Breast cancers grow at widely differing rates shows the size in centimeters. The fastest can double in size in about thirty days; the slowest doubles in about 200 days; the average time is four months.
In its earliest stages the growth is confined to the membrane lining the lobule or the ducts. At this stage it cannot spread to distant parts of the body. Eventually, however, the cells grow through the wall of the duct or lobule into the fatty tissue that makes up the bulk of the breast. The tumor must be about one centimeter less than one half inch before a trained person can feel it. (Of course, it is more difficult to feel a growth deep within a large breast.)
By this time the cancer may have existed for as long as two years. During this time cancer cells may have escaped from the breast through the veins or the lymph vessels. The spread of cancer through the lymph system is quite common in breast cancer. Cancer cells may collect in axillary lymph nodes, which act as filtration stations in the armpit, just below the collarbone. From there they may spread to other parts of the body. Since these lymph nodes are usually the first way station in the spread of a breast cancer, their study is a most valuable indicator of whether the cancer has metastasized to other parts of the body. The fewer of these underarm lymph nodes that are found to contain cancer cells, the better the prognosis is, with respect to both survival and recurrence.
The most common sites of metastases are the lungs, liver, brain, and bones. If the biopsy does show breast cancer, a number of other tests, including X rays, blood tests, and body scans will be performed to determine whether the cancer has spread. If a mastectomy is to be done immediately after the biopsy in the one-step procedure, these tests should be done before the mastectomy.
Another important test, and one that should be done in all breast cancer biopsies, is the estrogen and progesterone receptor assay. This is performed on a bit of fresh tumor tissue to see whether the cancer’s growth is increased by estrogen or progesterone, hormones that vary every month in the bodies of pre menopausal women. About 40 percent of breast cancers contain receptors for estrogen. In about two thirds of these cases the tumors will shrink if the body is deprived of estrogen, either by removal of the glands that manufacture this hormone, or by administration of drugs or other hormones to counter it. These receptor tests are important in determining whether hormone manipulation should be undertaken and if so, what kind, or whether chemotherapy should be given when breast cancer recurs.
About 50 percent of all breast cancers develop in the upper outer quadrant of the breast;
shows where the others arise. In their early stages, most breast cancers do not produce pain. Still, recurrent or ill-defined breast pain should be investigated by a doctor.