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Tests and diagnosis
By Mayo Clinic staffIf your doctor suspects recurrent breast cancer based on results of a mammogram or physical exam, or because of signs and symptoms, you'll likely need further imaging tests and a biopsy.
The following tests may be used to help diagnose recurrent breast cancer:
- Breast ultrasound. Ultrasound uses sound waves to produce images of the inside of the body. For women who've had lumpectomy, breast ultrasound may be used to evaluate an abnormality seen on a mammogram or found during a physical exam of your breast.
- Magnetic resonance imaging (MRI). MRI uses a magnet and radio waves to make images of the inside of your body. MRI may be able to detect abnormal areas within the breast, chest wall, lymph node areas, and blood vessels and nerves around the breast and armpit. The MRI by itself can't tell the difference between cancer and benign tissue, but it can help your doctor determine the best areas for a biopsy or further testing. Not all women with a local recurrence benefit from having an MRI. Discuss your situation with your doctor.
- Computerized tomography (CT). A CT scan is a type of computerized X-ray that provides more-detailed pictures than do ordinary X-rays. CT scans of your chest, abdomen, pelvis, bones and head can help look for evidence of cancer that's spread to your internal mammary lymph nodes or to distant sites, such as the bones, lungs or liver.
- X-rays. Chest X-rays may detect a recurrence in your lungs, while bone X-rays may be able to detect cancer in your bones.
- Bone scan. A bone scan can provide an image of your whole skeleton and may detect cancer recurrence in your bones. During a bone scan, a small amount of radioactive material (tracer) is injected into your bloodstream. The tracer binds to your bone cells. Areas with cancer absorb more of the tracer and "light up" on the scan.
- Positron emission tomography (PET). A PET scan also uses radioactive material injected into your body to produce an image. Tumors often absorb greater amounts of the material and show up more prominently on the scan. A PET scan or hybrid PET/CT scan of your whole body may be used to look for areas of cancer recurrence.
- Biopsy. A biopsy — a small sample of tissue removed for analysis in the laboratory — is needed to confirm the diagnosis of recurrent breast cancer. The tissue specimen will be tested for the presence of estrogen and progesterone receptors. A breast cancer that makes receptors for the female hormones estrogen and progesterone (hormone receptor positive cancer) can be treated with hormone therapy. The hormone receptor status of your cancer may change with a recurrence. The tissue is also tested for extra amounts of the HER2 protein, which some breast cancers overproduce. Cancers that are HER2 positive can be treated with biotherapies that target this protein.
- Blood tests. A complete blood count and liver function tests can help evaluate how your body is doing and may help guide treatments. Doctors often use blood tests that measure breast cancer tumor markers to follow the course of cancer. But tumor markers aren't specific for a cancer recurrence. These tests aren't recommended for looking for a recurrence, as they aren't always reliable.
References
- Hurria A. Follow-up for breast cancer survivors: Patterns of relapse and long-term complications of therapy. http://www.uptodateonline.com/home/index.html. Accessed March 19, 2011.
- Breast cancer. American Cancer Society. http://www.cancer.org/acs/groups/cid/documents/webcontent/003090-pdf.pdf. Accessed March 17, 2011.
- Punglia RS, et al. Local therapy and survival in breast cancer. New England Journal of Medicine. 2007;356:2399.
- Hayes DF. Overview of treatment for locally advanced, recurrent, and metastatic breast cancer. http://uptodateonline.com/index. Accessed March 19, 2011.
- What you need to know about breast cancer. National Cancer Institute. http://www.cancer.gov/cancertopics/wyntk/breast/AllPages/Print. Accessed March 19, 2011.
- Living with uncertainty: The fear of cancer recurrence. American Cancer Society http://www.cancer.org/docroot/MLT/content/MLT_4_1x_Living_With_Uncertainty_-_The_Fear_of_Cancer_Recurrence.asp. Accessed March 19, 2011.
- Hirsch A, et al. Management of locoregional recurrence of breast cancer after mastectomy. http://www.uptodateonline.com/home/index.html. Accessed March 19, 2011.
- Debled M et al.Prognostic factors of early distant recurrence in hormone receptor-positive, postmenopausal breast cancer patients receiving adjuvant tamoxifen therapy: Results of a retrospective analysis. Cancer. 2007;109:2197.
- Rausch SM, et al. Complementary and alternative medicine: Use and disclosure in radiation oncology community practice. Supportive Care Cancer. 2011;19:521.
- Pruthi S (expert opinion). Mayo Clinic, Rochester, Minn. April 11, 2011.
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