BIOPSY BASICS: What a Biopsy Reveals

Advocates for Breast Cancer: Biopsy Basics

In our last blog we explained what a biopsy is, the 3 different kinds of biopsy that can be performed – as well as what to expect if you are going to have one done. But what exactly will the doctor be looking for when the results come through?

From an advocacy aspect, the same diagnostic tools are used in both the Public and Private sector in South Africa – and a management decision is made by a team of specialists using all the information they can get. eg. (This will include the size of the tumour and whether it has moved into the lymph system.)

If the biopsy results show the presence of cancer, the doctor will also be able to see exactly what kind of breast cancer you have. And because there are so many different types of breast cancer, a wide variety of treatment options are available.

In terms of our goal of lobbying government to create an implement an effective and equitable BREAST HEALTH POLICY, this is an important fact to note: malaria or TB are ‘single’/simple diseases which only need one kind of treatment — thus making them more ‘affordable’ diseases for the government to manage, as opposed to the complex — and expensive — variety of breast cancer treatments!

The biopsy results help the surgeon and the oncologist to decide on the right treatment for the right patient at the right time. Tumours can be separated into 4 main types based on their ‘histological’ type (i.e. the type of tissue where the cancer originates), the grade of tumour (how fast it is growing) and whether the breast cancer cells have receptors for the hormones, oestrogen and progesterone. These hormone receptors are proteins (found in and on breast cells) which pick up hormone ‘signals’, telling the cells to grow.

Therefore, a cancer is called oestrogen-receptor-positive (ER+) if it has receptors for oestrogen. A cancer is progesterone-receptor-positive (PR+) if it has progesterone receptors. This means: cancer cells can receive signals from hormones which could make them grow faster.

***FACT: about 2 out of every 3 breast cancers test positive for hormone receptors.***

Her-2-neu Oncogene: A biopsy will also tell the doctor about the cancer’s Her-2-neu oncogene status — i.e. if there is a genetic link to the type of cancer you have. (Watch the video below for an excellent visual summary of Her-2-neu.)

 

Guest post by Dr Judith Whittaker, consulting pathologist.

Dr Judith Whittaker - Oncologist

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What is a Tissue Biopsy?

Advccates for Breast Cancer - South Africa - Types of Biopsies

One of the things that could happen as part of the breast cancer diagnosis process is that the doctor may ask for a tissue biopsy.

‘Tissue‘ is one of those words that can be confusing, especially if English is not your first language. In medical terms, tissue is the name given to a group of cells that perform the same function.

For a biopsy, a small sample of tissue will be taken from your body so that it can be examined more closely, deeply and thoroughly. (In many cases, an operation isn’t needed for a sample to be taken.)

The  type of tissue that needs to be removed and where it is situated in your breast will determine what type of biopsy you will need.

TYPES OF BIOPSIES:

  1. The doctor may use a fine needle attached to a syringe (see below) to remove a small amount of tissue from the suspicious area – called fine needle aspiration. (The needle is so thin that you’ll very little.)Advocates for Breast Cancer - South Africa - fine needle aspiration - FNA
  2.  If the doctor needs a larger amount of tissue, a core needle biopsy may be done which uses a fatter, hollow needle. As a result, this type of biopsy is somewhat more paintful, but be assured the area will be numbed before insertion of the needle. Whilst tenderness and/bruising typically occur after the procedure, no scarring occurs.
  3. Sometimes a surgical biopsy may be needed which can be done under either local or general anaesthetic, depending on where in the breast the lump actually is. (A whole lump can sometimes be removed for examination.)

TAKEAWAY: What happens to the tissue after it’s been removed from the breast? We found this fantastic explanation for you: The Journey of a Tissue Biopsy!

***ALSO: Here is a Biopsy FACT SHEET to download and print!

 

Rebecca Musi: Kilimanjaro Conquerer


“In 2001 I had a rough innings with breast cancer.

I detected a lump through breast self examination. It was not easy, however I bundled myself off to Chris Hani Baragwanath Hospital Breast Clinic where a mammogram and fine needle aspiration were done. Lo and behold the words I detested hearing came out of the doctor’s mouth:“You have breast cancer”. I went through a rollercoaster of emotions: from anger to denial and flooded with questions which didn’t have answers. Throughout this time I thought it was a bad dream that would be over in no time.

My message to people is: Don’t delay – and don’t think your symptoms are going to go away as if some fairy has waved a magic wand. When it hits, cancer strikes fear into everybody.

As a single mom, I wondered what was going to happen to my son. How was he doing to cope? I thought to myself …. Nkosi yam, Don’t make any plans.  There’s no shame and embarrassment feeling down and having a good cry – just for a few days. But it’s no good feeling sorry for yourself in the long term and thinking, “Why me?  Woe is me!” Sitting and crying doesn’t help. You’ve got to have a good go at beating this monster because otherwise it’s going to beat you. I said to myself, “Listen, this isn’t going to get rid of the cancer. I’ve got to pick myself up and say: Right, what are we going to do?”

I underwent lumpectomy surgery to remove the lump, as well as six courses of chemotherapy and 35 days of radiotherapy. Thereafter I was put on hormonal therapy as I had oestrogen positive breast cancer.  I got myself ‘buddies’ (fellow cancer patients) along the journey. We shared our moments that no-one else understands. During visits to the hospital for chemo we’d reminisce about the side effects. One day one of the guys took out a huge container of Zambuk that he used for his extremely dry mouth – Walla! We had Zambuk containers coming out of pockets and handbags. We had a Zambuk* party! The frank, fighting spirit kept us together during months of treatment.

After chemo gave the cancer its powerful kick: 35 daily sessions of radiotherapy followed.  This phase I called the “Poly Shorts” of my journey (a reference to South Africa’s epic Comrades Marathon). Don’t let anybody tell you this treatment is a picnic. It’s not just unpleasant, it’s a whole lot more awful than that. Every day it was all about having the treatment and getting through it, getting through the day to get to the next day. You have to stay focused and positive because it is easylet it get you down.

The support I got from my family and friends kept my hopes high.Though they did not understand anything about breast cancer they kept a diary of my appointments and would phone for constant feedback from my hospital visits.

I am pleased to be here. I am living proof that you can recover. When you have something as drastic as cancer, it doesn’t change who you are or your basic characteristics. It gives you a different perspective, a softer outlook on life. What I’ve learned is that breast cancer can affect anyone, which is why it is so important to take care of yourself and do monthly self breast examinations and annual mammograms – no matter what your risk profile.  When I was diagnosed I knew very little about breast cancer and would not like anyone being in my position. I now work for the Breast Health Foundation and there’s no work more fulfilling than educating and empowering women with regards to breast health issues, as well as providing emotional and informative support to those diagnosed with breast cancer.

Before I was diagnosed with breast cancer I just lived, now I live strong. As I celebrated each year of survivorship, I started to call deep into my courage and dream bigger. In 2013, to celebrate 10 years of survivorship and to help raise funds for breast health education, together with 10 other ladies, I conquered Africa’s highest peak, Mount Kilimanjaro. The climb was not about me — it was about millions of people facing breast cancer who need support as they fight the toughest battle of their lives. Together we can make a difference.  

Kilimanjaro

My motto:  By serving you can heal, bring hope and remove depression.  Service can heal without you knowing.

Next month I’ve been entrusted with the responsibility to represent the Republic of South Africa’s breast cancer survivors and ABC at a Metastatic Breast Cancer conference held in Taipei. It is a huge responsibility – however, I guess with the ‘peaks’ I had to overcome, I’m tested and tried. I’ve got the stamina, strength and courage for this task.”


 

Zambuk*‘Zambuk – the Real Makoya‘: a much loved South African green-coloured, eucalyptus balm which fixes everyting from chapped lips, cuts and scratches, tight chests, blocked noses, itchy bites and bee stings!