Metastatic Breast Cancer: Diagnosis and Treatment-Response Monitoring
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Bone Scan
CT Scan
PET Scan
A PET scan can also locate cancer that has spread, but it usually isn’t the first imaging test that doctors order. “A CT scan and bone scan are going to be a little bit more sensitive at catching the cancer. And that’s because PET scans inject a special tracer that will light up if you have quickly dividing cells. We always think of that as being cancer cells, but actually, the majority of breast cancers are not quickly dividing,” says Polly Niravath, MD, a breast oncologist at the Houston Methodist Neal Cancer Center in Texas. “That can give you a false-negative on the PET scan.”
A PET scan is more useful for finding aggressive cancers like triple-negative breast cancer — a subtype of breast cancer that has tested negative for the HER2 protein, estrogen receptors, and progesterone receptors — especially when the CT scan and bone scan weren’t conclusive. “Then the PET scan can be a good [way to] double-check,” says Dr. Niravath.
Breast Biopsy
Even if you had a breast biopsy when your cancer was at an early stage, your doctor will probably biopsy the area where the cancer has spread. Then they’ll test the tumor cells for markers like estrogen receptor (ER), progesterone receptor (PR), and HER2 because your cancer type could be different now.
“Let’s say somebody had an estrogen-positive and HER2-negative cancer five years ago and now they’re having a recurrence. At this point it may have changed. It may be estrogen-negative. It could have become HER2-positive,” says Niravath. In that case, you will need a different treatment from the one you had before.
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