Breast cancer diagnosis? Answers to 5 important questions.

Being diagnosed with cancer is overwhelming and confusing. Saju Rajan, MD, radiation oncologist at Cleveland Clinic Cancer Center in Sandusky, addresses five common questions.

1. What type of breast cancer do I have?

Most breast cancers – 70 percent to 80 percent – originate in the milk ducts. They’re known as infiltrating or invasive ductal carcinomas that have broken through the milk duct’s wall and proliferated into the breast’s fatty tissue.

Ten percent of breast cancers start in the milk-producing glands, or lobules, and are called invasive lobular carcinomas. They’re also capable of spreading.

Some breast cancers are non-invasive, meaning they haven’t spread. They’re contained within the milk ducts and are called ductal carcinoma in situ, or DCIS. As these can often progress to invasive carcinomas over time, they also warrant treatment.

2. What are the size, stage and grade of my tumor?

Tumor size, stage and grade are factors that determine the course of treatment. The tumor’s dimensions are estimated by a physical exam, mammogram and an ultrasound or MRI of the breast. The precise size won’t be known until a pathologist studies the tumor after surgical removal.

Staging is a standardized way of classifying the severity of the cancer. Stages I through IV reflect a tumor’s size and the extent of spread. A higher stage means a larger tumor and wider distribution of cancer cells.

Grading is based on the cancer cells’ appearance under a microscope. The more abnormal-looking the cells are, the more likely they are to quickly grow and spread. Grades usually run from 1 to 3. Grade 3 or poorly differentiated tumors tend to grow rapidly and spread faster.

3. Is the cancer in my lymph nodes?

Whether your breast cancer has spread to your lymph nodes is one of the most important predictors of the severity of your disease. When breast cancer cells have spread to the lymph nodes, we tend to discuss more aggressive treatment options. Lymph node involvement can often be picked up on physical examination or imaging but needs to be confirmed by the pathologist based on biopsy or lymph node sampling.

4. What is my estrogen receptor and progesterone receptor status?

Your body’s hormones, such as estrogen and progesterone, may play a role in how your breast cancer progresses. Normal cells are equipped with receptors that allow them to receive information from circulating hormones.

If your breast cancer cells have estrogen and progesterone receptors – known as ER/PR positive – then they’re capable of detecting estrogen’s signal and using it to fuel growth. About 70 percent of breast cancer patients have positive ER/PR hormone status. Doctors can take advantage of the receptors’ presence, either by using an anti-estrogen drug such as tamoxifen, or by using aromatase inhibitors such as anastrazole, which lower your body’s estrogen levels to deprive the cancer cells of fuel.

If the cancer cells lack the receptors – ER-/PR-negative – they are typically more aggressive and chemotherapy is the preferred treatment.

5. What is my HER2 status?

HER2 – human epidermal growth factor receptor 2 – is another type of growth signal receptor which may be present on your breast cancer cells. About 25 percent of breast cancers are HER2-positive.

HER2-positive cancers are a mix of good and bad news. The bad news is the tumors tend to grow more aggressively; the good news is that medicines can switch the HER2 growth receptor off.

Drugs such as trastuzumab, pertuzumab, and T-DM1 are extremely effective and have improved the prognosis for HER2-positive patients. Treatment outcomes are now as good as those with HER2-negative tumors. To schedule an appointment with Dr. Rajan or another Cleveland Clinic cancer specialist in Sandusky, Clyde or Norwalk, call 419.626.9090.