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Breast cancer

The incidence of malignant tumorous diseases of breasts increases from year to year, in Hungary it is the most frequent cancer type among women, 7000 new patients are discovered annually and 2500 women die of it. In most cases it occurs after the age of 50 but it may develop at a younger age, between 25 and 30 years. Breast cancer can occur not only among women but among men as well, but it is far less frequent. In case of a neglected breast cancer the chance of recovery is very low, the cancer diagnosed at an early stage can be cured by a good chance. Due to these facts regular self-examination and cancer screening (mammography) are very important.

The malignant breast cancer mainly develops from milk ducts (ductal carcinoma) and rarely from glandular edges (so-called lobular carcinoma). Initially it grows locally, then it intrudes into lymphatic vessels and bloodstream, and it may give metastases most frequently to lymph nodes of the axilla, chest wall, neck, to lungs, liver, bones or the opposite breast.

The most characteristic symptom is a palpable lump in the breast, but this does not necessarily indicate a malignant disease. It is characteristic to breast cancer symptoms that the shape and size of the tumorous breast has changed. Discharge may flow out of the breast. If the tumor is attached to the skin it forms a fold, inverts the nipple and fixes it in this inverted position. Later the skin may become ulcerated.
Pain is not characteristic, it only occurs in an early stage in 10% of the cases. The most important thing is the foreign-body feeling, the palpable, typical extra tissue. In an advanced stage symptoms are produced mainly by metastases. Bone metastases may cause pain and can be associated with fractures. Metastases in the lung may trigger gradually worsening respiratory and circulatory failure.

FDG PET-CT examination is capable of detecting the malignant breast cancer, the recurrence and metastases of it.

 

PET-CT examination can be useful in case of breast cancer patients in the following situations:

  • For judging the accurate extent of the locally advanced breast cancers, for detection of lymphatic and organ involvement of metastatic breast cancers, for the so-called primary stage classification of the cancer.
  • In case of locally advanced cancers for assessment of the efficacy of the so-called neo-adjuvant chemotherapy used before surgery.
  • In case of metastatic cancers for judging the efficacy of the applied drug therapy or radiation therapy.
  • After treating liver and lung metastases with radiofrequency ablation (RFA) for judging the viability of the tumor.
  • If levels of tumor markers are high during control examinations and traditional imaging techniques have negative results, performing a PET-CT examination is absolutely recommended.

 

The histological type of the tumor significantly influences the sensitivity of the test: in case of the rarely occurring lobular and tubular cancers the administered sugar-like substance (FDG) is accumulated in a smaller amount than in case of the more frequently occurring ductal type.
In screening for breast cancer and in detection of non-palpable tumors it is less useful – in case of tumors with smaller than 1 cm size the sensitivity of PET-CT is low.

 

DIAGNOSTIC PROCEDURES:

FDG PET-CT

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