Breast Cancer diagnosis confirmed! – What should I do now?
Step 0
- Initial breast lump was investigated via triple assessment which consists of clinical examination, breast imaging and breast biopsy to confirm the diagnosis of breast cancer
Step 1
- Immunohistochemistry (IHC) test is now recommended to be carried out on the breast tissue biopsy to provide further information on the molecular subtypes of breast cancer eg
- Hormone receptor status (ER/ PR positive or negative)
- Her2 receptor status
- Ki 67 proliferative index
- Knowing the molecular subtypes of breast cancer will guide you to make a better decision on your following treatment eg choices of surgery and adjuvant therapy
Step 2
- Whole body staging is also recommended and can be done concurrently while waiting for the IHC report to determine the spread of cancer and provide decision for treatment.
- CT scan whole body (usually done)
- PET-CT scan whole body (better choice)
- Chest xray and ultrasound abdomen and pelvis (minimally)
- MRI Brain (on selective cases)
- As a general rule, if the cancer is in early stage 1 or 2, then surgery can be offered first followed by adjuvant treatment if necessary
- However, if the cancer has spread to stage 3 or 4, then its advisable to proceed with neoadjuvant chemotherapy first before surgery
Step 3
- Once IHC test and Staging is done, your surgeon or oncologist will discussed the next step of treatment which is either surgery or neoadjuvant treatment
- Surgery choices
- Lumpectomy / Breast conserving surgery
- Total mastectomy with/out reconstruction
- Axillary surgery – Sentinel node biopsy or Axillary dissection
- Neoadjuvant treatment
- Chemotherapy treatment given first to reduce the size of the tumor so that more surgical options are available
Please Note
Some doctors or centers may not offer the choice for IHC test and staging first before surgery. This is at their discretion; hence please kindly ask about it.