Further tests for breast cancer
This page tells you about the tests you may go on to have after a diagnosis of breast cancer. There is information about
Further tests for breast cancer
If tests show that you have breast cancer you will have some further tests. These tests check the size of the cancer and whether there is any spread to nearby lymph nodes or to other parts of the body. They tell the doctor the stage of the cancer. The stage is important because it helps your doctor to decide on the best treatment for you.
Your doctor will test your breast cancer cells to see if they have receptors for hormones or other proteins (such as HER2). This helps the doctor to know whether hormone therapies or biological therapies (such as Herceptin) might work for you.
Blood test and chest X-ray
Most women have blood tests and some have a chest X-ray. Nearly everyone diagnosed with breast cancer has surgery, and these tests are part of the standard preparation before surgery.
You may need to have one or more scans. This might be to get a better picture of your breast cancer. Or it may be to see if the cancer has spread to your lymph nodes, liver or bones. Ultrasound, CT, MRI and bone scans are all used.
Waiting for your results
Waiting can be an anxious time. It may help to talk about your worries with a partner, close friend or relative. The breast clinic may have a trained breast care nurse or counsellor who can talk to you. Or you can contact a support group or an online forum such as CancerChat.
You can view and print the quick guides for all the pages in the Diagnosing breast cancer section.
If tests show that you have breast cancer you will need to have further tests. The tests check the size of the cancer and whether there is any spread to nearby 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 your doctor to decide on the best treatment for you.
Most women have blood tests and some have a chest X-ray. These may be done as part of standard preparation before surgery. Your doctor will also test your breast cancer cells 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.
For most people, a breast X-ray (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 is vital in planning the type of surgery you need. But in some people, these scans don't give the surgeon enough information. 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 may also use MRI scans for women with lobular breast cancer to help them decide if removing only the area of the cancer (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. Doctors may also use them to scan the opposite breast.
Ultrasound scans use sound waves to build up a picture of the inside of the body. If you have early breast cancer you 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 put a fine needle into the 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). Or, under local anaesthetic they may take a sample of cells from the node using a needle biopsy.
If the lymph nodes contain cancer cells the surgeon will remove more 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.
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. You can read our information about having a bone scan.
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. So it can be hard to see if a bone scan is showing areas of cancer or changes caused by other conditions such as an old fracture or 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 doctor will test your breast cancer cells to see if they have receptors for the female hormones, oestrogen or progesterone. Cells that have lots of oestrogen receptors are called oestrogen receptor positive. Cells that have lots of progesterone 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 doctor will also test your breast cancer cells 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 trastuzumab (Herceptin), are more likely to work well on HER2 positive cancers. The results of these receptor tests may take a couple of weeks.
Your doctor may ask you to have several other tests. They are useful for different situations. CT scans are a sophisticated type of X-ray. PET scans 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 laboratory 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 a very anxious time. It may help to talk about your worries with a partner, close friend or relative. You can phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. They will be happy to answer any questions that you have.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.
If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.
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