Biopsies may be used to help diagnose your cancer, or later on if a test turns up something during a post-treatment follow-up. During the procedure, a surgeon removes a small amount of tissue, which will then be examined under a microscope to determine the type of cells it contains and if they are cancerous. There are different types of biopsies, which include:
Fine needle aspiration biopsy: A thin, hollow needle attached to a syringe that’s inserted to collect cells from a small area
Core needle biopsy: A slightly larger, hollow needle that collects a cylinder of tissue. This type is chosen over the fine needle version if the doctor requires more tissue to analyze.
Surgical biopsy: An incision in the skin is made to remove some or all of the suspicious tissue. Surgical biopsies often occur only after a needle biopsy shows evidence of cancer. There are two types:
Vacuum-assisted biopsy: A hollow needle that allows a tissue sample to be extracted via suction. This type is chosen if the doctor requires multiple or larger samples from the same site, as it avoids having to insert the needle multiple times.
Imaging tests help determine whether cancer has spread to other areas in the body and to evaluate the size and location of a tumor. They are almost always used in conjunction with biopsies and/or blood tests when diagnosing. There are different types of imaging tests, which include:
X-ray: A device that uses radiation to take images of the inside of your body. X-rays specifically for the breast are called mammograms.
Dual-energy X-ray absorptiometry (DXA) or bone scan: An X-ray that helps doctors see inside your bones to determine their strength and locate any possible tumors. These may be given throughout cancer treatment to be sure your bones aren’t thinning.
CT or CAT scan: A three-dimensional X-ray machine that gives a cross-sectional view of the inside of the body
Positron emission tomography (PET) scan: A scan that helps locate a tumor using a radioactive tracer. Patients take a small amount of radioactive sugar, which is used by parts of the body that produce the most energy. Because cancer tends to be extremely active, it absorbs more of the substance and the area is easily seen on the scan images.
MRI: A scan that uses magnetic fields to produce images of the inside of the body
Ultrasound: A scan that uses sound waves to produce images of the inside of the body
Laboratory tests involve testing blood, urine and/or other body fluids. They can be used as part of the diagnosis process, as well as to monitor your health during treatment. Here are some you may encounter or want to ask about:
Hormone receptor tests: These can be done using tissue from your initial biopsy and/or from your surgery to determine whether the hormones estrogen, progesterone or both are fueling your cancer’s growth.
HER2 (human epidermal growth factor receptor 2): This test determines whether your cancer cells have HER2 receptors on their surfaces, which means they grow rapidly when a specific protein latches onto them. A targeted treatment called Herceptin is now available for these cancers.
OncotypeDX™: This is a test that studies the activity of 21 genes within a tumor to find out if chemotherapy can be helpful, and to help gauge the likelihood that the cancer will return. It is specifically used for those with favorable prognostic factors (estrogen receptor positive and Her2 negative) and serves as a tool for determining whether you would benefit from chemotherapy or hormonal therapy.
Complete blood count (CBC): When you’re on chemo, getting a blood test called a CBC (complete blood count) becomes part of the routine. It’s usually done right before you get your chemo and then about two weeks later to make sure the chemo isn’t causing your blood cell levels (red blood cells, white blood cells and platelets) to fall out of a healthy range. If they do, your doctor can prescribe medication to help you stay on course. Other blood tests may look for: