Breast cancer

Diagnosing and staging breast cancer

Every person with breast cancer is different, and every tumor is different. The more we can learn about your specific tumor, the better we can customize your treatment plan to you. 

At Seattle Cancer Care Alliance (SCCA), we do extensive testing to diagnose and stage your disease precisely and accurately. Identifying features of your disease is important. It helps your physicians choose the treatments that will work best. 

Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
“One of the important advances in breast cancer is that we’re increasingly able to personalize the selection and intensity of your therapy to the biology of the cancer.”
— Jennifer M. Specht, MD, medical oncologist

Getting a diagnosis

Getting a breast cancer diagnosis usually starts in one of two ways. One is that your screening mammogram shows something that isn’t normal. The other is that you notice signs or symptoms and decide to see a physician. Then, you will often have an exam, imaging tests and a biopsy

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Mammogram An X-ray of the breast. An X-ray of the breast. A mammogram is a method of finding breast cancer that can’t be felt using the fingers. Mammograms are done with a special type of x-ray machine used only for this purpose. Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.
Diagnosis process at SCCA

Many of our breast cancer patients are first diagnosed right here at SCCA. Our breast health experts look at your signs and symptoms, and they do screenings, imaging tests and biopsies. SCCA breast imaging specialists study your imaging tests and give the results. Our pathologists test your tissue samples to get details about your specific cancer. Together, these details create a complex picture that will help guide decisions about your treatment. For example, some medicines may work well against some types of breast cancers but not others.

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.
If you were diagnosed elsewhere

We have many patients with breast cancer who come to SCCA after they have been diagnosed somewhere else. Before your first visit with SCCA physicians, we will go over the results of your scans and tests so far. Our breast imaging specialists look at your mammograms and any other scans. Our pathologists look at the pathology slides and the report from your biopsy. We may also run more tests on your tissue samples. We do this in order to be sure about your diagnosis and to plan treatment that matches your needs.

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope.

Imaging tests and biopsies

We offer a full range of imaging tests and biopsy methods to get the details we need to know your diagnosis, stage your disease and plan your care.

Imaging tests for breast cancer

SCCA is recognized as a Breast Imaging Center of Excellence by the American College of Radiology. 

Our technologists and radiologists specialize in breast imaging only. They will do your imaging tests and give the results. To help find and diagnose breast cancer, we use mammography, ultrasound and breast MRI (magnetic resonance imaging).

Your team uses the same types of imaging to figure out the stage of your disease. For staging, you may also need more imaging, like a chest X-ray, CT (computed tomography) scan, PET (positron emission tomography) scan or bone scan.
 

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Bone scan A procedure to check for abnormal areas or damage in the bones. A bone scan may be used to diagnose bone tumors or cancer that has spread to the bone. A procedure to check for abnormal areas or damage in the bones. A very small amount of radioactive material is injected into a vein and travels through the blood. The radioactive material collects in the bones and is detected by a scanner (a special camera that takes pictures of the inside of the body). A bone scan may be used to diagnose bone tumors or cancer that has spread to the bone. It may also be used to help diagnose fractures, bone infections or other bone problems. [removed comma] Chest X-ray A type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease. An X-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease. Computed tomography A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are used to create three-dimensional (3-D) views of tissues and organs. A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create three-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This scan may be used to help diagnose disease, plan treatment or find out how well treatment is working. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Mammography The use of film or a computer to create a picture of the breast. Magnetic resonance imaging A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or X-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints and the inside of bones. Radiologist A physician who has special training in creating and interpreting pictures of areas inside the body. The pictures are made with X-rays, sound waves or other types of energy. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Staging Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from where it first formed to other parts of the body. Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from where it first formed to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment. Ultrasound A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen. A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen (sonogram). Ultrasound may be used to help diagnose diseases, such as cancer. It may also be used during pregnancy to check the fetus (unborn baby) and during medical procedures, such as biopsies. Also called ultrasonography.
Mammogram

SCCA physicians use 3D mammography to check breast problems or symptoms. We also use it to follow up if a screening showed something abnormal. Typically, we take more views of one or both breasts to get more details. 

Our radiologists specialize in mammography. Studies show that specialists like ours can read the images more accurately than physicians with less experience.

Learn More 
 

Mammography The use of film or a computer to create a picture of the breast. Radiologist A physician who has special training in creating and interpreting pictures of areas inside the body. The pictures are made with X-rays, sound waves or other types of energy. Screening Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease Checking for disease when there are no symptoms. Because screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (for breast cancer), colonoscopy (for colon cancer) and Pap and HPV tests (for cervical cancer). Screening can also include a genetic test to check for a person’s risk of developing an inherited disease. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.
Ultrasound

If your mammogram shows anything that isn’t normal, it might help to get a breast ultrasound. This can help your care team check lumps that are hard to see on a mammogram. 

Sound waves bounce off solids and fluids differently. So an ultrasound can often help us tell if a lump is a solid mass or a benign cyst (a sac of fluid that is not cancer).
 

Benign Not cancer. Benign tumors may grow larger but do not spread to other parts of the body. Mammogram An X-ray of the breast. An X-ray of the breast. A mammogram is a method of finding breast cancer that can’t be felt using the fingers. Mammograms are done with a special type of x-ray machine used only for this purpose. Ultrasound A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen. A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen (sonogram). Ultrasound may be used to help diagnose diseases, such as cancer. It may also be used during pregnancy to check the fetus (unborn baby) and during medical procedures, such as biopsies. Also called ultrasonography.
Breast MRI

MRI can help us see breast cancers that are harder to see on a mammogram. This makes MRI an important test for some people. We use it to diagnose and plan treatment.

SCCA radiologists are experts at knowing if this test will help you. We have the training and knowledge to get high-quality breast MRI images. 

Learn More

Mammogram An X-ray of the breast. An X-ray of the breast. A mammogram is a method of finding breast cancer that can’t be felt using the fingers. Mammograms are done with a special type of x-ray machine used only for this purpose. Magnetic resonance imaging A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or X-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints and the inside of bones. Radiologist A physician who has special training in creating and interpreting pictures of areas inside the body. The pictures are made with X-rays, sound waves or other types of energy.

Biopsies for breast cancer 

To know for sure if you have breast cancer, you will need a biopsy. Biopsies show if there are cancer cells in a small tissue sample or in a tumor that was taken out by surgeons. 

In most cases, SCCA breast health specialists get a sample of tissue using a small needle (core biopsy) under precise image guidance. This can mean using ultrasound, mammography (stereotactic biopsy) and MRI imaging. If core biopsies do not give your care team clear results, you might need a surgical biopsy

After diagnosis, most people will need surgery to take out their breast tumor. We may do more tests on the tumor as well as nearby lymph nodes to see if cancer has spread there (sentinel lymph node biopsy). 

SCCA pathologists will study and test your tissue samples to learn about your specific disease. This matters so your team can choose the treatments that will work best for you. 

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Mammography The use of film or a computer to create a picture of the breast. Magnetic resonance imaging A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or X-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints and the inside of bones. Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Surgical biopsy A procedure in which a cut is made through the skin to remove abnormal tissue so it can be checked under a microscope for signs of disease. A procedure in which a cut is made through the skin to remove abnormal tissue so it can be checked under a microscope for signs of disease. The two types of surgical biopsy are incisional biopsy (in which part of a lump or a sample of tissue is removed) and excisional biopsy (in which an entire lump or suspicious area is removed). Also called open biopsy. Ultrasound A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen. A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen (sonogram). Ultrasound may be used to help diagnose diseases, such as cancer. It may also be used during pregnancy to check the fetus (unborn baby) and during medical procedures, such as biopsies. Also called ultrasonography.

Staging breast cancer

Staging means finding out how far cancer has spread in your breast or other parts of your body. Accurate staging helps your physicians decide which therapies to use to treat your disease. There are two main systems for staging breast cancer: TNM staging and overall stage grouping.

Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Staging Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from where it first formed to other parts of the body. Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from where it first formed to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.
How we determine your stage

Your SCCA physicians will base your stage on a physical exam, imaging tests and biopsies. This is sometimes called clinical staging. We will do all the tests you need at SCCA. Your team will help plan your appointments to make a schedule that works best for you. 

Most people with breast cancer will have surgery to remove their tumor as well as some lymph nodes under their arm. Tests on the tumor and nodes can give your physicians more details about the type of cancer and the treatments you may need. It is normal to learn more about your stage after this surgery. This is called pathologic staging.
 

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Staging Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from where it first formed to other parts of the body. Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from where it first formed to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.
TNM staging

TNM stands for tumor, nodes and metastasis. Your TNM stage is:

  • The letter T with a number from 0 to 4. A higher T number means the tumor is larger, has spread more widely into nearby tissues or both.
  • The letter N with a number from 0 to 3. A higher N number means more spread of cancer cells to lymph nodes near the breast, such as in the armpit or under the collarbone.
  • The letter M with a 0 or 1. M0 means physicians did not find cancer in lymph nodes away from your breast or in distant organs. M1 means distant spread was found.
Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.
Overall stage grouping

After your physician finds your TNM stage, they will assign a stage using Roman numerals I (one), II (two), III (three) or IV (four).

  • Stage 0: Noninvasive cancers (which are only in the milk ducts or glands). 
  • Stage I: The tumor is smaller than 1 inch across. It has not spread to lymph nodes under your arm or to other places outside your breast.
  • Stage II: The tumor is 1 to 2 inches across, or cancer has spread to lymph nodes under your arm. Stage I or II cancers are considered early-stage cancers.
  • Stage III: Cancer is in your breast, surrounding tissues and lymph nodes. Stage III cancers may be considered early-stage or advanced cancers.
  • Stage IV: Cancer has spread to distant parts of your body or to lymph nodes outside your armpit. This is called metastatic cancer.
Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.

Types and features of breast cancer

There are many types of breast cancer. Knowing your type is important in planning the right treatment.

In this noninvasive type of breast cancer, cancer cells are only in the milk ducts. Surgery to remove the cancer is recommended to keep it from turning into invasive cancer. Surgery is also important to rule out the chance that some invasive cancer is already there. Radiation therapy and hormone therapy are also common parts of treatment. 

Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body.

This type can start in the milk ducts or the lobules (glands that make milk), and it can grow into surrounding breast tissue. The most common types of invasive breast cancer are:

  • Invasive ductal carcinoma
  • Invasive lobular carcinoma 

Invasive breast cancer can spread beyond your breast. Breast cancer typically spreads to lymph nodes under the arm and to other nodes in the same region before it spreads to other parts of the body. Breast cancer that spreads to other organs, such as the lung, liver or bones, is called metastatic or stage IV (four) disease.

Along with the types listed above, there are other types of breast cancer. They include rare types like inflammatory breast cancer, metaplastic breast cancer, angiosarcoma and Paget disease of the nipple.
     

Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.

To select the right treatments for you, your care team needs to know if your cancer cells have hormone receptors. These are points where estrogen, progesterone or both can attach and make the cells grow. If your cancer cells have these, your cancer is hormone receptor-positive (HR+). It may respond to endocrine therapies (also called hormonal or anti-estrogen therapies).

Another key feature is if the cancer cells have more HER2 receptors than normal. HER2 stands for human epidermal growth factor type 2. If your cancer cells have more of these receptors than normal, the cancer is HER2-positive (HER2+). It may respond to certain targeted therapies, such as trastuzumab.

Triple-negative breast cancer is breast cancer that has normal HER2 receptors and doesn’t have receptors for estrogen or progesterone.
 

Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.

Based on the type and stage of your breast cancer, your SCCA care team may run more tests on your cancer cells. For example, we may do genetic testing to see how likely early-stage breast cancer is to spread or come back. If tests show that the risk is high, you may benefit from having chemotherapy along with endocrine therapy, rather than endocrine therapy alone. 

There are many more examples. If tests show that you have genetic changes in the genes BRCA1 or BRCA2, you might benefit from a group of medicines called PARP inhibitors. At SCCA, we do any testing that can help us choose the treatments that are right for you. 
 

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Genetic testing Tests that can be done to see if a person has certain gene changes known to increase cancer risk. Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.

Breast cancer infographic