Staging Breast Cancer, Including in Settings Without PET CT

It's mandatory, and Dr. Jain considers it roughly 95% of overall cancer management. Physical rehabilitation covers arm exercises and lifelong protection of the affected arm, no rings, blood pressure cuffs or needles on that side. Psychological rehabilitation matters just as much, since patients carry real emotional weight after a cancer diagnosis, and in some settings social rehabilitation is needed too, since patients can lose their jobs, or in some communities face marital breakdown, because of the diagnosis.

Prognosis is improving steadily. Five-year survival is around 97-98% for stage one, 90-95% for stage two, 80-85% for stage three, and even stage four disease has a 25-30% five-year survival rate. Triple-negative and locally advanced cases carry a higher recurrence risk specifically, so they need especially stringent follow-up to catch any recurrence early enough to treat.

Surgery alone, all-inclusive, costs roughly $5,000. Chemotherapy adds around $10,000, and radiation is roughly $3,500 to $4,000. Extended targeted therapy such as trastuzumab can add another $10,000, though that portion can often be continued at the patient's home location. As a rough guide, surgery plus basic chemotherapy runs around $15,000 for most patients, and cases involving genuine financial hardship can always be discussed.

A whole-abdomen ultrasound, not just the upper abdomen, checks for liver metastasis and also covers the ovaries and uterus. A chest X-ray checks for lung metastasis. For bone, a skeletal survey, plain X-rays covering the spine, skull and limbs, substitutes for a bone scan where nuclear medicine isn't available. This combination is less accurate than PET CT but is a reasonable, optimal fallback when resources are limited.

For a young patient with early, well-localised disease, breast conservation surgery is advisable over mastectomy: a wide excision with lymph node dissection or sentinel biopsy, followed by pathology review. If the oestrogen receptor is positive on the final specimen, tamoxifen is started after surgery, and chemotherapy is added if indicated by the pathology. Starting tamoxifen before surgery is not advisable.

No. A small lesion under 2 cm with no palpable axillary nodes only needs a chest X-ray and abdominal ultrasound. PET CT becomes more useful once the lesion is over 2 cm or nodes are palpable.

A CT scan of the abdomen and chest combined with a skeletal survey (plain X-rays of the spine, skull and limbs) is a reasonable fallback, though less sensitive than PET CT.