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.
Breast cancer is not a single disease. There are many types
of breast cancer, and they may have vastly different implications. Breast cancers
range
from localized cancers such as ductal carcinoma in situ
(DCIS) to invasive cancers that can rapidly spread (metastasize). In
the middle of the
spectrum are breast cancers, such as colloid carcinomas and papillary
carcinomas, which have a much more favorable outlook (prognosis) than
the other more typically invasive breast cancers. Sometimes,
noninvasive
DCIS is found around invasive breast cancers.
The treatment team should be able to explain what type of cancer you have, how they determined this, and the treatment they recommend.
What difference does a precise diagnosis make?
The importance of an accurate diagnosis cannot be overstated.
It is the precise diagnosis that determines the recommended
treatment. Treatment must be specifically tailored to the specific
type of breast cancer as well as to the individual patient.
Your doctor should be able to give you a clear description of your
type of
breast cancer along with the treatment options that are appropriate
to your
case.
What has been done to exclude cancer in other areas of the same
breast or in my other breast?
Unfortunately, there are some patients who may have more than
one area of malignancy in the same breast or even an additional
malignancy in the other breast. If this does occur, it can greatly
change the recommendations for treatment.
Therefore, it is critically important that your doctors carefully investigate
beyond the immediate site of the tumor to make certain there are no other areas
with possible malignancy.
Sometimes discovering these "secondary" areas requires careful review of your mammograms. It may also require the addition of special views from different angles and specialized examination of your breasts by ultrasound, MRI, or other imaging techniques. Sometimes imaging techniques will be used to evaluate the rest of your body as well.
What type of medical team do I need for the most accurate
diagnosis?
A well-coordinated team which includes input from the pathologist, surgeon, and radiologist is usually the best way to approach treatment decisions. Advice from the entire team must be available during biopsies and any tumor-clearing surgery to ensure the best chance of a favorable outcome for the patient.
How important is the role of the pathologist reading my
slides?
The pathologist evaluating the slides made from fine-needle
aspiration biopsies, core biopsies, and tissue slides of the breast
must have a great deal of experience and special training. It is
important that the pathologist reliably determine the presence or
absence of cancer and distinguish cancer from other conditions such
as hyperplasia with atypia (an overgrowth with unusual-looking but benign cells). The pathologist also orders and interprets special studies (see below) on your cancer tissue to determine the precise characteristics of the cancer cells, such as whether the cancer expresses hormone receptors. These results are used to further specify the type of breast cancer and optimize treatment decisions. The remainder of the treatment will be based on the pathologist's diagnosis.
Have my slides been reviewed by more than one
pathologist?
A review by more than one pathologist is optimal. There are many
subtleties which
can
be overlooked when reviewing microscope slides. These can lead to
both over-reading (making a false-positive diagnosis) and under-reading
(making a false-negative diagnosis). When slides are read a second
time by another pathologist followed by a discussion of the
conclusions, most
diagnostic problems are resolved.
There are almost always several pathologists
available who can review the pathology of your slides (this is termed
a "double reading"). The added safeguard of double reading may not
be
necessary in most cases of breast cancers but can be a critical
factor
in some cases.
Can I have my biopsy reviewed by a pathologist at another
diagnostic center?
It should always be possible to send slides from your biopsy to a
pathologist at another diagnostic center. First of all, there should
not be
a rush to treatment; breast cancer is almost never an emergency.
Developing the best treatment plan depends on a good, thorough
pathologic
evaluation as well as a complete workup of both breasts, as noted
above. You should discuss this with your treatment team or primary-care giver as they can help you arrange for this.
Second, good pathologists are never offended by a request for
an outside opinion. They also usually know the names of some of the
finest breast pathologists in the country and should be willing to
arrange a consultation with one of these doctors.
In most cases of breast cancer, it is not necessary to obtain this
in-depth consultation. However, if there are any unusual aspects of
your case, it can be important in your decision-making process. The
matter of obtaining additional consults may take a week or more.
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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