A breast cancer diagnosis has many different layers to understand. It can be confusing at first, but it’s also a good thing. It means science and cancer doctors understand the nuances of breast cancer, how it grows, spreads and how best to treat it.
“There are many different treatments for breast cancer and treatment is personalized to each patient that comes to us based on tumor testing,” said Ally Higgins, MD, a breast oncologist with Avera Medical Group Oncology & Hematology.
Your cancer care team will explain in detail the type of cancer you have based on testing for your specific tumor. The type of breast cancer you have begins with where in the breast it is growing. Cancer can develop in the lobules, which are glands that produce milk, or the ducts, which carry milk to the nipple.
Staging and Grading Your Cancer
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Your tumor will be graded with a number 1-3 according to what the cells look like. Lower numbers mean the cells look more like breast tissue and are likely slower growing. Higher grades indicate the cells look very different, are faster growing and more likely to spread outside the breast.
Your doctor will also stage your cancer. There are different methods of staging, but all methods incorporate the extent of your cancer, how large the tumor is and how far it has spread.
There is one type of breast cancer, ductal carcinoma in situ (DCIS), in which cancer cells are contained within the ducts and not able to spread to other areas in the body, this is considered non-invasive breast cancer. The two main types of invasive breast cancers are:
- Invasive ductal carcinoma. Starts in the cells that line a milk duct and breaks through the duct wall to spread to nearby breast tissue.
- Invasive lobular carcinoma. Starts in the milk-producing glands and can spread to nearby breast tissue, lymph nodes or other parts of the body. Can be harder to detect on exams such as mammograms.
- Inflammatory breast cancer. This is a less common type but is often more aggressive. The cancer is caused by blocked lymph nodes in the skin. Symptoms include breast swelling and thickening of the skin of the breast.
Hormones, Proteins and Breast Cancer
After your biopsy is completed, you’ll know about the hormone receptors in your tumor. The tests will look for estrogen and progesterone receptors and HER2, a growth-promoting protein on the outside of breast cells.
Receptors are important because by attaching to the hormone or protein the breast cancer cell can grow. Knowing what is helping your cancer grow can personalize the treatment.
- Hormone receptor positive. Your cancer cells have estrogen or progesterone receptors and can be treated with hormone therapy drugs. These cancers tend to be slower growing but can recur many years after treatment.
- Hormone receptor negative. You have neither estrogen nor progesterone receptors. These cancers grow faster and hormone therapy drugs are not responsive. If you have recurring cancer it is often in the first few years after treatment.
- HER2 positive or triple positive. HER2-positive breast cancer tests positive for a protein called human epidermal growth factor receptor 2 (HER2). This protein promotes the growth of cancer cells. HER2-positive breast cancers tend to be more aggressive, yet treatments that target HER2 are very effective. Triple positive means the breast cancer is positive for both estrogen and progesterone receptors as well as HER2. These cancers are treated with hormone drugs as well as drugs that target HER2.
- Triple-negative. You don’t have estrogen or progesterone receptors and don’t make too much of the protein called HER2. These cancers grow and spread more quickly. Chemotherapy, sometimes combined with immunotherapy, is used to treat these cancers.
Once you have all the information your doctors will start to put together the plan that’s best for you.
Surgery, chemotherapy, radiation and hormone therapy are common breast cancer treatments. You may also be eligible for clinical trials, which use new treatments along with standard of care.
Get Answers
At this time, you may also consider a second opinion. You can also call the Avera Navigation Center 24/7 at 888-422-1410 for questions – available to both Avera and non-Avera patients.
