Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Staging is the process of determining the extent of the cancer and its spread
in the body. Together with the type of cancer, staging is used to determine the
appropriate therapy and to predict chances for survival.
To determine if the cancer has spread, several different imaging techniques
can be used.
Chest X-ray: It looks for spread of the cancer to the lung.
Mammograms: More detailed and additional mammograms provide more images of
the breast and may locate other abnormalities.
Computerized tomography (CT scan): These specialized X-rays are used to
look at different parts of your body to determine if the breast cancer has
spread. It could include a CT of the brain, lungs, or any other area of concern.
Bone scan: A bone scan determines if the cancer has spread (metastasized) to
the bones. Low level radioactive material is injected into the bloodstream, and
over a few hours, images are taken to determine if there is uptake in certain
bone areas, indicating metastasis.
Positron emission tomography (PET scan): A radioactive material is injected
that is absorbed preferentially by rapidly growing cells (such as cancer cells). The PET scanner then locates these areas in your body.
Staging system:
This system is used by your health-care team to summarize in a standard way
the extent and spread of your cancer. This staging can then be used to determine
the treatment most appropriate for your type of cancer.
The most widely used system in the U.S. is the American Joint Committee on
Cancer TNM system.
Besides the information gained from the imaging tests, this system also uses
the results from surgical procedures. After surgery, a pathologist looks at the
cells from the breast cancer as well as from the lymph nodes. This information
gained is incorporated into the staging as it tends to be more accurate than the
physical exam and X-ray findings alone.
TNM staging:
T: describes the size of the tumor. It is followed by a number from 0 to 4.
Higher numbers indicate a larger tumor or greater spread:
TX: Primary tumor cannot be assessed
T0: No evidence of primary tumor
Tis: Carcinoma in situ
T1: Tumor is 2 cm or less across
T2: Tumor is 2 cm-5 cm
T3: Tumor is more than 5 cm
T4: Tumor of any size growing into the chest wall or
skin.
N: describes the spread to lymph node near the breast. It is followed by a
number from 0 to 3.
NX: Nearby lymph nodes cannot be assessed (for example if they have
previously been removed).
N0: There has been no spread to nearby lymph nodes. In addition to the numbers, this part of the staging is
modified by the designation "i+" if the cancer cells are only seen by
immunohistochemistry (a special stain) and "mol+" if the cancer could only be
found using PCR (special detection technique to detect cancer at the molecular
level).
N1: Cancer has spread to one to three axillary lymph nodes
(underarm lymph nodes) or tiny amounts of cancer are found in internal mammary
lymph nodes (lymph nodes near breastbone).
N2: Cancer has spread to four to nine
axillary lymph nodes or the cancer has enlarged the internal mammary lymph
nodes.
N3: Any of the conditions below
Cancer has spread to 10 or more axillary lymph nodes with at least one
cancer spread larger than 2 mm
Cancer has
spread to lymph nodes under the clavicle with at least area of cancer spread
greater than 2 mm
M: This letter is followed by a 0 or 1, indicating whether the cancer has
spread to other organs.
MX: Metastasis can not be assessed.
M0: No distant spread is found on imaging
procedures or by physical exam.
M1: Spread to other organs is present.
Once the T, N, and M categories have been determined they are combined into
staging groups. There are five major staging groups, stage 0 to stage IV, which are
subdivided into A and B, or A and B and C, depending on the underlying cancer
and the T, N, and M scale.
Cancers with similar stages often require similar treatments.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Fibrocystic breast condition (sometimes called fibrocystic breast disease) is characterized by lumpiness and usually discomfort in one or both breasts. The condition is very common and benign (not malignant). Fibrocystic breast condition is the most common cause of "lumpy breasts" in women. A common symptom of fibrocystic breast condition is breast pain or discomfort. There are two types of fibrocystic breast condition, cysts and fibrosis, and Hyperplasia and atypical hyperplasia of breast cells.
Pleurisy, an inflammation of the lining around the lungs, is associated with sharp chest pain upon breathing in. Cough, chest tenderness, and shortness of breath are other symptoms associated with pleurisy. Pleurisy pain can be managed with pain medication and by external splinting of the chest wall.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Pleural effusion is an excess fluid between the two membranes that envelop the lungs. There are two classifications of causes of pleural effusion; transudate and exudate. The treatment of pleural effusion depends on the cause.
Breast lumps in women can have a variety of causes such as breast inflammation, infection, injuries, cancer, and non-cancerous growths. Breast lumps in women are diagnosed with physical exam, mammogram, ultrasound, MRI, and biopsy. Treatment of breast lumps in women depend on the cause.
The breast generally refers to the chest, however, more specifically, to the mammary gland. The mammary gland is a milk producing gland comprised largely of fat. Within the mammary gland is a complex network of branching ducts. The ducts exit from sac-like structures called lobules, which can produce milk in females. The darkened area around the nipple is called the areola. Common medical concerns in regard to the breast include breast lumps, breast cysts, breast cancer, and breast infections.
Male breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.
Phlebitis is the inflammation of a vein. Thrombophlebitis is when a blood clot causes the inflammation. Phlebitis can be superficial or deeper in the veins. A blood clot deep in a vein is deep vein thrombosis (DVT). Some of the common causes of phlebitis include prolonged inactivity, varicose veins, trauma to a vein, underlying cancers, clotting disorders, etc. Symptoms of phlebitis may be mild (pain, tenderness, redness, or bulging of a vein. Treatment of phlebitis depends on the cause.
Hypercalcemia is a condition in which calcium levels in the blood are elevated. Hypercalcemia is associated with other conditions such as hyperparathyroidism, lung cancer, breast cancer, kidney failure, and elevated levels of vitamin D. Symptoms of hypercalcemia include constipation, nausea, abdominal pain, kidney stones, to name a few. Treatment depends on the cause of hypercalcemia.
Lymphedema is a condition in which one or more extremities become swollen as the result of an impaired flow of the lymphatic system. There are two types of lymphedema; primary, secondary. Filariasis is the most common cause of lymphedema worldwide; however, in the U.S. breast cancer surgery is the most common cause. Symptoms include swelling of one or more limbs, thickening, cracked, and secondary bacterial or fungal infections of the skin. There is no cure for lymphedema.
Enjoying a satisfying sex life as we age is important to both physical and mental health. As we age, diseases and conditions may pose challenges in our sexual health, and sexual experiences. Learn how to manage your conditions and still have a gratifying sex life as you age.
Inflammatory breast cancer is an accelerated form of breast cancer that is not usually detected by mammogram or ultrasound. Symptoms of inflammatory breast cancer include pain in the breast, skin change in the breast area, bruise on the breast,sudden swelling of the breast, nipple retraction or discharge, and swelling of the lymph nodes.
Lymphedema is a common chronic, debilitating condition in which excess fluid called lymph collects in tissues and causes swelling in them. It is common after a mastectomy, lumpectomy or breast cancer surgery and radiation therapy.
Women's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.
Lifestyle changes, a healthy antioxidant-rich diet, exercise, and weight reduction can help reduce a woman's risk of developing breast cancer. It's important to be aware of how risk factors such as family history, lifestyle factors, breast conditions, radiation therapy, and hormonal factors may influence your chances of developing breast cancer. Mammography and breast self-examinations are crucial steps in breast cancer prevention.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
As breast cancer is the most diagnosed non-skin cancer in American women, it is important to know your breast cancer risk. Risk factors include age, age at menarche, age at first live birth, history of breast abnormalities, breast biopsies, race, and history or breast cancer among first-degree relatives.
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