Further tests for breast cancer

If the first tests show you have breast cancer your doctor may want to do further tests. This is to check the size of the cancer and whether there has been any spread to lymph nodes or to other parts of the body. This tells the doctor the stage of the cancer. The stage is important because it helps the doctor to decide on the best treatment for you. If your breast cancer has spread to another part of the body, it is called advanced, or secondary breast cancer. There is information about the tests for secondary breast cancer in this section of CancerHelp UK.

Most women have blood tests and a chest X-ray. These may be done as part of standard preparation before surgery. Your breast cancer cells may also be tested to see if they have receptors for hormones or other proteins. This helps the doctor to know which hormone therapies or biological therapies might work for you.

There is detailed information about treatments for breast cancer in this section. We also have a general cancer treatment section, where you can find out about the main types of cancer treatment.

For most people, a mammogram or ultrasound will show up the size of the cancer in your breast. This is important information for you and your specialist. It helps to tell the surgeon the stage of the cancer. And it will be vital in planning the type of surgery you need. But in some people, these scans don't give the surgeon enough information. And sometimes, a woman's breast tissue is too dense to get accurate information from a mammogram. In these situations, you may have an MRI scan as well. MRI scans use magnetism to build up a picture of the inside of the breast. Doctors also use MRI scans for women with lobular breast cancer to help them decide if lumpectomy (breast conserving surgery) is an option. MRI scans can show the size of lobular breast cancer tumours more accurately than a mammogram or ultrasound scan.

Ultrasound scans use sound waves to build up a picture of the inside of the body. If you have early breast cancer you usually have an ultrasound scan of the area under your arm (axilla) to see if the lymph nodes there look normal. If they look abnormal, your doctor will want to put a fine needle into these lymph nodes guided by an ultrasound scan. The doctor then sucks out some fluid and cells into a syringe to check for signs of cancer (fine needle aspiration). If the lymph nodes contain cancer cells the surgeon will remove the lymph nodes during surgery to remove the breast cancer. If no cancer cells are seen, you will probably be offered further tests of the lymph nodes with a sentinel lymph node biopsy.

Ultrasound scans can also be useful for checking breast cysts.

Some women may have a liver ultrasound or liver CT scan to see if there is any spread of the breast cancer to their liver. Both these tests are quick and painless. There is detailed information about having an ultrasound and having a CT scan in the cancer tests section of CancerHelp UK.

Some women may have a bone scan to check for any breast cancer spread to the bones. The test takes quite a while because you have to have an injection and then wait for a couple of hours. There is information about having a bone scan in CancerHelp UK.

Above is an example of a bone scan. The dark areas are called hot spots. Bone scans show up general bone damage, but they are not very specific. In other words, it can be hard to see if a bone scan is showing cancer spread or whether the hot spot is scarring from an old area of arthritis. So your doctor may ask you to have further X-rays or MRI scans to help clarify what they see on a bone scan.

Your breast cancer cells will be tested to see if they have receptors for oestrogen or progesterone. Cells that have lots of oestrogen receptors are called oestrogen receptor positive. Cells that have lots of progestrone receptors are progesterone receptor positive. Breast cancers that are oestrogen receptor positive are more likely to respond to hormone therapies. It may take a couple of weeks to get the results of the receptor tests.

Your breast cancer cells will also be tested to see if they have receptors for a protein called HER2. HER2 is made by a specific gene called the HER2/neu gene. HER2 is a receptor for a particular growth factor made in the body called human epidermal growth factor. When human epidermal growth factor attaches itself to HER2 receptors on breast cancer cells it can stimulate the cells to divide and grow. If the breast cancer cells have a lot of HER2 receptors, the tumour is described as being HER2 positive. Biological therapies, such as Herceptin, are more likely to work well on HER2 positive cancers. The results of these receptor tests may take a couple of weeks.

There are several other tests you might be asked to have. They are useful for different situations. CT scans are a sophisticated type of X-ray. PET scanners are a newer type of scan. They are very specialised. They can show whether tissue is active and growing or not. This is useful for deciding whether a shadow on a CT scan is scar tissue or active cancerous tissue, for example. So they are useful in some situations after cancer treatment. But PET scans are not used very often for diagnosing breast cancer.

There is more information about all these different types of scan in the section about cancer tests.

Specialist breast care units may offer a 24 to 48 hour diagnostic service for scan results. But it can take longer for the lab results to come through. Before you leave the hospital after your tests the clinic nurse will probably book a follow up appointment for you. You usually get your results at this appointment. Waiting for results can be an anxious time. It may help to talk about your worries with a partner, close friend or relative. The breast clinic may also have a trained breast care nurse or counsellor who can talk to you.

You may also find it useful to get in touch with some of the breast cancer organisations. Many will be able to put you in touch with local counselling and support services, including other women with experience of breast cancer.