Tuesday, October 27, 2009

Diagnosis of suspected breast cancer

A guide to breast self-examination here.

When striking the breast self-examination or the examination by the gynecologist in the breast lump or hardening, must be clarified what it is. There are several options available:
  • Physical exam
  • Mammography (radiography of the chest)
  • Microscopic examination
If it turns out that it was actually a breast cancer that have diagnostic procedure is still another meaning: they seek to determine how far the disease has progressed, and the treatment planning.

Medical history and physical examination:

As a first diagnostic step, the physician's medical history rises, to obtain information about symptoms and possible risk factors. After collecting the medical history is usually the physical examination. In both breasts and the region around the breasts and armpits carefully palpated and examined for nodules or lumps. If it finds a node that is sure how big it is, whether it hurts and whether he can move. The skin is thoroughly considered, and also took care whether fluid can be squeezed from the breast.

Sometimes, after the physical examination, an ultrasound scan of the chest to give further information. With the help of ultrasound, structures within the body including hardened tissue, cysts or lumps in the breast represent.

The next diagnostic step is followed by a rule called a mammogram. This is an X-ray examination of the breast. In addition, the breast between 2 plates and is positioned relatively firmly clamped. Through this rather unpleasant procedure for the chest radiograph can be somewhat spread out ", thus resulting better pictures, then allow a more accurate assessment. A good picture quality for the correct interpretation of great importance. It will be made once per breast 2 shots, one from the side and once from above. Therefore, it is necessary to position each breast, each with 2 times for the X-ray between the plates. The inclusion of healthy breast serves as a reference recording for improved assessment of the affected side. In addition, a lump in one breast does not exclude that the other side is possibly affected as well. Exposure to X-rays is now limited by the use of modern X-ray machines.

However, it is possible that it may be decided according to this diagnosis is not yet sure whether this is a palpable node is a benign or malignant findings. This distinction has important consequences. Thus, a benign node can remain untreated in many cases, however, therapy needs to be a malicious immediately. Next, comes the possibility of diagnostic investigation of a tissue sample into question. This is using a thin needle from the district suspects obtained the chest and then examined under a microscope.

Puncture under ultrasound guidance

To obtain the tissue sample, there are several options: If a node is easily palpable, because it lies close to the surface, for example, it is the physician palpated with one hand and run with the other hand the needle into the nodule. This approach is very small or difficult in the deep lying nodes. In these cases, a so-called "puncture under ultrasound guidance can be performed. This means that the doctor initially by ultrasound for the nodes in the chest and it looks then "reserves in the picture. Now he can with the other hand, so to speak, "lead under direct vision, the needle safely into the node. There are also ultrasonic devices are available that are directly provided with a needle. In this way, the node can be represented with the ultrasound device and simultaneously targeted with the needle out, will be. Another way of "puncture under direct vision" is to puncture based on an X-ray examination. In this case, be made from several directions, x-rays of the node. A computer then calculates the exact path of the needle into the nodule, so that they reach their destination safely.

And fine-needle aspiration biopsy

For the 2 different tissue sampling methods can be used to come, the fine-needle aspiration and biopsy. In fine-needle aspiration of a very thin needle will be guided in the nodes and a small amount of tissue, "sucked". Because the needle is very thin (comparable to the injection) in a blood sample, no anesthesia is necessary. This method is particularly suitable for very small knots that could not be accurately achieved with a larger needle. For larger nodes, however it is possible to gain some more tissue for the investigation, here's the punch biopsy is used. It is run by a local anesthetic, a slightly larger needle into the nodule. This cuts out a small piece of tissue from the node, which can be removed after removing the needle from its interior. With injuries of the chest or bleeding in both procedures is not likely. The risk of kidnap by the puncture of cancer cells, is negligible.

The stage must be determined.

The removed tissue is used for histological examination under a microscope. In this way, it may be established from which the breast tissue (mammary glands and milk ducts), the tumor starts and whether it is hormone sensitive. Moreover, can the grading stage to determine (see section "Staging, Grading"). These results are important in order to plan subsequent treatment as accurately as possible.

Investigation for metastases.

Must be further investigated whether the breast cancer may be "daughter tumors (metastases have formed). Various regions of the body (liver, lung, bone, brain) are using such X-rays, computed tomography, magnetic resonance imaging, ultrasound or scintigraphy.

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