to the needle biopsies. If you have a sense of humor, this procedure is pretty comical looking. http://www.bannerhealth.com/community/br...

Guide Wire biopsy – When the lump is not palpable, but is visual on mammogram, they sometimes do this procedure. You hop up on the ultrasound table; they apply some gel to your chest and they run the scanner around to find the spot, while watching the computer monitor. When they find the spot, the radiologist inserts a small needle and then does some fancy threading by putting the guidewire through the needle. Then you must proceed to the mini operating room suite. (That is where it was done in the breast center where I was treated.) The nurse wants to make sure you do not dislodge the wire, so she must secure it. My nurse placed an upside-down paper cup over the wire (I swear I am not making this up!) and then proceeded to place wads of adhesive tape across my chest. Pain level: The ultrasound is non-invasive and not painful at all. The needle wasn’t any worse than any other needle – remember, the breast area is anesthetized. Inserting the guidewire was a bit odd – you can feel the pushing and pulling, but no real pain. http://www.health.harvard.edu/fhg/diagno...

Lumpectomy – Most people associate this with a diagnosis of breast cancer. I had two lumpectomies that turned out to be benign cysts, several years before my cancer appeared. This procedure is usually done in a mini operating room. Different surgeons and anesthesiologists prefer varying types of sedation. I had twilight sleep, which is an intravenous drip. This made me oblivious to the pain, but allowed me to converse with the surgeon and nurses, in a slow-motion state. The breast is numbed; the surgeon makes an incision, removes the lump and stitches up the area. The lump is sent to pathology for testing. I was in the OR less than one hour. I lounged in recovery for another hour and went home with a large bandage and a tight sports bra. Not a fun afternoon, but not horrendous either.

We will discuss lumpectomy in greater detail as a surgical procedure, when it is used as THE surgical procedure to remove your cancer. http://www.breastcancer.org/tre_surg_con...

The worst part, for me, of any biopsies is the waiting post-biopsy. In this day and age I find it exasperating that it takes so many days for them to get the results and finally get back to you. Biopsies are not pleasant, but neither are they horrific. They are a useful diagnostic tool. For me, knowing the results is always more appealing than conjuring up the worst in my mind. The truth is always better than waiting.

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