Northwest Indiana Breast Cancer Center

Breast cancer is a complicated disease with different classifications and types, so everyone’s experience with breast cancer is different. Although breast cancer is most commonly found in women, it is possible for men to develop breast cancer also. Thankfully, due to decades of research, it’s possible for breast cancer patients to receive effective treatment for their specific type of breast cancer.

Regular breast cancer screening using mammograms has also made it possible to find breast cancer at its earliest stages when it’s easiest to treat. This results in fewer treatments for many patients and better outcomes because the area affected by cancer is small.

If you or a loved one was diagnosed with breast cancer, we are here to help you understand your cancer and treatment options. The information that we provide can also help you communicate better with our Northwest Cancer Centers' team of breast cancer specialists.

Learn more about about breast cancer including understanding your breast cancer type and treatment options.

Types of Breast Cancer

Breast cancer is not a single disease but rather a broad term that covers a number of different types of breast cancer. Treatment for one patient may look completely different than another patient’s treatment plan, all because of their specific breast cancer type.

Most breast cancers are categorized as carcinomas. These tumors start in the cells that line organs and tissues in the body. When carcinomas start in the breast, they’re specifically called adenocarcinoma. Adenocarcinomas start in the milk ducts or the lobules that produce milk.

Along with determining where breast cancer starts within your breast (i.e. milk glands or ducts), it's also classified as either noninvasive or invasive.

In situ (Non-Invasive) Breast Cancer

Non-invasive breast cancer cells remain in their point of origin within your breast lobules or milk ducts. They don't invade or grow into normal tissues beyond or within your breast.

Infiltrating (Invasive) Breast Cancer

This type of breast cancer spreads to neighboring tissues. This is the more common type of breast cancer.

Treatment is Based in Part on the Type of Breast Cancer

At Northwest Cancer Centers, the care team creates breast cancer treatment plans based on the type, stage, and hormone receptor status. For invasive breast cancers, patients are likely to need a combination of a few of the following cancer treatments:

• Breast cancer surgery such as lumpectomy or mastectomy
• Radiation therapy
• Chemotherapy
• Hormone therapy
• Immunotherapy
• Targeted therapy

How Is Breast Cancer Diagnosed?

Most women, starting by age 40, should have an annual mammogram to screen for breast cancer. A clinical breast exam is also an important part of screening. During an in-office breast exam, both of your breasts are checked by your doctor — usually a gynecologist. This may include raising your arms over your head, letting them hang by your sides, or pressing your hands against your hips.

In addition to looking for differences in size or shape between your breasts, your doctor will check your breasts' skin for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid. If your doctor detects something abnormal during a breast exam, further tests are needed to make an accurate diagnosis.

What is a Mammogram?

A mammogram is an x-ray picture of tissues inside the breast. They can show a breast lump before it can be felt. If something is identified by the radiologist who reviews the images, your doctor will recommend additional testing. In some cases, it’s simply calcifications, but it’s important to find out.

Women should get regular screening mammograms to detect breast cancer early— even before they have symptoms. According to the American Cancer Society:

• Women between the ages of 40 to 44 have the choice to start yearly mammography
• Women aged 45 to 54 are recommended to receive a mammogram every year
• Women age 55 and older can switch to having a mammogram every two years or continue yearly screening if they choose

Women under the age of 40 who have risk factors for breast cancer should ask their health care provider about when to start mammograms.

Some doctors will also recommend a baseline mammogram at age 35, so they can compare future mammograms to one when you were younger.

Breast Biopsy & Lymph Node Biopsy

If an abnormal area is found during a diagnostic mammogram or breast MRI, you will likely need a biopsy. A biopsy is the removal of tissue from the breast to determine if the unusual area contains cancer cells. It is the only way to tell for sure if cancer is present.

The breast surgeon removes fluid or tissue from your breast using a thin needle. This is a short, outpatient procedure. A pathologist will check the tissue or fluid removed from your breast for cancer cells as well as hormones and the cell pattern to determine the type. From this, the pathologist will produce a report that the oncologist will use to create a personalized breast cancer treatment plan.

Sentinel Lymph Node Biopsy

There is often a lymph node biopsy performed at the same time as cancer removal surgery. Not only will the surgeon remove the breast cancer tumor, but they will also test to see if there are cancer cells in the lymph nodes near the breast.

The surgeon injects a radioactive substance and/or a blue dye near the tumor to locate the position of the closest lymph node to the area of concern. This is called the “sentinel lymph node.” Once the sentinel lymph node is found, the surgeon makes a small incision in the overlying skin and removes the node to test it for cancer cells. If the results come back showing that cancer is present in the lymph node, the treatment plan will be adjusted to target cancer cells that may have moved through the body via lymph fluid.

Determining Hormone Receptors and HER2 Status

If you are diagnosed with breast cancer, your doctor may order special lab tests on the breast tissue that was removed, including:

• Hormone receptor tests: Some breast tumors need hormones to grow. These tumors have receptors for the hormones estrogen, progesterone, or both. If the hormone receptor tests show that the breast tumor has these receptors, then hormone therapy is most often recommended as a treatment option. 
• HER2 test: HER2 is a protein found in or on some breast cancer cells that fuels growth and can make breast cancer spread quicker. If the test shows you are HER2 positive, a special drug targeting the HER2 protein is recommended.

All of these diagnostic tests may not happen at once. It can sometimes take a few weeks to get all of the information needed to fully develop the treatment plan for your type of breast cancer. However, this doesn’t mean the treatment will necessarily be put on hold. Most oncologists recommend a treatment plan that begins shortly after diagnosis to begin the process of shrinking the breast tumor. 

Hormone Status and Breast Cancer

In addition to understanding the type of breast cancer and the stage, it’s critical that your oncologist knows which hormones, if any, are involved in the growth of the breast cancer. The results play a role in creating the best treatment plan for you.

The hormone receptor status of your breast cancer refers to whether your breast cancer cells are fueled by estrogen and/or progesterone, naturally occurring hormones in both women and men. Due to special proteins inside the tumor cells, called hormone receptors, the hormones attach to the tumor cells and fuel the cancer’s growth. 

Breast cancer patients are given either hormone receptor status that is either hormone receptor (HR) positive or hormone receptor (HR) negative:

• Hormone receptor-positive breast cancer means that the cancer cells have the protein in or on them that attracts estrogen, progesterone, or both hormones.
• Hormone receptor-negative breast cancer means that no estrogen or progesterone receptors are present. These types of cancers will not benefit from hormone therapy drugs and typically grow faster than HR-positive cancers.

Hormone Receptor Categories of Breast Cancer

Your oncology team will run tests and give you at least one of the following hormone receptor categories:

Hormone Therapies and Targeted Therapies for Breast Cancer

Several unique breast cancer treatments have been developed to specifically counteract ER+, PR+, and HER2+ breast cancers.

If your breast cancer is hormone receptor-positive (ER+ and PR+), your treatment will typically include hormone therapy. Hormone therapy is designed to block the receptors on the cancer cells from attracting the hormone. This slows the growth of the cancer.

If your cancer has tested positive for HER2, it is likely that your breast cancer will grow and spread more aggressively. To slow the growth, it will likely be treated with targeted therapy. Clinical research has recently made available several targeted therapies for breast cancer patients that specifically block the growth of the HER2 protein, slowing the growth of the cancer.

Knowing both your hormone receptor and HER2 status will help the oncologists at Northwest Cancer Centers create the best treatment plan for you.

Stages of Breast Cancer

After a breast cancer diagnosis, the oncologist must determine if cancer cells have spread outside the breast. Staging can sometimes take a little while to determine because results need to be gathered from different types of tests. One of these tests may be available after surgery when nearby lymph nodes are examined to see if cancer cells have spread there.

In breast cancer, the stage is based on several factors: 

• The size and location of the primary tumor
• Whether the cancer has spread to nearby lymph nodes or other parts of the body
• Tumor grade
• The presence of certain biomarkers

To begin the staging process, the TNM system is used. The TNM staging system is a classification system developed by the American Joint Committee on Cancer for describing the extent of disease progression in cancer patients. It is used to answer the following questions: 

• Tumor (T): How large is the primary tumor in the breast? What are its biomarkers?
• Node (N): Has the tumor spread to the lymph nodes? If so, where, what size, and how many?
• Metastasis (M): Has the cancer spread to other parts of the body?

T categories for breast cancer

T followed by a number from 0 to 4 describes the main (primary) tumor's size and if it has spread to the skin or to the chest wall under the breast. Higher T numbers mean a larger tumor and/or wider spread to tissues near the breast.

TX: The primary tumor cannot be evaluated.

T0 (T zero): There is no evidence of cancer in the breast.

Tis: Refers to carcinoma in situ. The cancer is confined within the ducts of the breast tissue and has not spread into the surrounding tissue of the breast. There are 2 types of breast carcinoma in situ:

• Tis (DCIS): DCIS is a non-invasive cancer, but if not removed, it may develop into an invasive breast cancer later. DCIS means that cancer cells have been found in breast ducts and have not spread past the layer of tissue where they began.
• Tis (Paget’s disease): Paget's disease of the nipple is a rare form of early, non-invasive cancer that is only in the skin cells of the nipple. Sometimes Paget's disease is associated with invasive breast cancer. If there is an invasive breast cancer, it is classified according to the stage of the invasive tumor.

T1: The tumor in the breast is 20 millimeters (mm) or smaller in size at its widest area. This is a little less than an inch. This stage is then broken into 4 substages depending on the size of the tumor:

• T1mi is a tumor that is 1 mm or smaller.
• T1a is a tumor that is larger than 1 mm but 5 mm or smaller.
• T1b is a tumor that is larger than 5 mm but 10 mm or smaller.
• T1c is a tumor that is larger than 10 mm but 20 mm or smaller.

T2: The tumor is larger than 20 mm but not larger than 50 mm.

T3: The tumor is larger than 50 mm.

T4: The tumor falls into 1 of the following groups:

• T4a means the tumor has grown into the chest wall.
• T4b is when the tumor has grown into the skin.
• T4c is cancer that has grown into the chest wall and the skin.
• T4d is inflammatory breast cancer.

N categories for breast cancer

N followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are involved.

• N1mi: cancer has spread to the axillary (armpit area) lymph nodes and is larger than 0.2 millimeters but not larger than 2 millimeters.
• N1a: cancer has spread to 1 to 3 axillary lymph nodes, and the cancer in at least one of the lymph nodes is larger than 2 millimeters.
• N1b: cancer has spread to lymph nodes near the breastbone on the same side of the body as the primary tumor, and the cancer is larger than 0.2 millimeters and is found by sentinel lymph node biopsy. Cancer is not found in the axillary lymph nodes.
• N1c: Cancer has spread to 1 to 3 axillary lymph nodes, and the cancer in at least one of the lymph nodes is larger than 2 millimeters. Cancer is also found by sentinel lymph node biopsy in the lymph nodes near the breastbone on the same side of the body as the primary tumor.

• N2a: cancer has spread to 4 to 9 axillary lymph nodes, and the cancer in at least one of the lymph nodes is larger than 2 millimeters.
• N2b: cancer has spread to lymph nodes near the breastbone, and imaging tests found the cancer. Cancer is not found in the axillary lymph nodes by sentinel lymph node biopsy or lymph node dissection.

• N3a: cancer has spread to 10 or more axillary lymph nodes, and the cancer in at least one of the lymph nodes is larger than 2 millimeters, or cancer has spread to lymph nodes below the collarbone.
• N3b: cancer has spread to 1 to 9 axillary lymph nodes, and the cancer in at least one of the lymph nodes is larger than 2 millimeters. Cancer has also spread to lymph nodes near the breastbone, and imaging tests found the cancer;
  OR
  ​cancer has spread to 4 to 9 axillary lymph nodes, and cancer in at least one of the lymph nodes is larger than 2 millimeters. Cancer has also spread to lymph nodes near the breastbone on the same side of the body as the primary tumor, and the cancer is larger than 0.2 millimeters and is found by sentinel lymph node biopsy.
• N3c: Cancer has spread to lymph nodes above the collarbone on the same side of the body as the primary tumor.

M categories for breast cancer

M0: There is no sign that cancer has spread to other parts of the body.
M1: Cancer has spread to other parts of the body, most often the bones, lungs, liver, or brain. If cancer has spread to distant lymph nodes, the cancer in the lymph nodes is larger than 0.2 millimeters. The cancer is called metastatic breast cancer.

Breast Cancer Stage Grouping

The following grouping by T, N, and M according to the stage is provided by the American Society of Clinical Oncology. The breast cancer stage is usually expressed as a number on a scale of 0 through IV — with stage 0 describing non-invasive cancers that remain within their original location and stage IV describing invasive cancers that have spread outside the breast to other parts of the body. 

Breast Cancer Tumor Grade

Grade refers to how different the cancer cells look from healthy cells and whether they appear slower-growing or faster-growing. If the cancer looks similar to healthy tissue and has different cell groupings, it is called "well-differentiated" or a "low-grade tumor." If the cancerous tissue looks very different from healthy tissue, it is called "poorly differentiated" or a "high-grade tumor."

There are three grades:

• Grade 1 (well-differentiated): total score of 3 to 5
• Grade 2 (moderately differentiated): total score of 6 to 7
• Grade 3 (poorly differentiated): total score of 8 to 9

Breast Cancer Treatment Options

Because there are several types of breast cancer, there are also several types of breast cancer treatment. At Northwest Cancer Centers, our dedicated team of medical oncologists use the latest breast cancer treatment technologies to create a unique treatment plan for each patient. They are available to take questions and guide you through the process of starting a cancer treatment plan that is right for you.

The following is a broad description of breast cancer treatments that may be used as part of your treatment plan.

Breast Cancer Surgery

Most women will receive surgery as part of their breast cancer treatment. Your oncologist and breast surgeon will discuss your options to compare the benefits and risks of each and describe how each will change the way you look:

The surgeon usually does a sentinel lymph node biopsy at this time to see if there may be lymph node involvement.

You may choose to have breast reconstruction, which involves using plastic surgery to rebuild the shape of the breast. It may be done at the same time as the cancer surgery or later. If you’re considering breast reconstruction, you may wish to talk with a plastic surgeon before having cancer surgery.

Radiation Therapy for Breast Cancer

To destroy breast cancer cells that remain in the area after surgery, radiation therapy may be recommended. It could also be given to the nearby lymph nodes. For women who had a modified radical mastectomy, it may or may not be recommended depending on the size of the tumor, whether it has spread to lymph nodes and how many lymph nodes.

There are two standard types of radiation therapy that oncologists use to treat breast cancer. Depending on your situation, you may receive both types, which include:

Hormone Therapy to Treat Breast Cancer

If lab tests show that the tumor in your breast has hormone receptors, then hormone therapy may be an option. Hormone therapy, also sometimes called anti-hormone treatment, keeps cancer cells from getting or using the natural hormones (estrogen and progesterone) they need to grow.

Hormone therapy is usually given along with other therapies (adjuvant) and may be recommended for several years after your other breast cancer treatments are complete.

Breast Cancer Chemotherapy

Chemotherapy drugs kill cancer. They are usually given through a vein (intravenous) or as a pill. If chemotherapy is part of your treatment plan, you will probably receive a combination of drugs based on the type, stage, and grade of breast cancer you have.

Some anticancer drugs cause damage to the ovaries. If you have not gone through menopause yet, you may experience symptoms such as hot flashes and vaginal dryness. Your menstrual periods may no longer be regular or may stop. You may become infertile (unable to become pregnant). For women over the age of 35, this damage to the ovaries is likely to be permanent.

On the other hand, you may remain able to become pregnant during chemotherapy. Before treatment begins, you should talk with your doctor about birth control because many drugs given during the first trimester are known to cause birth defects.

Targeted Therapy

Another breast cancer treatment approach is targeted therapy. Targeted therapy uses drugs that block the growth of breast cancer cells. For example, targeted therapy may block the action of the HER2 protein that stimulates the growth of breast cancer cells.

Trastuzumab (Herceptin®), lapatinib (TYKERB®), or other approved targeted therapies for breast cancer may be given to a woman whose lab tests show that her breast tumor has too much HER2.