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Inflammatory Breast Cancer

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Inflammatory Breast Cancer

Breast Anatomy BreastCancer Female

Image by TheVisualMD

What Is

Breast Cancer Cross Section

Image by TheVisualMD

What Is Inflammatory Breast Cancer?

Inflammatory breast cancer is a rare and very aggressive disease in which cancer cells block lymph vessels in the skin of the breast. This type of breast cancer is called “inflammatory” because the breast often looks swollen and red, or inflamed.

Inflammatory breast cancer is rare, accounting for 1 to 5 percent of all breast cancers diagnosed in the United States. Most inflammatory breast cancers are invasive ductal carcinomas, which means they developed from cells that line the milk ducts of the breast and then spread beyond the ducts.

Inflammatory breast cancer progresses rapidly, often in a matter of weeks or months. At diagnosis, inflammatory breast cancer is either stage III or IV disease, depending on whether cancer cells have spread only to nearby lymph nodes or to other tissues as well.

Additional features of inflammatory breast cancer include the following:

Compared with other types of breast cancer, inflammatory breast cancer tends to be diagnosed at younger ages.
Inflammatory breast cancer is more common and diagnosed at younger ages in African American women than in white women.
Inflammatory breast tumors are frequently hormone receptor negative, which means they cannot be treated with hormone therapies, such as tamoxifen, that interfere with the growth of cancer cells fueled by estrogen.
Inflammatory breast cancer is more common in obese women than in women of normal weight.

Like other types of breast cancer, inflammatory breast cancer can occur in men, but usually at an older age than in women.

Source: National Cancer Institute (NCI)

Additional Materials (9)

4:34

Inflammatory breast cancer Q & A | Dana-Farber Cancer Institute

Dana-Farber Cancer Institute/YouTube

3:12

Life After Inflammatory Breast Cancer | Dana-Farber Cancer Institute

Dana-Farber Cancer Institute/YouTube

2:09

Inflammatory Breast Cancer: Know the symptoms | Dana-Farber/Brigham & Women's Cancer Center

Dana-Farber Cancer Institute/YouTube

8:17

Inflammatory Breast Cancer - Suzy's Story

Mayo Clinic/YouTube

1:17

Inflammatory breast cancer survivor finds hope with clinical trial

MD Anderson Cancer Center/YouTube

1:59

How MD Anderson treats inflammatory breast cancer (IBC)

MD Anderson Cancer Center/YouTube

2:05

Diagnosis of Inflammatory Breast Cancer

MD Anderson Cancer Center/YouTube

2:33

Inflammatory Breast Cancer Treatment

MD Anderson Cancer Center/YouTube

Understanding Breast Changes: A Health Guide for Women

National Cancer Institute

Symptoms

Breast Cancer, Inflammatory

Image by © 2022 Terese Winslow, U.S. Govt. has certain rights

What Are the Symptoms of Inflammatory Breast Cancer?

Symptoms of inflammatory breast cancer include swelling (edema) and redness (erythema) that affect a third or more of the breast. The skin of the breast may also appear pink, reddish purple, or bruised. In addition, the skin may have ridges or appear pitted, like the skin of an orange (called peau d'orange). These symptoms are caused by the buildup of fluid (lymph) in the skin of the breast. This fluid buildup occurs because cancer cells have blocked lymph vessels in the skin, preventing the normal flow of lymph through the tissue. Sometimes the breast may contain a solid tumor that can be felt during a physical exam, but more often a tumor cannot be felt.

Other symptoms of inflammatory breast cancer include a rapid increase in breast size; sensations of heaviness, burning, or tenderness in the breast; or a nipple that is inverted (facing inward). Swollen lymph nodes may also be present under the arm, near the collarbone, or both.

It is important to note that these symptoms may also be signs of other diseases or conditions, such as an infection, injury, or another type of breast cancer that is locally advanced. For this reason, women with inflammatory breast cancer often have a delayed diagnosis of their disease.

Source: National Cancer Institute (NCI)

Additional Materials (4)

Breast Cancer, Inflammatory

© 2007 Terese Winslow, U.S. Govt. has certain rights

2:04

How to Identify the Symptoms of Inflammatory Breast Cancer | Dana-Farber Cancer Institute

Dana-Farber Cancer Institute/YouTube

6:10

Inflammatory Breast Cancer Program | Dana-Farber Cancer Institute

Dana-Farber Cancer Institute/YouTube

2:09

Inflammatory Breast Cancer: Know the symptoms | Dana-Farber/Brigham & Women's Cancer Center

Dana-Farber Cancer Institute/YouTube

Diagnosis

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Female Breast with Cancer

Image by TheVisualMD

How Is Inflammatory Breast Cancer Diagnosed?

Inflammatory breast cancer can be difficult to diagnose. Often, there is no lump that can be felt during a physical exam or seen in a screening mammogram. In addition, most women diagnosed with inflammatory breast cancer have dense breast tissue, which makes cancer detection in a screening mammogram more difficult. Also, because inflammatory breast cancer is so aggressive, it can arise between scheduled screening mammograms and progress quickly. The symptoms of inflammatory breast cancer may be mistaken for those of mastitis, which is an infection of the breast, or another form of locally advanced breast cancer.

To help prevent delays in diagnosis and in choosing the best course of treatment, an international panel of experts published guidelines on how doctors can diagnose and stage inflammatory breast cancer correctly. Their recommendations are summarized below.

Minimum criteria for a diagnosis of inflammatory breast cancer include the following:

A rapid onset of erythema (redness), edema (swelling), and a peau d'orange appearance (ridged or pitted skin) and/or abnormal breast warmth, with or without a lump that can be felt.
The above-mentioned symptoms have been present for less than 6 months.
The erythema covers at least a third of the breast.
Initial biopsy samples from the affected breast show invasive carcinoma.

Further examination of tissue from the affected breast should include testing to see if the cancer cells have hormone receptors (estrogen and progesterone receptors) or if they have greater than normal amounts of the HER2 gene and/or the HER2 protein (HER2-positive breast cancer).

Imaging and staging tests include the following:

A diagnostic mammogram and an ultrasound of the breast and regional (nearby) lymph nodes
A PET scan or a CT scan and a bone scan to see if the cancer has spread to other parts of the body

Proper diagnosis and staging of inflammatory breast cancer helps doctors develop the best treatment plan and estimate the likely outcome of the disease. Patients diagnosed with inflammatory breast cancer may want to consult a doctor who specializes in this disease.

Source: National Cancer Institute (NCI)

Additional Materials (3)

1:49

Inflammatory breast cancer diagnosis and treatment

MD Anderson Cancer Center/YouTube

2:05

Diagnosis of Inflammatory Breast Cancer

MD Anderson Cancer Center/YouTube

4:01

Two Minute Techniques - Inflammatory Breast Cancer

MAMMOGUIDE.COM/YouTube

Mammogram

Mammogram

Also called: Breast Cancer Screening - Mammography, Screening Mammography, Diagnostic Mammography

A mammogram is a low-dose x-ray picture of the breast. A mammogram is used to look for early signs of breast cancer. Regular mammograms are the best tests doctors have to find breast cancer early, sometimes up to three years before it can be felt.

Mammogram

Also called: Breast Cancer Screening - Mammography, Screening Mammography, Diagnostic Mammography

A mammogram is a low-dose x-ray picture of the breast. A mammogram is used to look for early signs of breast cancer. Regular mammograms are the best tests doctors have to find breast cancer early, sometimes up to three years before it can be felt.

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Use the slider below to see how your results affect your health.
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Your result is Negative.
This score confirms that your mammogram results are negative, indicating that the breast tissue shows no signs of a mass or calcifications. However, it’s important to continue regular screening mammograms.
Related conditions
- Screening mammograms are done for women who have no symptoms of breast cancer. It usually involves two x-rays of each breast. Screening mammograms can detect lumps or tumors that cannot be felt. They can also find microcalcifications or tiny deposits of calcium in the breast, which sometimes mean that breast cancer is present.
- Diagnostic mammograms are used to check for breast cancer after a lump or other symptom or sign of breast cancer has been found. Signs of breast cancer may include pain, thickened skin on the breast, nipple discharge, or a change in breast size or shape. This type of mammogram also can be used to find out more about breast changes found on a screening mammogram, or to view breast tissue that is hard to see on a screening mammogram. A diagnostic mammogram takes longer than a screening mammogram because it involves more x-rays in order to obtain views of the breast from several angles. The technician can magnify a problem area to make a more detailed picture, which helps the doctor make a correct diagnosis.
A digital mammogram also uses x-rays to produce an image of the breast, but instead of storing the image directly on film, the image is stored directly on a computer. This allows the recorded image to be magnified for the doctor to take a closer look. Current research has not shown that digital images are better at showing cancer than x-ray film images in general. But, women with dense breasts who are pre- or perimenopausal, or who are younger than age 50, may benefit from having a digital rather than a film mammogram. Digital mammography may offer these benefits:
- Long-distance consultations with other doctors may be easier because the images can be shared by computer.
- Slight differences between normal and abnormal tissues may be more easily noted.
- The number of follow-up tests needed may be fewer.
- Fewer repeat images may be needed, reducing exposure to radiation.
A mammogram is a low-dose x-ray exam of the breasts to look for changes that are not normal. A mammogram allows the doctor to have a closer look for changes in breast tissue that cannot be felt during a breast exam. Women ages 50 to 74 years should get a mammogram every 2 years. Women younger than age 50 should talk to a doctor about when to start and how often to have a mammogram.
Mammograms can not find all problems. So, every woman should work with her doctor to check her breasts. Call your doctor or clinic if you notice any change in your breasts like:
- a lump
- thickening
- liquid leaking from the nipple or changes in how the nipple looks
First, check with the place you are having the mammogram for any special instructions you may need to follow before you go. Here are some general guidelines to follow:
- If you are still having menstrual periods, try to avoid making your mammogram appointment during the week before your period. Your breasts will be less tender and swollen. The mammogram will hurt less and the picture will be better.
- If you have breast implants, be sure to tell your mammography facility that you have them when you make your appointment.
- Wear a shirt with shorts, pants, or a skirt. This way, you can undress from the waist up and leave your shorts, pants, or skirt on when you get your mammogram.
- Don't wear any deodorant, perfume, lotion, or powder under your arms or on your breasts on the day of your mammogram appointment. These things can make shadows show up on your mammogram.
- If you have had mammograms at another facility, have those x-ray films sent to the new facility so that they can be compared to the new films.
- Tell the clinic if you have physical disabilities that may make it hard for you to sit up, lift your arms, or hold your breath.
- Talk with the staff about how they will handle issues of modesty that you may have due to your religion.

Breast tissue that shows no signs of a mass or calcifications is considered normal. Most abnormal findings on a screening mammogram turn out to be benign (not cancer) or nothing to worry about. New findings or changes must be further evaluated.

What can mammograms show?

The radiologist will look at your x-rays for breast changes that do not look normal and for differences in each breast. He or she will compare your past mammograms with your most recent one to check for changes. The doctor will also look for lumps and calcifications.

Possible mammogram findings include:

Lumps (mass or tumor). Lumps come in different sizes and shapes. Fluid-filled cysts are usually smooth and rounded, with clear, defined edges and are not cancer. Lumps that have a jagged outline and an irregular shape are of more concern.
Calcifications. There are two types of breast calcifications, or calcium deposits:
- Macrocalcifications, which look like small white dots on a mammogram. They are often caused by aging, an old injury, or inflammation and are usually benign.
- Microcalcifications, which look like white specks on a mammogram. If found in an area of rapidly dividing cells or grouped together in a certain way, they may be a sign of DCIS or breast cancer.
Dense breast tissue: A dense breast has relatively less fat and more glandular and connective tissue. This mammogram finding is both common and normal, especially among younger women and women who use menopausal hormone therapy. Dense breast tissue can make a mammogram more difficult to interpret because both dense breast tissue and breast tumors appear as solid white areas in the image.

What happens if my mammogram is normal?

Continue to get mammograms according to recommended time intervals. Mammograms work best when they can be compared with previous ones. This allows the radiologist to compare them to look for changes in your breasts.

What happens if my mammogram is abnormal?

An abnormal mammogram does not always mean that there is cancer. But you will need to have additional mammograms, tests, or exams before the doctor can tell for sure. You may also be referred to a breast specialist or a surgeon. It does not necessarily mean you have cancer or need surgery. These doctors are experts in diagnosing breast problems. Doctors may order some of these tests:

Diagnostic mammogram, to focus on a specific area of the breast
Ultrasound, an imaging test that uses sound waves to create a picture of your breast. The pictures may show whether a lump is solid or filled with fluid. A cyst is a fluid-filled sac. Cysts are not cancer. But a solid mass may be cancer. After the test, your doctor can store the pictures on video or print them out. This exam may be used along with a mammogram.
Magnetic resonance imaging (MRI), which uses a powerful magnet linked to a computer. MRI makes detailed pictures of breast tissue. Your doctor can view these pictures on a monitor or print them on film. MRI may be used along with a mammogram.
Biopsy, a test in which fluid or tissue is removed from your breast to help find out if there is cancer. Your doctor may refer you to a surgeon or to a doctor who is an expert in breast disease for a biopsy.

What is the Breast Imaging Reporting and Database System (BI-RADS®)?

The American College of Radiology (ACR) has established a uniform way for radiologists to describe mammogram findings. The system, called BI-RADS, includes seven standardized categories, or levels. Each BI-RADS category has a follow-up plan associated with it to help radiologists and other physicians appropriately manage a patient’s care.

Breast Imaging Reporting and Database System (BI-RADS)

Category	Assessment	Follow-up
0	Need additional imaging evaluation	Additional imaging needed before a category can be assigned
1	Negative	Continue regular screening mammograms
2	Benign (noncancerous) finding	Continue regular screening mammograms
3	Probably benign	Receive a 6-month follow-up mammogram
4	Suspicious abnormality	May require biopsy
5	Highly suggestive of malignancy (cancer)	Requires biopsy
6	Known biopsy-proven malignancy (cancer)	Biopsy confirms presence of cancer before treatment begins

BI-RADS also includes four categories of breast density that may be reported. The radiologist who reads the mammogram chooses the category that best describes the level of breast density seen on the mammogram film. The categories, from the least amount of breast density to the highest, are as follows:

The breasts are almost entirely fatty
There are scattered areas of dense glandular tissue and fibrous connective tissue (together known as fibroglandular density)
The breasts are heterogeneously dense, which means they have more of these areas of fibroglandular density. This may make it hard to see small masses in the breast tissue on a mammogram.
The breasts are extremely dense, which makes it hard to see tumors in the breast tissue on a mammogram.

Many states in the U.S. have enacted laws requiring mammography providers to tell women if they have dense breasts (i.e., breasts that are heterogeneously or extremely dense on a mammogram) and to inform them of risks associated with having dense breasts. In addition to making mammograms harder to read, dense breasts are a risk factor for breast cancer.

Although they are not perfect, mammograms are the best method to find breast changes that cannot be felt. If your mammogram shows a breast change, sometimes other tests are needed to better understand it. Even if the doctor sees something on the mammogram, it does not mean it is cancer.
As with any medical test, mammograms have limits. These limits include:
- They are only part of a complete breast exam. Your doctor also should do a clinical breast exam. If your mammogram finds something abnormal, your doctor will order other tests.
- Finding cancer does not always mean saving lives. Even though mammography can detect tumors that cannot be felt, finding a small tumor does not always mean that a woman's life will be saved. Mammography may not help a woman with a fast growing cancer that has already spread to other parts of her body before being found.
- False negatives can happen. This means everything may look normal, but cancer is actually present. False negatives don't happen often. Younger women are more likely to have a false negative mammogram than are older women. The dense breasts of younger women make breast cancers harder to find in mammograms.
- False positives can happen. This is when the mammogram results look like cancer is present, even though it is not. False positives are more common in younger women, women who have had breast biopsies, women with a family history of breast cancer, and women who are taking estrogen, such as menopausal hormone therapy.
- Mammograms (as well as dental x-rays and other routine x-rays) use very small doses of radiation. The risk of any harm is very slight, but repeated x-rays could cause cancer. The benefits nearly always outweigh the risk. Talk to your doctor about the need for each x-ray. Ask about shielding to protect parts of the body that are not in the picture. You should always let your doctor and the technician know if there is any chance that you are pregnant.
1. https://www.womenshealth.gov/a-z-topics/mammograms [accessed on Feb 16, 2019]
2. https://www.nibib.nih.gov/science-education/science-topics/mammography [accessed on Feb 16, 2019]
3. https://www.cdc.gov/cancer/breast/basic_info/mammograms.htm [accessed on Feb 16, 2019]
4. https://www.cancer.gov/types/breast/mammograms-fact-sheet [accessed on Feb 16, 2019]
5. https://www.cancer.gov/types/breast/breast-changes#ui-id-4 [accessed on Feb 16, 2019]
6. https://www.fda.gov/ForConsumers/ByAudience/ForWomen/WomensHealthTopics/ucm117967.htm [accessed on Feb 16, 2019]
7. https://medlineplus.gov/ency/article/003380.htm [accessed on Feb 16, 2019]
8. https://www.healthline.com/health/birads-score [accessed on Feb 16, 2019]
9. https://www.acr.org/-/media/ACR/Files/RADS/BI-RADS/Mammography-Reporting.pdf [accessed on Feb 16, 2019]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (48)

Mammography Fact Sheet

Mammography is an x-ray imaging method used to examine the breast for the early detection of cancer and other breast diseases. It is used as both a diagnostic and screening tool.

Document by www.nibib.nih.gov

Mammograms

Document by Office on Women's Health, U.S. Department of Health and Human Services

Top Four Mammogram Myths

Knowing the truth about mammograms could help save your life, or the life of someone you love. Over 60% of breast cancer cases are diagnosed before they spread. Nearly 90% of women who find and treat their breast cancer are cancer-free at five years. Mammograms can help reduce the number of deaths from breast cancer among women ages 40 to 70.

Image by The U.S. Food and Drug Administration

Screening for Cancer

Common Screening Tests and American Cancer Society Recommendations

Image by TheVisualMD

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Mammography

A woman getting a mammogram, showing a cone in position on her right breast.

Image by National Cancer Institute / Unknown Illustrator

Mammography

Image by BruceBlaus

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Mammogram

An adult female is assisted in a mammogram machine by an African-American technician.

Image by National Cancer Institute / Alan Hoofring (Illustrator)

Woman Having Mammogram

Photograph of woman having mammogram. Mammograms are considered the gold standard for breast cancer screening. Mammography requires the breasts to be compressed between plates while the image is captured. Typically, two views are taken of the breast: cranial-caudal (top to bottom) and mediolateral oblique (angled side view).

Image by TheVisualMD

Mammography

Mammogram being conducted

Image by CDC

Woman Receives Mammogram

An African-American female technician positions a Caucasian woman at an imaging machine to receive a mammogram.

Image by National Cancer Institute / Rhoda Baer (Photographer)

Woman Receives Mammogram

A Caucasian female technician positions an Asian woman at an imaging machine to receive a mammogram.

Image by National Cancer Institute / Rhoda Baer (Photographer)

Woman Receives Mammogram

A Caucasian female technician positions a Hispanic woman at an imaging machine to receive a mammogram.

Image by National Cancer Institute / Rhoda Baer (Photographer)

Woman Receives Mammogram

An Asian female technician positions an African-American woman at an imaging machine to receive a mammogram.

Image by National Cancer Institute / Rhoda Baer (Photographer)

Mammography Patient

A female technician prepares to give an older Caucasian female patient a mammogram. the patient is preparing for the exam next to machine with technician in background adjusting controls.

Image by National Cancer Institute / Bill Branson (Photographer)

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Mammography

A woman's breast being compressed to get the optimum mammographic image.

Image by National Cancer Institute / Bill Branson (Photographer)

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Mammography

A Caucasian female patient, while sitting, is receiving a mammogram with a technician is standing in the background. The conical tip is compressing the right breast and the left breast is visible. Note the older machine.

Image by National Cancer Institute / Unknown Photographer

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Mammography

A Caucasian female patient receives a lateral mammogram treatment. She is lying on her left side with the left breast compressed and she is holding her right breast out of the way so as to not block the x-ray. Note the older methods of the diagnostic procedure.

Image by National Cancer Institute / Unknown Photographer

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Mammography

A female Caucasian radiology technician preparing a 42 year old Caucasian woman for a mammogram. The technician is positioning the paddle that compresses the breast. The patient's face is turned towards the technician, away from the camera, and her right shoulder and breast are exposed.

Image by National Cancer Institute / Bill Branson (Photographer)

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Mammography

A female Caucasian radiology technician preparing a 42 year old Caucasian woman for a mammogram. The technician is positioning the paddle used to compress the breast. The patient's face is turned towards the technician, away from the camera, with her right shoulder and breast are exposed.

Image by National Cancer Institute / Bill Branson (Photographer)

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Mammography Patient

A female Caucasian radiology technician preparing a 42 year old Caucasian woman for a mammogram. The technician is positioning the paddle used to compress the breast. The patient's face is turned towards the technician, away from the camera. Her right shoulder is raised obscuring the breast.

Image by National Cancer Institute / Bill Branson (Photographer)

Male Breast Cancer

Senior Airman Elisabeth Stone compresses a male patient's breast tissue during a baseline screening of mammogram at Joint Base Elmendorf-Richardson, Alaska

Image by Staff Sgt. Sheila deVera

Doctor Viewing Mammogram

A doctor examines mammograms on a view box.

Image by National Cancer Institute / Bill Branson (photographer)

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Mammogram Showing Dense And Fatty Breasts

Title Mammogram Showing Dense And Fatty Breasts Description A side-by-side of two normal mammograms showing the difference between a dense breast (left) and a fatty breast (right). The dense breast is that of a woman aged 39, the fatty breast is that of a 59-year old woman. Abnormal lesions are easier to detect and diagnose in a fatty breast making mammography more accurate.

Image by Dr. Kathy Cho. NIH Radiology / National Cancer Institute

Abnormal Mammogram

This abnormal mammogram is not necessarily cancerous. Also seen are calcifications through ductal patterns. Patient would be avised to have follow-up at 3-month intervals.

Image by National Cancer Institute / Unknown Photographer

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Mammogram vs. MRI

A mammography on left and a Magnetic resonance image (MRI) on right. Breast imaging technology has changed over the years. Note MRI's enhancement ability to confirm diagnosis.

Image by Mitchell D. Schnall, M.D., Ph.D. University Of Pennsylvania / Unknown Photographer

Bilateral digital mammography images of the breasts

Bilateral digital mammography images of the breasts; mediolateral oblique view.

Image by © Nevit Dilmen

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Normal (left) versus cancerous (right) mammography image.

Normal (left) versus cancerous (right) mammography image.

Image by National Cancer Institute

Duct ectasia of breast

Detail of a mammography showing liponecrosis (round/oval calcifications) and plasma cell mastitis with typical rod-like calcifications

Image by Hellerhoff

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Mammogram - Normal

Breast tomosynthesis (3D Mammography) of the left craniocaudal.

Image by National Cancer Institute (NCI)

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Mammogram - Normal

Breast tomosynthesis (3D Mammography) of the left craniocaudal projection.

Image by National Cancer Institute (NCI)

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Mammogram - Normal

Breast tomosynthesis (3D Mammography) of the left craniocaudal reconstruction.

Image by National Cancer Institute (NCI)

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Mammogram - Normal

Breast tomosynthesis (3D Mammography) of the left mediolateral oblique projection.

Image by National Cancer Institute (NCI)

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Mammogram Showing Dense And Fatty Breasts

A side-by-side of two normal mammograms showing the difference between a dense breast (left) and a fatty breast (right). The dense breast is that of a woman aged 39, the fatty breast is that of a 59-year old woman. Abnormal lesions are easier to detect and diagnose in a fatty breast making mammography more accurate.

Image by Dr. Kathy Cho. NIH Radiology / Unknown Photographer

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Thermography of breast

Image by FDA

Mammograms vs Breast Ultrasounds

Video by Lee Health/Vimeo

Breast Density: Higher Risk & New Screening Options

Video by Breast Cancer School for Patients/YouTube

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Mammography: NCI B-roll [video]

NCI B-roll of female patient (simulated) receiving a digital mammogram. This video is intentionally silent. This footage, which was filmed at Sibley Memorial Hospital (a Johns Hopkins affiliate institution), includes images of a technician setting up the equipment, a Caucasian female being positioned to receive a mammogram, and mammography images of of dense breasts and fatty breasts. Downloadable video files are 960x540 at 30 fps. This image is part of the NCI B-Roll Videos collection. View video using embedded player on this page or at youtube.com.

Video by National Cancer Institute (NCI)

What to Expect -- Digital Mammography

Video by Hologic, Inc./YouTube

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Mammography

Breast radiologist Dr.Gillian Newstead of the University of Chicago Medical Center explains the process of a typical mammogram screening.

Video by TheVisualMD

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Breast Density

Women with dense breast tissue often require a further look with ultrasound for screening. University of Chicago Medical Center breast radiologist Dr. Gillian Newstead and a breast cancer survivor with dense breast tissue explain.

Video by TheVisualMD

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Breast Cancer Screening & Diagnosis

Breast cancer is one of the most common cancers among women in the U.S., with about 1 in 8 women developing the disease within her lifetime. Breast cancer is an uncontrolled growth of breast cells that has the potential to spread into the breast and possibly to other parts of the body. Early detection through screening saves the lives of thousands of women every year. If there is a history of breast cancer in the family, women should consider the BReast CAncer susceptibility test (or BRCA) to identify a gene that may indicate an increased risk of developing the disease. Women forty and over should be screened for abnormalities yearly to detect and evaluate changes in breast tissue. If an abnormality is found, a biopsy and pathological exam are necessary for a definitive diagnosis and prognosis. After diagnosis, your doctor may want to learn more about your specific cancer through immunohistochemistry (IHC) and HER2 protein tests. IHC testing can help determine if a specific abnormality is present in the cancer cells. HER2 tests can tell your physician if the breast cancer is turned on by the HER2 gene, and can help determine the best course of treatment. Knowing what type of breast cancer is involved, what stage the cancer is, and the characteristics of that specific cancer, allows a woman's physician to determine best possible therapy for her individual case.

Video by TheVisualMD

A closer look at modern mammography

Video by Siemens Healthineers/YouTube

Mammogram

A mammographic image is displayed on state of the art mammography monitors at the David Grant USAF Medical Center. (U.S. Air Force photo/Staff Sgt. Liliana Moreno)

Image by U.S. Air Force photo/Staff Sgt. Liliana Moreno

Nipple Aspirate Test No Substitute for Mammogram

Some companies are marketing a new test—the nipple aspirate test—as the latest and greatest tool in early breast cancer screening. But FDA warns that the nipple aspirate test is no substitute for a mammogram.

Image by The U.S. Food and Drug Administration

Do More Screening Tests Lead to Better Health? Choosing Wisely

Video by DocMikeEvans/YouTube

New Guidelines for Mammograms

Video by Lee Health/Vimeo

Mammogram questions | Mercy Health

Video by Bon Secours Mercy Health/Vimeo

Getting Screened for Breast Cancer

Video by Lee Health/Vimeo

Mammography Fact Sheet

www.nibib.nih.gov

Mammograms

Office on Women's Health, U.S. Department of Health and Human Services

Top Four Mammogram Myths

The U.S. Food and Drug Administration

Screening for Cancer

TheVisualMD

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Mammography

National Cancer Institute / Unknown Illustrator

Mammography

BruceBlaus

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Mammogram

National Cancer Institute / Alan Hoofring (Illustrator)

Woman Having Mammogram

TheVisualMD

Mammography

CDC

Woman Receives Mammogram

National Cancer Institute / Rhoda Baer (Photographer)

Woman Receives Mammogram

National Cancer Institute / Rhoda Baer (Photographer)

Woman Receives Mammogram

National Cancer Institute / Rhoda Baer (Photographer)

Woman Receives Mammogram

National Cancer Institute / Rhoda Baer (Photographer)

Mammography Patient

National Cancer Institute / Bill Branson (Photographer)

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Mammography

National Cancer Institute / Bill Branson (Photographer)

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Mammography

National Cancer Institute / Unknown Photographer

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Mammography

National Cancer Institute / Unknown Photographer

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Mammography

National Cancer Institute / Bill Branson (Photographer)

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Mammography

National Cancer Institute / Bill Branson (Photographer)

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Mammography Patient

National Cancer Institute / Bill Branson (Photographer)

Male Breast Cancer

Staff Sgt. Sheila deVera

Doctor Viewing Mammogram

National Cancer Institute / Bill Branson (photographer)

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Mammogram Showing Dense And Fatty Breasts

Dr. Kathy Cho. NIH Radiology / National Cancer Institute

Abnormal Mammogram

National Cancer Institute / Unknown Photographer

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Mammogram vs. MRI

Mitchell D. Schnall, M.D., Ph.D. University Of Pennsylvania / Unknown Photographer

Bilateral digital mammography images of the breasts

© Nevit Dilmen

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Normal (left) versus cancerous (right) mammography image.

National Cancer Institute

Duct ectasia of breast

Hellerhoff

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Mammogram - Normal

National Cancer Institute (NCI)

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Mammogram - Normal

National Cancer Institute (NCI)

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Mammogram - Normal

National Cancer Institute (NCI)

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Mammogram - Normal

National Cancer Institute (NCI)

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Mammogram Showing Dense And Fatty Breasts

Dr. Kathy Cho. NIH Radiology / Unknown Photographer

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Thermography of breast

FDA

1:51

Mammograms vs Breast Ultrasounds

Lee Health/Vimeo

8:30

Breast Density: Higher Risk & New Screening Options

Breast Cancer School for Patients/YouTube

2:39

Mammography: NCI B-roll [video]

National Cancer Institute (NCI)

4:07

What to Expect -- Digital Mammography

Hologic, Inc./YouTube

0:37

Mammography

TheVisualMD

0:43

Breast Density

TheVisualMD

4:57

Breast Cancer Screening & Diagnosis

TheVisualMD

3:37

A closer look at modern mammography

Siemens Healthineers/YouTube

Mammogram

U.S. Air Force photo/Staff Sgt. Liliana Moreno

Nipple Aspirate Test No Substitute for Mammogram

The U.S. Food and Drug Administration

10:18

Do More Screening Tests Lead to Better Health? Choosing Wisely

DocMikeEvans/YouTube

1:41

New Guidelines for Mammograms

Lee Health/Vimeo

1:08

Mammogram questions | Mercy Health

Bon Secours Mercy Health/Vimeo

1:45

Getting Screened for Breast Cancer

Lee Health/Vimeo

Breast Biopsy

Breast Biopsy

Also called: Biopsy of the Breast

A breast biopsy is a test that can confirm or rule out breast cancer. It is used if other breast tests or a physical exam show you might have breast cancer. There are three main types of breast biopsy procedures: fine-needle aspiration, core needle biopsy, and surgical biopsy.

Breast Biopsy

Also called: Biopsy of the Breast

A breast biopsy is a test that can confirm or rule out breast cancer. It is used if other breast tests or a physical exam show you might have breast cancer. There are three main types of breast biopsy procedures: fine-needle aspiration, core needle biopsy, and surgical biopsy.

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Use the slider below to see how your results affect your health.
Your result is Normal.
A normal biopsy means that no cancer or abnormal cells were found.
Related conditions
You may need a breast biopsy if:
- You or your health care provider felt a lump, thickening, or other change in your breast.
- A mammogram, ultrasound, or MRI test shows a lump, calcium deposits, or other signs that might mean cancer.
- The skin on your breast or nipple is red, scaly, or swollen, or your nipple is pulled inward.
- You have a discharge of abnormal fluid coming from your nipple.
If your provider suggests that you have a breast biopsy, it doesn't mean you have breast cancer. Most breast lumps and other changes that are checked with biopsies turn out to be benign, which means they are not cancer.
There are three main types of breast biopsy procedures. They are usually done on an outpatient basis, which means you go home the same day:
- Fine needle aspiration biopsy uses a very thin needle to remove a sample of breast cells or fluid. The biopsy takes about 15 minutes.
- Core needle biopsy uses a wide needle to remove one or more small tissue samples about the size of a grain of rice. Sometimes a small vacuum probe is used instead of a needle. The device gently suctions some tissue and removes it with a small rotating blade. A core needle biopsy takes between 15 minutes and an hour, depending on how it's done.
- Surgical biopsy (or open biopsy) is surgery to remove all or part of a lump. The biopsy usually takes about an hour.
Biopsies are often done using mammography, ultrasound, MRI, or x-rays to help see exactly where to take the tissue sample. Your procedure will vary depending on which method is used to guide the biopsy, but the general steps are usually the same.
For a fine needle aspiration biopsy or a core needle biopsy:
- Your provider will clean the skin on your breast and give you a shot of medicine to numb the area, so you won't feel any pain. The shot may sting briefly.
- You may be sitting or lying down. If images are used to guide the biopsy, you may lie on your side, back, or belly with your breast over an opening on the table.
- For a fine needle aspiration biopsy, your provider will insert the needle into the biopsy site and remove a sample of cells or fluid. For a core biopsy, a tiny cut may be made to insert a wide needle or a vacuum device. You may feel a little pressure when the sample or samples are removed.
- Pressure will be applied to area until the bleeding stops.
- Your provider will cover the biopsy site with a sterile bandage. If you had a small incision, small strips of medical tape may be used to close the wound.
For a surgical biopsy:
- You'll lie on an operating table. You may have an IV (intravenous line) in your arm or hand that may be used to give you medicine to relax. The skin over the biopsy area will be cleaned.
- To prevent pain, you'll have either:
  A shot of medicine to numb your breast. The shot may sting briefly.
  General anesthesia, which is medicine given through an IV to make you sleep.
- When you are numb or asleep, the surgeon will make a small cut in your breast tissue to remove part or all of the lump. In certain cases, tissue around the lump may also be removed. This may help avoid the need for more surgery if cancer cells are found in the lump.
- The cut in your skin will be closed with small strips of medical tape or stitches and covered with a sterile bandage.
The type of biopsy you have will depend on:
- The size and location of the suspicious tissue in your breast
- How many areas of your breast are involved
- How abnormal the tissue looks on a mammogram or other image
- Your general health and preferences
Ask your provider about why you need a biopsy and which type is right for you.
It's common to have some bruising and temporary discomfort after a breast biopsy. Possible risks include:
- Infection, which can be treated with antibiotics
- Bleeding
Your provider will give you instructions for how to care for biopsy area and manage any discomfort. If you're having general anesthesia, talk with your provider about how it may affect you. General anesthesia is very safe even for most people with other health conditions.
It may take several days to a week to get your biopsy results. The results are called a pathology report. The report is written for your provider and will include a lot of medical terms. Your provider can explain what your report means.
The most important part of your report will be the diagnosis. In general, your results will be one of these categories:
- Normal. No cancer or abnormal cells were found.
- Abnormal breast changes that aren't cancer and don't increase your risk for breast cancer. Some of these conditions often get better on their own and others may need treatment.
- Abnormal breast changes that increase your risk for breast cancer. These cells are not cancer, but if you have them, you are more likely to develop cancer.
  If you had a needle biopsy that diagnosed a condition that increases your breast cancer risk, you may need a surgical biopsy to remove all the abnormal tissue. To find out what you can do to reduce your breast cancer risk, you will likely see a doctor who specializes in breast cancer.
- Breast cancer. If your biopsy finds cancer cells, your report will include details about how fast the cancer cells are growing, how much they look like normal cells, and other information to help plan the most effective treatment for your type of cancer. Usually, a doctor who specializes in breast cancer will provide your care.
1. Breast Biopsy: MedlinePlus Medical Test [accessed on Mar 22, 2022]
2. Having a Breast Biopsy | Effective Health Care (EHC) Program [accessed on Mar 22, 2022]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (13)

PreOp® Breast Biopsy Wire Guide Patient Education - Patient Engagement

Video by PreOp.com Patient Engagement - Patient Education/YouTube

How a core breast biopsy is taken

Video by Bupa Health UK/YouTube

Stereotactic Biopsies for Breast Evaluation | UPMC Magee-Womens Hospital

Video by UPMC/YouTube

What It’s Like to Get a Breast Biopsy

Video by RAYUS Radiology™/YouTube

Ultrasound-guided core-needle breast biopsy

Video by Institute for Cancer Genetics and Informatics/YouTube

Having a breast biopsy. A review of the research for women and thier families (2016 report)

This information is right for you if: -- You are a woman. The information in this summary is from research on women. -- Your doctor has found a breast lump or shadow on your mammogram and has recommended a breast biopsy.

Document by effectivehealthcare.ahrq.gov

Ultrasound Guided Breast Biopsy 1

Ultrasound image of possible breast tumor before biopsy. The procedure is performed by a radiologist and sonographer. A local anesthetic is injected into the breast. The transducer is pressed to the breast and the suspicious area is located. The biopsy needle is inserted in the breast and guided in realtime by watching its movement through the breast on a computer monitor. The tissue sample is taken and the needle is removed.

Image by TheVisualMD

Ultrasound Guided Breast Biopsy 2

Ultrasound image of possible breast tumor showing core needle penetrating suspicious breast lesion during biopsy. The procedure is performed by a radiologist and sonographer. A local anesthetic is injected into the breast. The transducer is pressed to the breast and the suspicious area is located. The biopsy needle is inserted in the breast and guided in realtime by watching its movement through the breast on a computer monitor. The tissue sample is taken and the needle is removed.

Image by TheVisualMD

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Needle Biopsy

Adult Black female breast visible. Physician's hands are seen performing a needle biopsy to determine nature of lump either fluid-filled cyst or solid tumor.

Image by National Cancer Institute / Linda Bartlett (Photographer)

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Biopsy

A Caucasian woman patient is being operated on. Her nipple is being incised by the surgeon. The male surgeon and an operating room attendant are visible. A surgical biopsy is being performed to determine exact nature of solid tumor.

Image by National Cancer Institute / Linda Bartlett (Photographer)

Breast Biopsy

Image Caption : Needle Breast Biopsy

Image by BruceBlaus

Mammotome

Mammotome probe - biopsy

Image by Waglione/Wikimedia

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Breast Cancer Biopsy

If a woman has symptoms of breast cancer (such as a lump), or if a suspicious area is found in an imaging exam, the next step is to physically examine the breasts by noting any changes in their appearance and palpating the breast and the underarm region. A complete physical exam may be done as well. If symptoms or results of these exams suggest cancer might be present, then further tests will be done. (Note: The following diagnostic procedures are common to the US; procedures may vary in other countries.)

Video by TheVisualMD

2:22

PreOp® Breast Biopsy Wire Guide Patient Education - Patient Engagement

PreOp.com Patient Engagement - Patient Education/YouTube

1:39

How a core breast biopsy is taken

Bupa Health UK/YouTube

2:47

Stereotactic Biopsies for Breast Evaluation | UPMC Magee-Womens Hospital

UPMC/YouTube

3:57

What It’s Like to Get a Breast Biopsy

RAYUS Radiology™/YouTube

1:29

Ultrasound-guided core-needle breast biopsy

Institute for Cancer Genetics and Informatics/YouTube

Having a breast biopsy. A review of the research for women and thier families (2016 report)

effectivehealthcare.ahrq.gov

Ultrasound Guided Breast Biopsy 1

TheVisualMD

Ultrasound Guided Breast Biopsy 2

TheVisualMD

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Needle Biopsy

National Cancer Institute / Linda Bartlett (Photographer)

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Biopsy

National Cancer Institute / Linda Bartlett (Photographer)

Breast Biopsy

BruceBlaus

Mammotome

Waglione/Wikimedia

0:56

Breast Cancer Biopsy

TheVisualMD

Estrogen and Progesterone Receptor Tests

Estrogen and Progesterone Receptor Tests

Also called: Breast Cancer Hormone Receptor Status, ER/PR Testing, ER/PR IHC Testing, ERPR, Hormone Receptor (HR) Status

Receptors are proteins that attach to certain substances. Estrogen receptor/progesterone receptor tests look for receptors that attach to the hormones estrogen and/or progesterone in breast cancer cells. Breast cancers that have these receptors often respond well to some types of treatments.

Estrogen and Progesterone Receptor Tests

Also called: Breast Cancer Hormone Receptor Status, ER/PR Testing, ER/PR IHC Testing, ERPR, Hormone Receptor (HR) Status

Receptors are proteins that attach to certain substances. Estrogen receptor/progesterone receptor tests look for receptors that attach to the hormones estrogen and/or progesterone in breast cancer cells. Breast cancers that have these receptors often respond well to some types of treatments.

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Use the slider below to see how your results affect your health.
Your result is ER/PR-negative.
An ER/PR-negative (also called a hormone receptor-negative or HR-) result means that your breast tumor does not have receptors for either estrogen (ER) or progesterone (PR). This means that you are not likely to benefit from treatment with hormonal therapy. About 25% of breast cancers have no hormone receptors.
Related conditions
Estrogen receptor/progesterone receptor (ER/PR) tests are used to help guide breast cancer treatment. Receptors are proteins that attach to certain substances. ER/PR tests look for receptors that attach to the hormones estrogen and progesterone in a sample of breast cancer tissue. Estrogen and progesterone play key roles in a woman's sexual development and reproductive functions. Men also have these hormones, but in much smaller amounts.
About 70 percent of all breast cancers in women have receptors that attach to estrogen and/or progesterone. About 80 percent to 90 percent of breast cancers in men have these receptors. Breast cancers with estrogen and/or progesterone receptors include the following types:
- ER-positive (ER+): Cancers that have estrogen receptors (ER)
- PR-positive (PR+): Cancers that have progesterone receptors (PR)
- Hormone receptor-positive (HR+): Cancers that have one or both types of these receptors.
Breast cancers without ER or PR receptors are known as HR-negative (HR-).
ER/PR tests will show whether there are ER and/or PR receptors on your breast cancer cells. Test results are frequently referred to as the hormone receptor status. If your hormone receptor status shows you have one or both of these receptors on your cancer cells, you may respond well to certain types of treatments.
Your provider will need to take a sample of breast tissue in a procedure called a breast biopsy. There are three main types of breast biopsies:
- Fine needle aspiration biopsy, which uses a very thin needle to remove a sample of breast cells or fluid
- Core needle biopsy, which uses a larger needle to remove a sample
- Surgical biopsy, which removes a sample in a minor, outpatient procedure
Fine needle aspiration and core needle biopsies usually include the following steps:
- You will lay on your side or sit on an exam table.
- A health care provider will clean the biopsy site and inject it with an anesthetic, so you won't feel any pain during the procedure.
- Once the area is numb, the provider will insert either a fine aspiration needle or core biopsy needle into the biopsy site and remove a sample of tissue or fluid.
- You may feel a little pressure when the sample is withdrawn.
- Pressure will be applied to the biopsy site until the bleeding stops.
- Your provider will apply a sterile bandage at the biopsy site.
In a surgical biopsy, a surgeon will make a small cut in your skin to remove all or part of a breast lump. A surgical biopsy is sometimes done if the lump can't be reached with a needle biopsy. Surgical biopsies usually include the following steps.
- You will lie on an operating table. An IV (intravenous line) may be placed in your arm or hand.
- You may be given medicine, called a sedative, to help you relax.
- You will be given local or general anesthesia, so you won't feel pain during the procedure.
  For local anesthesia, a health care provider will inject the biopsy site with medicine to numb the area.
  For general anesthesia, a specialist called an anesthesiologist will give you medicine so you will be unconscious during the procedure.
- Once the biopsy area is numb or you are unconscious, the surgeon will make a small cut into the breast and remove part or all of a lump. Some tissue around the lump may also be removed.
- The cut in your skin will be closed with stitches or adhesive strips.
1. Estrogen Receptor, Progesterone Receptor Tests: MedlinePlus Medical Test [accessed on Dec 22, 2023]
2. Breast Cancer Treatment - NCI. National Cancer Institute. Dec 6, 2023 [accessed on Dec 22, 2023]
3. Estrogen Receptor and Progesterone Receptor Test | Testing.com. Dec 3, 2021 [accessed on Dec 22, 2023]
4. Breast Cancer Hormone Receptor Status [accessed on Dec 22, 2023]
5. Immunohistochemical Test for Estrogen and Progesterone Receptors - Health Encyclopedia - University of Rochester Medical Center [accessed on Dec 22, 2023]

Additional Materials (5)

2:57

Hormone Receptor Positive Breast Cancer

Dr. Susan Love Foundation/YouTube

7:47

Introduction to Cancer Biology (Part 1): Abnormal Signal Transduction

Mechanisms in Medicine/YouTube

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Estrogen Receptor Assay

National Cancer Institute / Linda Bartlett (Photographer)

Using FFNP to “Light Up” Tumors

National Cancer Institute

Circulating Progesterone May Increase Breast Cancer Risk

National Cancer Institute (NCI)

HER2 Tumor Marker Testing

HER2 Tumor Marker Testing

Also called: Human Epidermal Growth Factor Receptor 2, HER2, HER2 Gene, ERBB2 Amplification, HER2 Overexpression, HER2/neu Tests

HER2 genes there are and how much HER2 protein is made in a sample of tissue. These tests can help guide treatment choices for certain cancers of the breast, stomach, and esophagus.

HER2 Tumor Marker Testing

Also called: Human Epidermal Growth Factor Receptor 2, HER2, HER2 Gene, ERBB2 Amplification, HER2 Overexpression, HER2/neu Tests

HER2 genes there are and how much HER2 protein is made in a sample of tissue. These tests can help guide treatment choices for certain cancers of the breast, stomach, and esophagus.

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Use the slider below to see how your results affect your health.
{score}
2
3
Your result is HER2-negative.
0 (zero) or 1+ means that your cancer cells don't have too much HER2 protein. Your cancer is HER2-negative and will not respond to HER2-targeted therapy. Your provider will discuss other treatment options.
Related conditions
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Use the slider below to see how your results affect your health.
Your result is HER2-negative.
HER2 genes in your cancer cells. HER2-targeted therapy won't help your cancer, so your provider will discuss other treatment options.
Related conditions
Tumor marker tests look for substances, called tumor markers, that are often made by cancer cells or normal cells in response to cancer. The test results can provide important information, such as how fast a cancer may grow and which treatments are most likely to work.
HER2 is a type of tumor marker. It stands for human epidermal growth factor receptor 2. It's also called HER2/neu. HER2 is a protein involved in normal cell growth. Some types of cancer cells make larger than normal amounts of HER2, including certain cancers of the breast, stomach, and esophagus.
Cancers with large amounts of HER2 protein tend to grow quickly and spread to other parts of the body. Certain medicines, called HER2 targeted therapy, can block or slow HER2 proteins and help control these cancers. But these medicines won't help cancers that don't have high levels of HER2 proteins. So, HER2 tumor marker testing is necessary to find out if targeted therapy will be helpful.
A HER2 tumor marker test usually uses a sample of tumor tissue to measure either:
- The amount of HER2 protein on the surface of cancer cells
- How many copies of the HER2 gene are inside the cancer cells
Genes are parts of DNA in your cells that you inherit from your parents. HER2 genes have instructions for making the HER2 protein. Normally, you have two HER2 genes in each cell, one from each parent. But certain cancers have extra copies of the HER2 gene, which leads to too much HER2 protein on the cancer cells.
A HER2 tumor marker test looks to see whether certain cancers are:
- HER2 positive, which means the cancer has high levels of the HER2 protein or HER2 genes. These cancers are likely to respond to HER2 targeted therapy.
- HER2 negative, which means your cancer cells have little to no HER2 protein or a normal number of HER2 genes. This type of cancer may grow more slowly than HER2-positive cancer. It is also less likely to come back after treatment or spread to other parts of the body. HER2 targeted therapy will not work for this type of cancer, but other treatment options may help.
There are different HER2 tumor marker tests for checking HER2 proteins and HER2 genes. Usually, a protein test is done first because those tests are faster and less expense. Blood tests to measure HER2 usually aren't recommended. That's because it's not clear how blood test results can plan cancer treatment.
HER2 tumor marker tests are mostly used to find out whether certain cancers are HER2 positive or negative. This information shows how fast cancer may grow and whether medicine to target HER2 proteins may be helpful.
HER2 tumor marker testing is mainly used for cancers that start in the:
- Breast (most common)
- Stomach
- Esophagus
- Ovaries
- Bladder
- Pancreas
You may need HER2 tumor marker testing to help guide cancer treatment decisions if you have:
- Breast cancer that has:
  Just been diagnosed and is growing in the normal breast tissue around the tumor. This is called "invasive" cancer.
  Spread beyond your breast and is growing in other parts of your body. This is called metastatic cancer. The cancer growing outside of your breast should be tested to see if it's HER2 positive, even if your breast tumor was already tested.
  Come back after treatment, usually after a period of time when no cancer could be found in your body. This is called recurrent cancer. The new tumor should be tested to see if it's HER2 positive even if your first tumor was tested. That's because cancer cells can change over time.
- Stomach or esophageal cancer that:
  Can't be removed using surgery.
  Has come back after treatment.
- Cancer of the pancreas, bladder, ovaries, or certain other cancers that may have high levels of HER2 which may be treated with medicines that target HER2.
Most HER2 testing uses a sample of tumor tissue. The tissue will be removed during a procedure called a biopsy. There are many ways to do a biopsy. The type of biopsy you have depends on where the tumor is located. In general, a biopsy may be done using:
- A hollow needle inserted through your skin. Imaging tests, such as ultrasound, may be used to guide the needle:
  A fine needle aspiration biopsy uses a very thin needle to remove a sample of cells and/or fluid.
  A core needle biopsy uses a larger needle to remove a sample.
- Surgery. A surgeon may remove a sample of the tumor (incisional biopsy) or the entire tumor (excisional biopsy).
- Endoscopy. This procedure uses a scope to look inside your body. Special tools may be used with a scope to remove a tissue sample. An endoscopy may be used for a biopsy of a tumor in your stomach or esophagus.
The results of HER2 tumor marker tests are reported differently, depending on the type of test you had. The main HER2 tumor marker tests are:
- IHC (immunohistochemistry staining assay) to measure the amount of HER2 protein on cancer cells
- FISH (fluorescence in situ hybridization) to check for extra copies of HER2 genes in cancer cells
IHC test results for cancer of the breast, stomach, or esophagus show the amount of HER2 protein as a score:
- 0 (zero) or 1+ means that your cancer cells don't have too much HER2 protein. Your cancer is HER2 negative and will not respond to HER2 targeted therapy. Your provider will discuss other treatment options.
- 2+ means that the amount of HER2 protein is borderline. This may be reported as "equivocal." It means the test result is not clear. You may need to have a different type of HER2 tumor marker test. The test may be done on the same tissue sample, or you may need to provide a new sample.
- 3+ means that your cancer cells have too much HER2 protein. Your cancer is HER2 positive and is likely to respond to HER2 targeted therapy.
FISH results for cancer of the breast, stomach, or esophagus will be reported as either:
- HER2 negative, which means that you don't have too many HER2 genes in your cancer cells. HER2 targeted therapy won't help your cancer, so your provider will discuss other treatment options.
- HER2 positive, which means that your cancer cells have too many HER2 genes. HER2 targeted therapy is likely to help your cancer.
Talk with your provider to learn what your results mean for your treatment.
1. HER2 Tumor Marker Test: MedlinePlus Medical Test [accessed on Dec 22, 2023]
2. Breast Cancer Treatment - NCI. National Cancer Institute. Dec 6, 2023 [accessed on Dec 22, 2023]

Additional Materials (6)

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Diagnosing Breast Cancer

Breast imaging and early detection of breast cancer have evolved immensely over the last 25 years, leading to increased survival rates and improved quality of life for millions of women with breast cancer. This video takes you through the process of screening and diagnosis using various imaging modalities, including mammogram, ultrasound and MRI.

Video by TheVisualMD

DNA Methylation and Cancer

Video by Armando Hasudungan/YouTube

How to Recognize Breast Cancer Symptoms

Video by Howcast/YouTube

Sensitive content

This media may include sensitive content

Human Epidermal Growth Factor Receptor 2 (HER2): Aggressive Breast Cancers

Most breast cancers begin in the lobules or ducts of the breast, which produce breast milk and carry it to the nipples after pregnancy. Invasive cancers spread outside of the lobules and ducts and penetrate into the surrounding breast tissue. From there, cancer cells may travel to lymph nodes in the armpit area. In stage IV breast cancer, cancer cells have spread into other parts of the body, such as the lungs or bones. HER2-positive breast cancer is aggressive and is likely to spread quickly. It is also resistant to hormone therapy. However, treatment with the drugs trastuzumab and/or lapatinib may help women who test positive for HER2.

Image by TheVisualMD

Human Epidermal Growth Factor Receptor 2 (HER2): Her2/neu Receptors on Cell Surface

HER2 is a cell surface receptor that responds to chemicals called growth factors. Normally, there are few HER2 receptors on the surface of the cell. But when a mutated gene causes the overproduction of HER2, it can spur the growth of tumors. The test called immunohistochemistry (IHC) measures the amount of HER2 protein present and can help with determining the patient's prognosis.

Image by TheVisualMD

Human Epidermal Growth Factor Receptor 2 (HER2): Breast Cancer and HER2

In about one out of five breast cancers, a protein called human epidermal growth factor receptor 2 (HER2) is overproduced due to a gene mutation. High levels of HER2 on cell surfaces spur the growth of cancerous tumors and also make the cancer less responsive to hormone therapy. This type of breast cancer usually occurs in younger women.

Image by TheVisualMD

4:47

Diagnosing Breast Cancer

TheVisualMD

5:17

DNA Methylation and Cancer

Armando Hasudungan/YouTube

3:01

How to Recognize Breast Cancer Symptoms

Howcast/YouTube

Sensitive content

This media may include sensitive content

Human Epidermal Growth Factor Receptor 2 (HER2): Aggressive Breast Cancers

TheVisualMD

Human Epidermal Growth Factor Receptor 2 (HER2): Her2/neu Receptors on Cell Surface

TheVisualMD

Human Epidermal Growth Factor Receptor 2 (HER2): Breast Cancer and HER2

TheVisualMD

Breast Ultrasound

Breast Ultrasound

Also called: Breast Ultrasonography, Breast Sonogram, Ultrasound - Breast

A breast ultrasound is a noninvasive, painless, and risk-free imaging test in which an ultrasound machine is used to evaluate your breast tissue.

Breast Ultrasound

Also called: Breast Ultrasonography, Breast Sonogram, Ultrasound - Breast

A breast ultrasound is a noninvasive, painless, and risk-free imaging test in which an ultrasound machine is used to evaluate your breast tissue.

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Use the slider below to see how your results affect your health.
Your result is Normal.
A normal result means that no abnormalities or masses were found in your breast tissue.
Related conditions
Your doctor may want to order this test in the following situations:
- As the first test to examine young women (usually less than 35-year-old) who have breast symptoms, such as pain, lumps, or abnormal nipple discharge
- As a follow-up test if a clinical breast exam or mammogram has revealed an abnormality
- To evaluate breast tissue that is obscured by breast implants
- To evaluate breast tissue in pregnant women
- To guide the placement of a needle during breast biopsies
It is important to point out that a breast ultrasound is not usually done to screen for breast cancer because some early signs of cancer can be easily missed with this test.
A normal result means that no abnormalities or masses were found in your breast tissue.
An abnormal result indicates that a problem was detected, including but not limited to:
- Cysts, which are fluid-filled sacs
- Solid tumors, which can be cancerous or non-cancerous
- Fibroadenomas (non-cancerous solid growths)
- Lipomas (non-cancerous fatty tumors)
1. https://www.insideradiology.com.au/breast-ultrasound/ [accessed on Mar 12, 2019]
2. https://www.webmd.com/breast-cancer/breast-ultrasound [accessed on Mar 12, 2019]
3. https://www.hopkinsmedicine.org/healthlibrary/test_procedures/gynecology/breast_ultrasound_92,p07764 [accessed on Mar 12, 2019]
4. https://medlineplus.gov/ency/article/003379.htm [accessed on Feb 16, 2019]
5. https://ww5.komen.org/BreastCancer/Ultrasound.html [accessed on Feb 16, 2019]
6. https://www.health.ny.gov/diseases/cancer/breast/nys_breast_cancer_faqs.htm [accessed on Feb 16, 2019]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (7)

Diagnosing Breast Cancer

TheVisualMD

Tubular carcinoma of breast ultrasound

© Nevit Dilmen

Breast ultrasound

© Nevit Dilmen

Breast ultrasound

© Nevit Dilmen

Breast ultrasound

© Nevit Dilmen

Breast ultrasound

© Nevit Dilmen

Breast ultrasound

© Nevit Dilmen

PET Scan

PET Scan

Also called: PET Imaging, Positron Emission Tomography, Positron Emission Testing

A PET scan is an imaging test that uses a radioactive substance (tracer) to check for changes in chemical activity in the body. This activity may be a sign of cancer, heart disease, or a brain disorder.

PET Scan

Also called: PET Imaging, Positron Emission Tomography, Positron Emission Testing

A PET scan is an imaging test that uses a radioactive substance (tracer) to check for changes in chemical activity in the body. This activity may be a sign of cancer, heart disease, or a brain disorder.

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Use the slider below to see how your results affect your health.
Your result is Normal.
There are no problems detected in the size, shape, or function of the organ being scanned. There are no areas in which the tracer has abnormally collected.
Related conditions
A PET scan is most often used to:
- Diagnose or monitor certain cancers, including breast, thyroid, and lung cancers
- Find out how well your heart muscle is working
- Check blood flow to the heart
- Check for signs of certain brain disorders, such as Parkinson's disease, Huntington's disease, Alzheimer's disease, and types of dementia. Dementia is not a specific disease. It is a term used to describe a decline in mental function that is severe enough to affect daily living.
A PET scan is often done along with a CT scan, a type of x-ray that takes a series of pictures as it rotates around you.
You may need a PET scan to find out if you have cancer. If you've already been diagnosed with cancer, you may need this test to see if your cancer treatment is working.
A PET scan also helps diagnose and monitor heart and brain diseases. So you may need this test if you:
- Have a family history of heart disease
- Are being treated for heart disease. This test can show if the treatment is working.
- Have symptoms of a brain disease, such as tremors, memory problems, and/or seizures
Before the scan, you will change into a hospital gown. You may be asked to empty your bladder. During the scan:
- A health care provider will inject the radioactive tracer into your vein through an intravenous (IV) line. The tracer sends out a form of energy called gamma rays. The rays are picked up by the scanner to create images of the inside of your body.
- You will need to wait for the tracer to be absorbed by your body. This takes 45 to 60 minutes.
- You will then lie on a narrow, padded table, which will slide into a large, tunnel-shaped scanner.
- The scanner will move slowly across your body to capture images. You will need to be very still as this happens.
- The scanner will send images to a computer monitor for the provider to review.
- Your provider will then remove the IV line.
Depending on which part of the body was being scanned, your results may show:
- Cancer. Cancer cells show up as bright spots on a PET scan.
- Heart disease. The scan can show decreased blood flow to the heart.
- A brain disorder. The scan may show changes in certain brain chemicals that can indicate disease.
If you also had a CT scan, your provider will review the results of the two scans to help make a diagnosis.
If you have questions about your results, talk to your health care provider.
1. https://my.clevelandclinic.org/health/diagnostics/10123-pet-scan [accessed on Jul 27, 2021]
2. https://medlineplus.gov/ency/article/007341.htm [accessed on Jul 27, 2021]
3. https://medlineplus.gov/ency/article/007342.htm [accessed on Jul 27, 2021]
4. https://medlineplus.gov/ency/article/007343.htm [accessed on Jul 27, 2021]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (23)

What is it Like to Have a PET Scan? | Cancer Research UK

Video by Cancer Research UK/YouTube

PET Scan in 3 views

1

2

3

PET Scan in 3 views

PET Scan in 3 views

Interactive by TheVisualMD

PET/CT

1

2

3

PET/CT Scans of Colorectal Cancer 1) Pet/CT scan 2) CT Scan 3) Pet Scan

PET scans can often detect a tumor that can't be seen on CT scans or regular X-rays. Cancer tumors grow rapidly and so actively metabolize glucose. In a PET scan, the patient is injected with glucose containing a radioactive tracer. The PET scan image shows areas of the body that utilize the glucose. The brain, heart, and bladder all metabolize glucose and appear black in the image, along with any cancer tumors that are present.

Interactive by TheVisualMD

How Does a PET Scan Work?

Video by NIBIB gov/YouTube

UCSF Radiology: How does a PET scan help with cancer imaging?

Video by UCSF Imaging/YouTube

Your PET/CT scan at University College Hospital

Video by University College London Hospitals NHS Foundation Trust/YouTube

How X-rays see through your skin - Ge Wang

Video by TED-Ed/YouTube

PET Scans and CAT Scans

Video by Lee Health/YouTube

Having a PET-CT scan

Video by Design Science/YouTube

How does a PET scan work?

Video by Imperial College London/YouTube

Patient exercises

1

2

3

4

5

6

Myocardial perfusion scan

Myocardial perfusion imaging is a test that uses a low dose of a radioactive agent to evaluate the blood flow and function of the heart. This scan is done in conjunction with a cardiac stress test a diagnostic test in which a person walks on a treadmill or pedals (a stationary bicycle) while hooked up to equipment that monitors the heart. The test monitors heart rate breathing blood pressure electrical activity (on an electrocardiogram) and the person's level of tiredness. It shows if the heart's blood supply is sufficient and if the heart rhythm is normal. A stress test can detect the following problems: - Abnormal changes in heart rate or blood pressure - Symptoms such as shortness of breath or chest pain - Abnormal changes in the heart's rhythm or electrical activity

Interactive by TheVisualMD

Testing for bowel cancer

Video by Cancer Research UK/YouTube

MRI Animation

Video by Blausen Medical Corporate/YouTube

Carcinogenesis head and neck short version only animation

Video by Amsterdam UMC/YouTube

Head and Neck Cancer

Video by Robert Miller/YouTube

What are the Risk Factors and Symptoms of Head and Neck Cancers? | Dana-Farber Cancer Institute

Video by Dana-Farber Cancer Institute/YouTube

Introduction to Head and Neck Cancer | Memorial Sloan Kettering

Video by Memorial Sloan Kettering/YouTube

Throat Cancer

Video by Michigan Medicine/YouTube

Rush Radiosurgery: Head and Neck Cancer Radiation

Video by Rush Radiosurgery/YouTube

Treating the head and neck - Radiotherapy and its physics (3/15)

Video by OpenLearn from The Open University/YouTube

Nutrition Video for Head & Neck Cancer

Video by Stanford Health Care/YouTube

Throat Cancer Largely Due to Smoking And Drinking, Studies Show

Video by VOA News/YouTube

What is nuclear medicine? An illustrated introduction

Video by navalorama/YouTube

3:13

What is it Like to Have a PET Scan? | Cancer Research UK

Cancer Research UK/YouTube

PET Scan in 3 views

TheVisualMD

PET/CT Scans of Colorectal Cancer 1) Pet/CT scan 2) CT Scan 3) Pet Scan

TheVisualMD

1:33

How Does a PET Scan Work?

NIBIB gov/YouTube

1:30

UCSF Radiology: How does a PET scan help with cancer imaging?

UCSF Imaging/YouTube

3:31

Your PET/CT scan at University College Hospital

University College London Hospitals NHS Foundation Trust/YouTube

4:42

How X-rays see through your skin - Ge Wang

TED-Ed/YouTube

1:37

PET Scans and CAT Scans

Lee Health/YouTube

5:17

Having a PET-CT scan

Design Science/YouTube

4:25

How does a PET scan work?

Imperial College London/YouTube

Myocardial perfusion scan

TheVisualMD

1:37

Testing for bowel cancer

Cancer Research UK/YouTube

0:36

MRI Animation

Blausen Medical Corporate/YouTube

4:03

Carcinogenesis head and neck short version only animation

Amsterdam UMC/YouTube

7:27

Head and Neck Cancer

Robert Miller/YouTube

2:35

What are the Risk Factors and Symptoms of Head and Neck Cancers? | Dana-Farber Cancer Institute

Dana-Farber Cancer Institute/YouTube

18:04

Introduction to Head and Neck Cancer | Memorial Sloan Kettering

Memorial Sloan Kettering/YouTube

6:01

Throat Cancer

Michigan Medicine/YouTube

1:13

Rush Radiosurgery: Head and Neck Cancer Radiation

Rush Radiosurgery/YouTube

1:57

Treating the head and neck - Radiotherapy and its physics (3/15)

OpenLearn from The Open University/YouTube

4:25

Nutrition Video for Head & Neck Cancer

Stanford Health Care/YouTube

2:39

Throat Cancer Largely Due to Smoking And Drinking, Studies Show

VOA News/YouTube

3:02

What is nuclear medicine? An illustrated introduction

navalorama/YouTube

Chest CT Scan

Chest CT Scan

Also called: Chest CT, Thoracic CT, Chest X-Ray Computer Assisted Tomography, Chest CAT scan

A chest computed tomography (CT) scan is an imaging test that takes detailed pictures of the lungs and the inside of the chest. Computers combine the pictures to create a 3-D model showing the size, shape, and position of the lungs and structures in the chest.

Chest CT Scan

Also called: Chest CT, Thoracic CT, Chest X-Ray Computer Assisted Tomography, Chest CAT scan

A chest computed tomography (CT) scan is an imaging test that takes detailed pictures of the lungs and the inside of the chest. Computers combine the pictures to create a 3-D model showing the size, shape, and position of the lungs and structures in the chest.

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Use the slider below to see how your results affect your health.
Your result is Normal.
A chest CT scan provides detailed pictures of the size, shape, and position of your lungs and other structures in your chest. A normal chest CT means your chest appears normal.
Related conditions
A chest CT scan provides detailed pictures of the size, shape, and position of your lungs and other structures in your chest. Doctors use this test to:
- Follow up on abnormal results from standard chest x rays.
- Find the cause of lung symptoms, such as shortness of breath or chest pain.
- Find out whether you have a lung problem, such as a tumor, excess fluid around the lungs, or a pulmonary embolism (a blood clot in the lungs). The test also is used to check for other conditions, such as tuberculosis, emphysema, and pneumonia.
Your doctor may recommend a chest CT scan if you have symptoms of lung problems, such as chest pain or trouble breathing. The scan can help find the cause of the symptoms.
A chest CT scan looks for problems such as tumors, excess fluid around the lungs, and pulmonary embolism (a blood clot in the lungs). The scan also checks for other conditions, such as tuberculosis, emphysema, and pneumonia.
Your doctor may recommend a chest CT scan if a standard chest x ray doesn't help diagnose the problem. The chest CT scan can:
- Provide more detailed pictures of your lungs and other chest structures than a standard chest x ray
- Find the exact location of a tumor or other problem
- Show something that isn't visible on a chest x ray
Chest CT scans have some risks. In rare instances, some people have an allergic reaction to the contrast dye. There is a slight risk of cancer, particularly in growing children, because the test uses radiation. Although the amount of radiation from one test is usually less than the amount of radiation you are naturally exposed to over three years, patients should not receive more CT scans than the number that clinical guidelines recommend. Another risk is that chest CT scans may detect an incidental finding, which is something that doesn’t cause symptoms but now may require more tests after being found.
Talk to your doctor and the technicians performing the test about whether you are or could be pregnant. If the test is not urgent, they may have you wait to do the test until after your pregnancy. If it is urgent, the technicians will take extra steps to protect your baby during this test. Let your doctor know if you are breastfeeding because contrast dye can pass into your breast milk. If you must have contrast dye injected, you may want to pump and save enough breast milk for one to two days after your test or you may bottle-feed your baby for that time.
1. https://www.nhlbi.nih.gov/health-topics/chest-ct-scan [accessed on Aug 25, 2021]
2. https://medlineplus.gov/ency/article/003788.htm [accessed on Aug 25, 2021]

Additional Materials (50)

Pleural empyema

CT chest showing large right sided hydro-pneumothorax from pleural empyema. Arrows A: air, B: fluid

Image by Amit Banga, GC Khilnani, SK Sharma1, AB Dey, Naveet Wig and Namrata Banga

How Are Pleurisy and Other Pleural Disorders Diagnosed?

CT with the identification of underlying lung lesion: an apical bulla.

Image by Robertolyra

How Are Pleurisy and Other Pleural Disorders Treated?

Right-sided pneumothorax (right side of image) on CT scan of the chest with chest tube in place.

Image by en:User:Clinical Cases

Chest Radiograph

Chest X-Ray : Specialized test, like a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) scan, may be needed to confirm the presence of an aneurysm.

Image by TheVisualMD

What To Expect During a Coronary Calcium Scan

3D reconstruction of the thin multislice CT, covering human heart and lungs

Image by Semnic

Incision for Open-Chest Bypass Surgery

Open-chest bypass surgery requires the surgeon to make an incision down the center of the chest, along the breastbone. The rib cage is spread open to expose the heart.

Image by TheVisualMD

A child's guide to hospital: CT Chest

Video by The Royal Children's Hospital Melbourne/YouTube

What is it like to have a CT scan? | Cancer Research UK

Video by Cancer Research UK/YouTube

Coronary CT angiography of coronary arteries

Researchers have found that anti-inflammatory biologic therapies used to treat moderate to severe psoriasis can significantly reduce coronary inflammation in patients with the chronic skin condition. Scientists said the findings are particularly notable because of the use of a novel imaging biomarker, the perivascular fat attenuation index (FAI), that was able to measure the effect of the therapy in reducing the inflammation. The study published online in JAMA Cardiology, has implications not just for people with psoriasis, but for those with other chronic inflammatory diseases, such as lupus and rheumatoid arthritis. These conditions are known to increase the risk for heart attacks and strokes. The study was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health. In this image: Coronary CT angiography image of the coronary arteries depicting the perivascular fat attenuation index before and after biologic therapy at one-year follow-up for patients with excellent response to biologic therapy.

Image by Oxford Academic Cardiovascular CT Core Lab and Lab of Inflammation and Cardiometabolic Diseases at NHLBI

Coronary CT

Coronary CT

Image by Bác sĩ Nguyễn Minh Đức

CT of the blood vessels and heart

CT of the blood vessels and heart

Image by Bác sĩ Nguyễn Minh Đức

Chest CT showing pulmonary sequestration

chest CT: diagnosis is pulmonary sequestration

Image by RadsWiki

Scimitar syndrome chest CT

Scimitar syndrome chest CT

Image by Matthew Cham, MD /Wikimedia

Having a Cardiac CT Scan in Hospital

Video by Oxford AHSN/YouTube

What to Expect from a CT Exam with Contrast

Video by RAYUS Radiology™/YouTube

Protocoling chest CTs

Video by Thoracic Radiology/YouTube

Low Dose CT Scans to Look for Lung Cancer

Video by Lee Health/YouTube

Lung Cancer Screening (LCS)

Video by Cleveland Clinic/YouTube

CT Scan of the Chest Explained Clearly - High Resolution CT Scan (HRCT)

Video by MedCram - Medical Lectures Explained CLEARLY/YouTube

What to Expect: CT Scan | Cedars-Sinai

Video by Cedars-Sinai/YouTube

How I Read a Chest CT

Video by Thoracic Radiology/YouTube

Introduction to Computed Tomographic imaging of the Chest

Video by Yale Radiology and Biomedical Imaging/YouTube

Lung Cancer Screening: The Life-saving CT Scan

Video by RAYUS Radiology™/YouTube

How to prepare for a CT scan

Video by Sunnybrook Hospital/YouTube

Using CT Scans to Screen for Lung Cancer

Video by UConn Health/YouTube

Cardiac CT scan

Video by UHP_NHS/YouTube

Real look at Chest, Abdomen and Pelvis CT Scan from Start to Finish.

Video by Dumb Old Dad/YouTube

What is it like to get a CT Scan with Contrast?

Video by STRIDE Project/YouTube

Thorax with Healthy Heart

3D visualization based on scanned human data of a healthy heart in the thorax.

Image by TheVisualMD

Heart and Lungs

The heart and lungs are the primary contents of the thorax. They are interconnected with very large blood vessels. The heart sends oxygen-poor blood through the pulmonary arteries to the lungs, which oxygenate it and return it to the heart through the pulmonary veins. The pulmonary arteries arise from one large pulmonary trunk, and then begin branching exponentially once they enter the lungs in order to reach the functional respiratory units and pick up oxygen. The smallest pulmonary veins then take the oxygenated blood backwards through the lungs and empty into the back of the heart through four larger pulmonary veins. The oxygen-rich blood is then pumped by the heart out into the body through the aorta. Deoxygenated blood from body tissues returns to the heart through the superior and inferior vena cava and the cardiac cycle repeats continuously. The pulmonary veins and arteries are the only case where arteries carry deoxygenated blood and veins carry blood that has been oxygenated.

Image by TheVisualMD

Thorax with Muscle Involved in Respiration

3D visualization of an anterior view of the muscles involved in respiration. The primary job of the thorax is to promote movements necessary for breathing. Three muscles of the thorax assist in this function; the external intercostals, internal intercostals and diaphragm. The intercostals do the job of lifting the ribs up and pulling them outward, which in turn enlarges the lungs. As the lungs expand, the pressure inside them is reduced, and they suck in air. During extreme inhalation, the neck muscles also contract. During inhalation, the diaphragm contracts and pushes downward; during exhalation, it relaxes and is pushed up into a dome shape by the lower digestive organs, compressing the lungs. As pressure rises in the chest cavity, exhale occurs, pressure is equalized and the cycle restarts.

Image by TheVisualMD

Thorax with Muscle Involved in Respiration

3D visualization of an inferior view of the muscles involved in respiration. The primary job of the thorax is to promote movements necessary for breathing. Three muscles of the thorax assist in this function; the external intercostals, internal intercostals and diaphragm. The intercostals do the job of lifting the ribs up and pulling them outward, which in turn enlarges the lungs. As the lungs expand, the pressure inside them is reduced, and they suck in air. During extreme inhalation, the neck muscles also contract. During inhalation, the diaphragm contracts and pushes downward; during exhalation, it relaxes and is pushed up into a dome shape by the lower digestive organs, compressing the lungs. As pressure rises in the chest cavity, exhalation occurs, pressure is equalized and the cycle restarts.

Image by TheVisualMD

Thorax with visible Lung and Heart

3D visualization of a posterior view of the lungs and heart reconstructed from scanned human data. De-oxygenated red blood cells are sent by the right side of the heart through the pulmonary artery into the vessels of the lungs to be refilled with oxygen for their next circuit through the body. The blood is carried through the lung tissues, where it exchanges its carbon dioxide for oxygen in the alveoli. It is then returned through the pulmonary veins to the left side of the heart and sent out to the rest of the body. The pulmonary artery carries away the deoxygenated blood, which returns fully oxygenated through the pulmonary vein.

Image by TheVisualMD

Female Thorax Showing Breast

Visualization based on scanned human data of an anterior view of female breast.

Image by TheVisualMD

Male Thorax with Visible Heart

Visualization of male heart. The nerve supply of the heart is emphasized specifically the cardiac plexus. The plexus which rest around the base of the heart, mainly in the epicardium, is formed by cardiac branches from the vagus nerves and the sympathetic trunks and ganglia.

Image by TheVisualMD

Thorax with Heart and Lung

3D visualization of an anterior view of the lungs and heart reconstructed from scanned human data. The cone-shaped lungs occupy most of the thoracic cavity. Each lung is suspended in its own pleural cavity and connected to the mediastinum (which houses the heart) by its root which is made up of vascular and bronchial attachments. The anterior, lateral and posterior surfaces of the lung are in close contact with the ribs and form a continuously curving surface called the costal surface. De-oxygenated red blood cells are sent by the right side of the heart through the pulmonary artery into the vessels of the lungs to be refilled with oxygen for their next circuit through the body. The blood is carried through the lung tissues, where it exchanges its carbon dioxide for oxygen in the alveoli. It is then returned through the pulmonary veins to the left side of the heart and sent out to the rest of the body. The pulmonary artery carries away the deoxygenated blood, which returns fully oxygenated through the pulmonary vein.

Image by TheVisualMD

Cross Section of Human Thorax. Liver in bottom Left

Cross Section of Human Thorax. Liver in bottom Left

Image by TheVisualMD

Male Thorax Showing Trachea and Lung

3D visualization of an anterior view of the lungs and heart reconstructed from scanned human data. De-oxygenated red blood cells are sent by the right side of the heart through the pulmonary artery into the vessels of the lungs to be refilled with oxygen for their next circuit through the body. The blood is carried through the lung tissues, where it exchanges its carbon dioxide for oxygen in the alveoli. It is then returned through the pulmonary veins to the left side of the heart and sent out to the rest of the body. The pulmonary artery carries away the deoxygenated blood, which returns fully oxygenated through the pulmonary vein.

Image by TheVisualMD

Thoracic Aneurysm in the Aorta

Aneurysms that occur in the part of the aorta that is higher in the chest are called thoracic aortic aneurysms. Aortic aneurysms often grow slowly and usually without any symptoms therefore making them difficult to detect

Image by TheVisualMD

Ventilation/perfusion scan

subFusion processing applied to a SPECT lung ventilation-perfusion scan.

Image by KieranMaher at English Wikibooks

Bronchi and Bronchiole of Lung

3D visualization of an inferior view of a transverse section of the thorax, highlighting the lungs, reconstructed from scanned human data. The trachea, cardiac impression, and transverse sections of the thoracic aorta and esophagus are clearly illustrated. The bronchial tree is also visible. When air is inhaled into the lungs, it flows through large tubes called bronchi, branches into smaller tubes known as bronchioles, and ends up in the thousands of small pouches that are the alveoli. This is where the oxygen is transferred from the air into the bloodstream. Each alveolar sac, or air sac, is surrounded by a bed of capillaries, and the walls between the lung and the capillary are extremely thin. The walls are so delicate, in fact, that the inhaled oxygen can seep from the air sacs to bind to the hemoglobin in the blood, while the carbon dioxide and other waste gasses leave the blood and diffuse into the lungs where they can be exhaled.

Image by TheVisualMD

Chest Pain

Angina

Image by TheVisualMD

Chest Pain

Chest Pain

Image by TheVisualMD

Chest Pain or Tightness

Image by TheVisualMD

CT scanner

A view of the CT scanner in the new Fort Belvoir Community Hospital. The hospital, still under construction, is a 2005 Base Realignment and Closure project, and is scheduled to open later this year.

Image by Official Navy Page from United States of America MC2 Todd Frantom/U.S. Marine Corps

Illustration of 3 X-ray images and a patient entering a CT scanner

Radiation can be dangerous, but it can also save lives. When you’re faced with a medical test that uses radiation, don’t let fear get in your way. Learn about the risks and benefits, and know what questions to ask.

Image by NIH News in Health

Drawing of a computerized tomography scanner with a health care professional looking on a computer screen as a patient lies inside the scanner

CT scan.

Image by NIDDK Image Library

Advanced CT Scanning

An NIH Clinical Center study participant receives a scan in the Photon-Counting CT scanner.

Image by NIH Clinical Center

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This media may include sensitive content

CAT Scan

A computer-assisted tomographic (CAT) scanner, with a Caucasian female technician working at a screen and behind a glass wall. A patient is on a table and being tested by the CAT scanner. The lighting is very subdued. This new technology revolutionized detection of brain tumors.

Image by National Cancer Institute / Linda Bartlett (Photographer)

Virtual Colonoscopy Slice of CT Data

Virtual colonoscopy is a new imaging technology that uses computed tomography (CT) images to look for polyps and cancer in the colon. A computed tomography scanner takes cross-sectional images of the patient's colon, after the colon has been inflated with gas. A three-dimensional model is created from the CT slices and evaluated by a radiologist for abnormalities.

Image by TheVisualMD

Pleural empyema

Amit Banga, GC Khilnani, SK Sharma1, AB Dey, Naveet Wig and Namrata Banga

How Are Pleurisy and Other Pleural Disorders Diagnosed?

Robertolyra

How Are Pleurisy and Other Pleural Disorders Treated?

en:User:Clinical Cases

Chest Radiograph

TheVisualMD

What To Expect During a Coronary Calcium Scan

Semnic

Incision for Open-Chest Bypass Surgery

TheVisualMD

4:22

A child's guide to hospital: CT Chest

The Royal Children's Hospital Melbourne/YouTube

1:50

What is it like to have a CT scan? | Cancer Research UK

Cancer Research UK/YouTube

Coronary CT angiography of coronary arteries

Oxford Academic Cardiovascular CT Core Lab and Lab of Inflammation and Cardiometabolic Diseases at NHLBI

Coronary CT

Bác sĩ Nguyễn Minh Đức

CT of the blood vessels and heart

Bác sĩ Nguyễn Minh Đức

Chest CT showing pulmonary sequestration

RadsWiki

Scimitar syndrome chest CT

Matthew Cham, MD /Wikimedia

4:59

Having a Cardiac CT Scan in Hospital

Oxford AHSN/YouTube

2:33

What to Expect from a CT Exam with Contrast

RAYUS Radiology™/YouTube

7:48

Protocoling chest CTs

Thoracic Radiology/YouTube

1:44

Low Dose CT Scans to Look for Lung Cancer

Lee Health/YouTube

8:27

Lung Cancer Screening (LCS)

Cleveland Clinic/YouTube

5:10

CT Scan of the Chest Explained Clearly - High Resolution CT Scan (HRCT)

MedCram - Medical Lectures Explained CLEARLY/YouTube

3:29

What to Expect: CT Scan | Cedars-Sinai

Cedars-Sinai/YouTube

17:21

How I Read a Chest CT

Thoracic Radiology/YouTube

8:46

Introduction to Computed Tomographic imaging of the Chest

Yale Radiology and Biomedical Imaging/YouTube

3:09

Lung Cancer Screening: The Life-saving CT Scan

RAYUS Radiology™/YouTube

2:19

How to prepare for a CT scan

Sunnybrook Hospital/YouTube

2:07

Using CT Scans to Screen for Lung Cancer

UConn Health/YouTube

5:04

Cardiac CT scan

UHP_NHS/YouTube

6:28

Real look at Chest, Abdomen and Pelvis CT Scan from Start to Finish.

Dumb Old Dad/YouTube

2:52

What is it like to get a CT Scan with Contrast?

STRIDE Project/YouTube

Thorax with Healthy Heart

TheVisualMD

Heart and Lungs

TheVisualMD

Thorax with Muscle Involved in Respiration

TheVisualMD

Thorax with Muscle Involved in Respiration

TheVisualMD

Thorax with visible Lung and Heart

TheVisualMD

Female Thorax Showing Breast

TheVisualMD

Male Thorax with Visible Heart

TheVisualMD

Thorax with Heart and Lung

TheVisualMD

Cross Section of Human Thorax. Liver in bottom Left

TheVisualMD

Male Thorax Showing Trachea and Lung

TheVisualMD

Thoracic Aneurysm in the Aorta

TheVisualMD

Ventilation/perfusion scan

KieranMaher at English Wikibooks

Bronchi and Bronchiole of Lung

TheVisualMD

Chest Pain

TheVisualMD

Chest Pain

TheVisualMD

Chest Pain or Tightness

TheVisualMD

CT scanner

Official Navy Page from United States of America MC2 Todd Frantom/U.S. Marine Corps

Illustration of 3 X-ray images and a patient entering a CT scanner

NIH News in Health

Drawing of a computerized tomography scanner with a health care professional looking on a computer screen as a patient lies inside the scanner

NIDDK Image Library

Advanced CT Scanning

NIH Clinical Center

Sensitive content

This media may include sensitive content

CAT Scan

National Cancer Institute / Linda Bartlett (Photographer)

Virtual Colonoscopy Slice of CT Data

TheVisualMD

Bone Scan

Bone Scan

Also called: Bone Scintigraphy, Skeletal Scintigraphy, Nuclear Bone Scan

A bone scan is a safe, effective, and painless way to make images of your bones using a compound containing a small amount of radioactivity injected into the bloodstream. The test helps find out if there is a tumor, infection, or other abnormality in your bone.

Bone Scan

Also called: Bone Scintigraphy, Skeletal Scintigraphy, Nuclear Bone Scan

A bone scan is a safe, effective, and painless way to make images of your bones using a compound containing a small amount of radioactivity injected into the bloodstream. The test helps find out if there is a tumor, infection, or other abnormality in your bone.

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Use the slider below to see how your results affect your health.
Your result is Normal.
In a normal bone scan, the radioactive tracer is evenly spread among the bones. No areas of too much or too little tracer are seen, or areas of "cold" or "hot" spots.
Related conditions
1. https://www.cc.nih.gov/ccc/patient_education/procdiag/bonescan.pdf [accessed on Mar 21, 2019]
2. https://www.radiologyinfo.org/en/info.cfm?pg=bone-scan [accessed on Mar 21, 2019]
3. https://www.hopkinsmedicine.org/healthlibrary/test_procedures/orthopaedic/bone_scan_92,p07663 [accessed on Apr 01, 2019]
4. https://www.mayoclinic.org/tests-procedures/bone-scan/about/pac-20393136 [accessed on Apr 01, 2019]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (18)

Osteomyelitis

Osteomyelitis in both feet as seen on bone scan

Image by James Heilman, MD

Facing Forward: Life After Cancer Treatment

Facing Forward: Life After Cancer Treatment is for people who have completed cancer treatment. Family and friends may also want to read this booklet.

Document by National Cancer Institute (NCI)

Treatment Planning

A cancer's stage (how far it has progressed) is a very important factor in deciding on treatment and estimating the patient's prognosis. After biopsy confirms the presence of cancer in the prostate, the cancer is staged, meaning that more tests are done to find out how far the cancer has spread in the prostate and if it has spread outside the gland to adjacent tissues or to other sites in the body.

Image by TheVisualMD

Preventing Bone Complications From Bone Metastases

Video by For Your Life/YouTube

Impact of Bone Metastases on the Skeleton

Video by Amgen/YouTube

The Biology of Metastatic Bone Disease

Video by Amgen/YouTube

Having a bone scan | Cancer Research UK

Video by Cancer Research UK/YouTube

Introduction to Bone Biology

Video by Amgen/YouTube

bone-scan.swf

Video by Dr Amir Monir/YouTube

Bone Cancer

Video by Focus Medica/YouTube

Limb Lengthening and Reconstruction in Patient with Bone Cancer

Video by Hospital for Special Surgery/YouTube

Q&A: What is Ewing sarcoma? | Texas Children's Cancer and Hematology Centers

Video by Texas Children’s Hospital/YouTube

Ewing's Sarcoma - Mayo Clinic

Video by Mayo Clinic/YouTube

Ewing's Sarcoma, What Is It?

Video by EmpowHER/YouTube

Osteosarcoma - Mayo Clinic

Video by Mayo Clinic/YouTube

Treatment for Osterosarcoma at Boston Children's Hospital

Video by Boston Children's Hospital/YouTube

Chondrosarcoma, What Is This?

Video by EmpowHER/YouTube

Is Your Baby a Boy or a Girl? (Pregnancy Health Guru)

Video by Healthguru/YouTube

Osteomyelitis

James Heilman, MD

Facing Forward: Life After Cancer Treatment

National Cancer Institute (NCI)

Treatment Planning

TheVisualMD

4:17

Preventing Bone Complications From Bone Metastases

For Your Life/YouTube

2:21

Impact of Bone Metastases on the Skeleton

Amgen/YouTube

3:19

The Biology of Metastatic Bone Disease

Amgen/YouTube

1:35

Having a bone scan | Cancer Research UK

Cancer Research UK/YouTube

2:44

Introduction to Bone Biology

Amgen/YouTube

1:13

bone-scan.swf

Dr Amir Monir/YouTube

0:20

Bone Cancer

Focus Medica/YouTube

2:21

Limb Lengthening and Reconstruction in Patient with Bone Cancer

Hospital for Special Surgery/YouTube

5:41

Q&A: What is Ewing sarcoma? | Texas Children's Cancer and Hematology Centers

Texas Children’s Hospital/YouTube

9:01

Ewing's Sarcoma - Mayo Clinic

Mayo Clinic/YouTube

1:52

Ewing's Sarcoma, What Is It?

EmpowHER/YouTube

9:11

Osteosarcoma - Mayo Clinic

Mayo Clinic/YouTube

28:11

Treatment for Osterosarcoma at Boston Children's Hospital

Boston Children's Hospital/YouTube

1:13

Chondrosarcoma, What Is This?

EmpowHER/YouTube

1:29

Is Your Baby a Boy or a Girl? (Pregnancy Health Guru)

Healthguru/YouTube

Treatment

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Internal radiotherapy for breast cancer

Image by Cancer Research UK / Wikimedia Commons

How Is Inflammatory Breast Cancer Treated?

Inflammatory breast cancer is generally treated first with systemic chemotherapy to help shrink the tumor, then with surgery to remove the tumor, followed by radiation therapy. This approach to treatment is called a multimodal approach. Studies have found that women with inflammatory breast cancer who are treated with a multimodal approach have better responses to therapy and longer survival. Treatments used in a multimodal approach may include those described below.

Neoadjuvant chemotherapy: This type of chemotherapy is given before surgery and usually includes both anthracycline and taxane drugs. Doctors generally recommend that at least six cycles of neoadjuvant chemotherapy be given over the course of 4 to 6 months before the tumor is removed, unless the disease continues to progress during this time and doctors decide that surgery should not be delayed.
Targeted therapy: Inflammatory breast cancers often produce greater than normal amounts of the HER2 protein, which means that drugs such as trastuzumab (Herceptin) that target this protein may be used to treat them. Anti-HER2 therapy can be given both as part of neoadjuvant therapy and after surgery (adjuvant therapy).
Hormone therapy: If the cells of a woman’s inflammatory breast cancer contain hormone receptors, hormone therapy is another treatment option. Drugs such as tamoxifen, which prevent estrogen from binding to its receptor, and aromatase inhibitors such as letrozole, which block the body’s ability to make estrogen, can cause estrogen-dependent cancer cells to stop growing and die.
Surgery: The standard surgery for inflammatory breast cancer is a modified radical mastectomy. This surgery involves removal of the entire affected breast and most or all of the lymph nodes under the adjacent arm. Often, the lining over the underlying chest muscles is also removed, but the chest muscles are preserved. Sometimes, however, the smaller chest muscle (pectoralis minor) may be removed, too.
Radiation therapy: Post-mastectomy radiation therapy to the chest wall under the breast that was removed is a standard part of multimodal therapy for inflammatory breast cancer. If a woman received trastuzumab before surgery, she may continue to receive it during postoperative radiation therapy. Breast reconstruction can be performed in women with inflammatory breast cancer, but, due to the importance of radiation therapy in treating this disease, experts generally recommend delayed reconstruction.
Adjuvant therapy: Adjuvant systemic therapy may be given after surgery to reduce the chance of cancer recurrence. This therapy may include additional chemotherapy, hormone therapy, targeted therapy (such as trastuzumab), or some combination of these treatments.

Source: National Cancer Institute (NCI)

Additional Materials (4)

1:59

How MD Anderson treats inflammatory breast cancer (IBC)

MD Anderson Cancer Center/YouTube

1:17

Inflammatory breast cancer survivor finds hope with clinical trial

MD Anderson Cancer Center/YouTube

13:21

Inflammatory Breast Cancer: Rare, Not Impossible | Tatiana Cordts | TEDxACU

TEDx Talks/YouTube

2:33

Inflammatory Breast Cancer Treatment

MD Anderson Cancer Center/YouTube

Prognosis

Prognosis Icon

Image by mcmurryjulie/Pixabay

What Is the Prognosis of Patients with Inflammatory Breast Cancer?

The prognosis, or likely outcome, for a patient diagnosed with cancer is often viewed as the chance that the cancer will be treated successfully and that the patient will recover completely. Many factors can influence a cancer patient’s prognosis, including the type and location of the cancer, the stage of the disease, the patient’s age and overall general health, and the extent to which the patient’s disease responds to treatment.

Because inflammatory breast cancer usually develops quickly and spreads aggressively to other parts of the body, women diagnosed with this disease, in general, do not survive as long as women diagnosed with other types of breast cancer.

It is important to keep in mind, however, that survival statistics are based on large numbers of patients and that an individual woman’s prognosis could be better or worse, depending on her tumor characteristics and medical history. Women who have inflammatory breast cancer are encouraged to talk with their doctor about their prognosis, given their particular situation.

Ongoing research, especially at the molecular level, will increase our understanding of how inflammatory breast cancer begins and progresses. This knowledge should enable the development of new treatments and more accurate prognoses for women diagnosed with this disease. It is important, therefore, that women who are diagnosed with inflammatory breast cancer talk with their doctor about the option of participating in a clinical trial.

Source: National Cancer Institute (NCI)

Additional Materials (3)

3:12

Life After Inflammatory Breast Cancer | Dana-Farber Cancer Institute

Dana-Farber Cancer Institute/YouTube

8:17

Inflammatory Breast Cancer - Suzy's Story

Mayo Clinic/YouTube

3:14

Breast Cancer - A Patient's Journey with Inflammatory Breast Cancer: Dana-Farber Cancer Institute

Dana-Farber Cancer Institute/YouTube

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