NCCN Guidelines for Patients
Breast Cancer - Early-Stage
(STAGES I AND II)
, Version 1.2016
Liver function tests
Your liver is an organ in the upper right side of your
abdomen. It does many important jobs, such as
remove toxins from your blood. Liver function tests
assess for chemicals that are made or processed by
the liver. Levels that are too high or low may signal
that the cancer has spread to distant sites. One such
chemical is ALP (
hosphatase). High levels
of ALP may mean that the cancer has spread to your
liver or bones.
Imaging tests make pictures (images) of the insides
of your body. They can show which sites have cancer.
This information helps your doctors stage the cancer.
Your treatment team will tell you how to prepare
for these tests. You may need to stop taking some
medicines and stop eating and drinking for a few
hours before the scan. Tell your doctors if you get
nervous when in small spaces. You may be given a
sedative to help you relax.
Bilateral diagnostic mammogram
A mammogram is a picture of the insides of your
breast. The pictures are made using x-rays.
Mammograms that are used for breast cancer
screening are often made from two x-rays of each
breast. A computer combines the x-rays to make
See Figure 2.1
for more information.
Many women diagnosed with breast cancer have
already had a bilateral diagnostic mammogram. If
you haven’t had this test, it is advised. A bilateral
mammogram is a picture of each breast. Diagnostic
mammograms are made with more x-rays from
different angles than screening mammograms. By
using more x-rays, the picture is clearer and can
better show the size and number of tumors.
Ultrasound is a test that uses sound waves to make
pictures. For this test, you will need to lie down on
a table. Next, a technician or doctor will hold the
ultrasound probe on top of your breast. The probe
may also be placed below your armpit to view your
If the mammography and ultrasound images are
unclear, your doctors may want you to get a breast
maging). This test uses
a magnetic field and radio waves to make pictures
of the insides of your breasts. Before the test, a
contrast dye may be injected into your vein to make
the pictures clearer. The dye may cause you to feel
flushed or get hives. Rarely, serious allergic reactions
occur. Tell your doctor if you have had bad reactions
For breast MRI, you must remove your top and bra
and lie face down on a table. The table has padded
openings for your breasts. In the openings, there are
coils that help to make pictures. During breast MRI,
the table moves slowly through the tunnel of the MRI
A bone scan is recommended if you have bone pain
or if ALP levels are high. Before the pictures are
taken, a radiotracer will be injected into your vein.
The most common radiotracer used for bone scans
is technetium. You will need to wait about 3 hours for
the radiotracer to enter your bones. A special camera
is used to take pictures while you lie still on a table.
It takes 45 to 60 minutes to complete the pictures.
Areas of bone damage use more radiotracer than
healthy bone and thus appear as bright spots. Bone
damage can be caused by cancer as well as other