N Categories For Breast Cancer
N followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are involved.
Lymph node staging for breast cancer is based on how the nodes look under the microscope, and has changed as technology has gotten better. Newer methods have made it possible to find smaller and smaller groups of cancer cells, but experts haven’t been sure how much these tiny deposits of cancer cells influence outlook.
Its not yet clear how much cancer in the lymph node is needed to see a change in outlook or treatment. This is still being studied, but for now, a deposit of cancer cells must contain at least 200 cells or be at least 0.2 mm across for it to change the N stage. An area of cancer spread that is smaller than 0.2 mm doesn’t change the stage, but is recorded with abbreviations that indicate the type of special test used to find the spread.
If the area of cancer spread is at least 0.2 mm , but still not larger than 2 mm, it is called a micrometastasis . Micrometastases are counted only if there aren’t any larger areas of cancer spread. Areas of cancer spread larger than 2 mm are known to influence outlook and do change the N stage. These larger areas are sometimes called macrometastases, but are more often just called metastases.
NX: Nearby lymph nodes cannot be assessed .
N0: Cancer has not spread to nearby lymph nodes.
N1c: Both N1a and N1b apply.
N3: Any of the following:
Tumor Diameter Changes On Serial Breast Us And Comparison With Pathology
Changes in maximum tumor diameters between initial and second US images were significantly different among the molecular subtypes .4). Breast cancers with more aggressive molecular subtypes showed larger diameter changes than luminal breast cancers . The clinical T stage determined by breast US was more frequently upgraded from T1 to T2 during wait times for surgery in nonluminal breast cancers than in luminal cancers .
Grading Invasive Breast Cancer Cells
Three features of the invasive breast cancer cell are studied and each is given a score. The scores are then added to get a number between 3 and 9 that is used to get a grade of 1, 2, or 3, which is noted on your pathology report. Sometimes the terms well differentiated, moderately differentiated, and poorly differentiated are used to describe the grade instead of numbers:
- Grade 1 or well differentiated . The cells are slower-growing, and look more like normal breast cells.
- Grade 2 or moderately differentiated . The cells are growing at a speed of and look like cells somewhere between grades 1 and 3.
- Grade 3 or poorly differentiated . The cancer cells look very different from normal cells and will probably grow and spread faster.
Our information about pathology reports can help you understand details about your breast cancer.
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How Long Does It Take For Breast Cancer To Grow My Doctor Just Examined My Breasts A Month Ago And Today I Found A Lump Is It Possible That Breast Cancer Could Have Developed So Quickly
Answer from the expert staff of breast cancer research at the Robert W. Franz Cancer Research Center at Providence Portland Medical Center:
Like a lot of cancers, breast cancer grows by simple cell division. It begins as one malignant cell, which then divides and becomes two bad cells, which divide again and become four bad cells, and so on. Breast cancer has to divide 30 times before it can be felt. Up to the 28th cell division, neither you nor your doctor can detect it by hand.
With most breast cancers, each division takes one to two months, so by the time you can feel a cancerous lump, the cancer has been in your body for two to five years. It can certainly seem like a lump appeared out of nowhere especially if you or your doctor have recently examined your breasts and not felt anything suspicious but in reality, the cancer has simply doubled that one last time necessary to be noticeable. By the time you can feel it, a breast tumor is usually a little more than one-half inch in size about a third the size of a golf ball. It has also been in your body long enough to have had a chance to spread.
Its important to realize that there are two types of mammograms:
What Is Stage Iii Breast Cancer
In stage III breast cancer, the cancer has spread further into the breast or the tumor is a larger size than earlier stages. It is divided into three subcategories.
Stage IIIA is based on one of the following:
- With or without a tumor in the breast, cancer is found in four to nine nearby lymph nodes.
- A breast tumor is larger than 50 millimeters, and the cancer has spread to between one and three nearby lymph nodes.
In stage IIIB, a tumor has spread to the chest wall behind the breast. In addition, these factors contribute to assigning this stage:
- Cancer may also have spread to the skin, causing swelling or inflammation.
- It may have broken through the skin, causing an ulcerated area or wound.
- It may have spread to as many as nine underarm lymph nodes or to nodes near the breastbone.
In stage IIIC, there may be a tumor of any size in the breast, or no tumor present at all. But either way, the cancer has spread to one of the following places:
- ten or more underarm lymph nodes
- lymph nodes near the collarbone
- some underarm lymph nodes and lymph nodes near the breastbone
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How Quickly Breast Cancer Develops
The actual time it takes for breast cancer to grow from a single cancer cell to a cancerous tumor is unknown. Part of the reason is that estimates based on doubling time assume that the rate stays constant at all times as the tumor grows.
If this were true, cancer with a doubling time of 200 days would take 20 years to develop into a detectable tumor. A doubling time of 100 days would take 10 years to be found on exam. In contrast, a breast tumor with a doubling time of 20 days would take only 2 years to develop.
Most studies have found the average doubling time to be between 50 days and 200 days. This means it’s possible that breast cancers diagnosed now began at least 5 years earlier, but again, this assumes the growth rate is constant. It is not.
T Categories For Breast Cancer
T followed by a number from 0 to 4 describes the main tumor’s size and if it has spread to the skin or to the chest wall under the breast. Higher T numbers mean a larger tumor and/or wider spread to tissues near the breast.
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 more than 2 cm but not more than 5 cm across.
T3: Tumor is more than 5 cm across.
T4 : Tumor of any size growing into the chest wall or skin. This includes inflammatory breast cancer.
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Understanding Tumor Size Measurement
Tumor size is typically measured using millimeters or centimeters. For example, a tumor could be 2 centimeters or 20 millimeters. Common everyday foods may help with understanding measurements:
- 1 cm is about the width of a pea
- 2 cm is about the size of a peanut
- 3 cm is about the size of a grape
- 4 cm is about the size of a walnut
- 5 cm is about the size of a lime
- 6 cm is about the size of an egg
- 7 cm is about the size of a peach
- 10 cm is about the size of a grapefruit
Tumor size is measured based on an imaging scan or surgical removal of the tumor. Tests such as mammograms or ultrasounds may be used to take images and measure the tumor, and often may be instrumental in first detecting the tumor. If the tumor is operable, meaning it may be safely removed during surgery, it will also be measured after removal. Tumors are measured at their widest point.
How To Prevent Breast Cancer
There is no guaranteed way to prevent breast cancer. Reviewing the risk factors and modifying the ones that can be altered can help in decreasing the risk.
Following the American Cancer Society’s guidelines for early detection can help early detection and treatment.
There are some subgroups of women that should consider additional preventive measures.
- Women with a strong family history of breast cancer need genetic testing such as HER2-Positive and BRCA Gene tests. Discuss this with a health care provider and meet with a genetic counselor who can explain what the testing can and cannot tell and then help interpret the results after testing.
- Chemoprevention is the use of medications to reduce the risk of cancer. The two currently approved drugs for chemoprevention of breast cancer are tamoxifen and raloxifene , which also blocks the effect of estrogen on breast tissues. Their side effects and whether these medications are right for an individual need to be discussed with a health care provider.
- Aromatase inhibitors are medications that block the production of small amounts of estrogen usually produced in postmenopausal women. They prevent the reoccurrence of breast cancer but are not approved at this time for breast cancer chemoprevention.
- For a small group of patients who have a very high risk of breast cancer, surgery to remove the breasts may be an option. Although this reduces the risk significantly, a small chance of developing cancer remains.
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Tumor Size And Breast Cancer Staging
Doctors determine the stage of cancer as part of their diagnosis. To confirm the breast cancer stage, they assess several different factors, including tumor size.
Doctors use multiple tests and examinations to evaluate the specific characteristics of a persons breast cancer. They use this information to assign values to the TNM staging system, where:
- T refers to the size of the main, or primary, tumor.
- N refers to whether cancer has spread to nearby lymph nodes.
- M refers to whether the cancer is metastatic, which means if it has spread to distant parts of the body.
The overall stages of cancer range from 0 to 4. Stage 0 means the breast cancer is at a very early stage and has not yet spread. Stage 4 refers to late stage breast cancer, which means it has spread to other parts of the body.
While every persons breast cancer is different, its stage generally indicates an individuals treatment options and outlook.
People with early stage breast cancer are likely to have smaller tumors that doctors can easily treat. Larger tumors tend to indicate later stage breast cancer, which may be more difficult to treat.
Doctors measure the size of the primary breast cancer tumor at its widest point. They usually give the size in millimeters or centimeters .
According to the , doctors use the following system to grade tumor size:
Tumor size is just one of several factors that doctors consider when determining the stage of a persons breast cancer. Other factors include the following:
What Are The Initial Signs And Symptoms Of Breast Cancer
Breast cancer is a disease in which cells in the breast grow uncontrollably and destroy the normal cells. When breast cancer spreads to other parts of the body, it is called metastasized cancer. The initial signs of breast cancer include:
- A lump in the breast or underarms is often the first sign. It may also be associated with pain, itching and tenderness.
- Changes in the nipple area, nipple retraction and inverted nipple are common warning signs of breast cancer.
- Bleeding from the nipple may be limited and difficult to see, but if an individual notices bloodstains on bra and if the secretions are unusual, bloody or continuous, the individual may need urgent medical attention.
- Change in color and/or thickening of the skin on the breast is a warning sign of breast cancer. If the breast skin changes color, typically to a pink or reddish hue that covers more than half of the breast, you need to show your doctor.
- A nonhealing sore anywhere on the breast, including the nipple with or without blood or fluid from the nipple, maybe a warning sign of breast cancer.
- Increased warmth in the breast with change in size and appearance of the breast is a sign of breast cancer.
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Early Locally Advanced And Secondary Breast Cancer
Early breast cancer means the cancer hasn’t spread beyond the breast or the lymph nodes in the armpit on the same side of the body. So, the cancer hasn’t spread to any other part of the body.
Local recurrence means cancer that has come back in the breast, the armpit, or the chest wall after treatment.
Locally advanced breast cancer means the cancer has spread into the surrounding area, such as the lymph nodes, the skin or chest muscle. But it has not spread to other parts of the body.
Secondary breast cancer is also called metastatic breast cancer, advanced breast cancer, or stage 4 breast cancer. It means that the cancer has spread to other parts of the body, such as the liver or bones.
The Appearance Of Cancer Cells
The appearance, or differentiation, of cancer cells is another factor in cancer staging. Doctors grade cancer cells according to how similar they appear to noncancerous cells under a microscope.
Healthcare professionals classify cancer cells that are close to resembling healthy cells as being low grade or well-differentiated. These cancers typically grow more slowly.
High grade, or poorly differentiated, cancer cells appear very different from normal cells and tend to grow faster.
After assessing the different characteristics of the breast cancer, doctors use the information to determine its overall stage from 04.
Here is an overview of each breast cancer stage :
- Stage 0: This cancer is noninvasive and is only present inside the milk ducts. This stage includes ductal carcinoma in situ.
- Stage 1: These are small tumors that either have not spread to the lymph nodes or have only affected a small area of the sentinel lymph node.
- Stage 2: These are larger tumors that have spread to some nearby lymph nodes.
- Stage 3: These tumors are large or growing into surrounding tissues, such as breast skin, muscle, and lymph nodes.
- Stage 4: These are tumors that started in the breast but have spread to other parts of the body.
When recommending treatment options for breast cancer, a doctor will take into account:
Treatment options can include:
- surgery, which may involve a mastectomy, removal of one or both breasts, or the removal of any affected lymph nodes
- lymph node involvement
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Breast Cancer Cell Growth
Cancer begins when there are genetic changes, called mutations, in a normal breast cell. These changes happen in genes that control the growth of the cell. These changes may occur over a long period of time, even decades, before a cancer cell forms.
These tumor cells multiply and divide exponentially, meaning that one cell becomes two, two cells become four, and so on. That’s why a tumor size will increase more rapidly, the larger it becomes.
That said, not all cells are dividing at the same time. The cancer’s growth can change at different stages as a tumor forms. Compared with many types of cancer, breast cancer has a “low growth fraction.” This means that the proportion of cancer cells that are in an active cell cycle is low.
Some tumors, such as lymphomas and some leukemias, have much higher growth fractions. They may be active for a much shorter period of time before they are detected, even in children.
Management Of Breast Cancer
Surgery and radiation therapy, along with adjuvant hormone or chemotherapy when indicated, are considered primary treatment. Surgical therapy may consist of lumpectomy or total mastectomy. Radiation therapy may follow surgery in an effort to eradicate residual disease while reducing recurrence rates. There are 2 general approaches for delivering radiation therapy:
- External-beam radiotherapy
Surgical resection with or without radiation is the standard treatment for ductal carcinoma in situ.
Pharmacologic treatment for metastatic breast cancer is typically selected according to the molecular characteristics of the tumor. Agents used include the following :
- Hormone therapy
- HER2-targeted therapy
- CDK4/6 inhibitors
- mTOR inhibitors
- PIK3CA inhibitors
In patients receiving adjuvant aromatase inhibitor therapy for breast cancer who are at high risk for fracture, the monoclonal antibody denosumab or either of the bisphosphonates zoledronic acid and pamidronate may be added to the treatment regimen to increase bone mass. These agents are given along with calcium and vitamin D supplementation.
See Treatment and Medication for more detail.
Two selective estrogen receptor modulators , tamoxifen and raloxifene, are approved for reduction of breast cancer risk in high-risk women. Prophylactic mastectomy is an option for women found to be at extremely elevated risk.
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Measurement Of Tumor Diameters Tumor Volumes And The Specific Growth Rate
The 3 readers showed almost perfect agreement for the measurement of tumor diameters , tumor volumes , and SGR .1). The median tumor diameters and volumes at the time of surgery were significantly larger than those at the time of diagnosis . SGR calculated using median tumor diameters and volumes at the time of diagnosis and surgery was a mean of 0.337±1.067%/day .