Breast Cancer Stage 1 Chemotherapy

How Big Is My Tumor

Tumor size is another factor that will determine your course of treatment. Your doctor uses the size of your tumor to stage, or further categorize your cancer .

The tumors dimensions are estimated by a physical exam, a mammogram, an ultrasound or an MRI of the breast. The precise size wont be known until a pathologist studies the tumor after surgical removal.

How Is Stage 1a Breast Cancer Treated

Patients with stage 1 breast cancer typically undergo surgery upfront, Mouabbi said, which may be a breast-conserving surgery or a mastectomy.

Surgery essentially “puts the patient in a cancer-free state because the cancer is removed already,” Mouabbi said. “So I tell my patients, everything that comes after that step is prevention making sure the cancer does not come back.”

But the exact treatments involved depend on a few factors. For instance, if a patient opted for a lumpectomy, they will likely receive radiation after surgery, Zeidman said. And if the patient’s cancer did spread to nearby lymph nodes they may receive radiation to “the regional lymph nodes around the breast,” Mouabbi explained.

And, in a subset of patients with specific types of breast cancer, chemotherapy may be recommended, Mouabbi said.

Types Of Stage 1 And 2 Breast Cancer

The most common types of invasive breast cancers are named after the area of the breast where they begin. Types of early breast cancers include:

• Invasive ductal carcinoma IDC means that the cancer originated in the milk ducts of the breast, and has spread into the surrounding breast tissue. IDC is the most common type of breast cancer, accounting for 80% of all breast cancers.
• Invasive lobular carcinoma ILC means that the cancer originated in the milk-producing lobules of the breast, and has spread into the surrounding breast tissue. ILC is the second most common type of breast cancer, and accounts for 10% of breast cancers.
• There are also other less common forms of invasive breast cancer, such as inflammatory breast cancer and Pagets disease of the nipple. For more information on the various types of invasive breast cancer, including the less common forms, please visit Types of Breast Cancer page.

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What Is Stage 1a Breast Cancer

“Stage 1 indicates that it is the earliest stage of breast cancer,” Mouabbi said. At this stage, the tumor is less than 2 centimeters in size and, most likely, has not spread to the lymph nodes.

To find out how far the cancer has spread, during surgery, the surgeon will “sample a few of the lymph nodes” with a procedure called a sentinel lymph node biopsy, Zeidman explained.

Using this procedure, the surgeon injects a radiotracer compound into the breast that will “travel to the lymph nodes and provide a roadmap,” he said. “It’ll show me, if cancer were to spread to the lymph nodes, which would be the first few lymph nodes that it would spread to.”

From there, doctors will remove and biopsy those lymph nodes to determine whether or not “tiny clusters of cells” have accumulated there, Zeidman said.

If the cancer hasnt spread to the lymph nodes, it will be considered stage 1A. But if a small amount has spread to one of the lymph nodes, the cancer is considered stage 1B, Mouabbi said.

Crucially, stage 1A and stage 1B cancers are treated generally the same way, Zeidman said.

Treatment Of Metastatic Breast Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment options for metastaticbreast cancer may include the following:

Hormone therapy

In postmenopausal women who have just been diagnosed with metastatic breast cancer that is hormone receptor positive or if the hormone receptor status is not known, treatment may include:

• A clinical trial of high-dose chemotherapy with stem cell transplant.
• Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

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How Breast Cancer Cells Are Graded

• G1. Cells are well differentiated this is considered low grade.
• G2. Cells are moderately differentiated this is considered intermediate grade.
• G3. Cells are poorly differentiated this is considered high grade.

Your healthcare team will also test the cancer cells for receptors that are located on the outside of the cells. Knowing which receptors are present can help determine what type of treatment is likely to be more effective.

Chemotherapy For Metastatic Breast Cancer

Advances in treatment are making it possible for women with metastatic breast cancer to live for many years. New drug therapies can not only slow down or stop a tumors growth but also keep symptoms at bay.

Which treatment your doctor recommends will vary based on your medical history, age, and breast cancer type, among other factors. Combinations of drugs are commonly prescribed for women with early-stage disease. Most women with advanced breast cancer generally receive only one drug at a time.

Chemotherapy drugs that MSK doctors commonly prescribe for advanced breast cancer include:

Women with advanced disease can also benefit from genomic testing. This is also called tumor sequencing or molecular profiling. It is offered to all MSK patients with metastatic breast cancer. Genomic testing involves looking at the cancer cells to see if there are any genetic mutations that could be linked to the specific type of breast cancer you have.

Our experts use a highly sophisticated testing approach developed by MSK researchers called MSK-IMPACT. The information gained from MSK-IMPACT can help us personalize your care. We can rule out drug therapies that may not work for you or sometimes recommend cutting-edge clinical trials designed to target the specific mutations in your tumor.

There are three grades of invasive breast cancer:

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Stages Of Breast Cancer: How Theyve Changed Over Time

In the past, only the size of a tumor and the status of nearby lymph nodes were used to determine the stage of someones breast cancer. It was a fairly simple system based purely on anatomy, and was therefore easy for people to memorize.

• If a tumor was two centimeters wide or smaller, it was considered stage I.
• If a tumor was larger than that or the cancer was detectable in nearby lymph nodes, it was considered stage II.
• If a tumor had spread to the skin of the breast or not far beyond the adjacent lymph nodes, it was considered stage III.
• And if a tumor had spread anywhere else in the body, it was automatically considered stage IV.

But all of that changed in 2017. Advancements in tumor biology and prognostic biological markers such as estrogen receptor , progesterone receptor , and HER2/neu allowed clinicians to understand why similarly staged patients had significantly different outcomes. This led the American Joint Commission on Cancer to revise its staging manual for breast cancer.

Today, we know that what truly determines a breast cancers stage is not only its size and the amount of lymph node involvement, but also what type of breast cancer it is and how aggressive it looks under a microscope.

How hormones influence breast cancer stages

So, a patient with only three cancerous lymph nodes who has a hormone-sensitive tumor thats two centimeters wide could still be considered stage I despite the lymph node involvement.

How grades influence breast cancer stages

When To Consider Joining A Clinical Trial

If youre newly diagnosed with early or locally advanced breast cancer, consider joining a clinical trial before starting treatment. For most people, treatment doesnt usually start right after diagnosis. So, theres time to look for a clinical trial that youre eligible for and fits your needs.

Once youve begun standard treatment for early or locally advanced breast cancer, it can be hard to join a clinical trial.

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Breast Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Breast

The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes. Each lobe has many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can make milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.

Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless, watery fluid called lymph. Lymph vessels carry lymph between lymph nodes. Lymph nodes are small, bean-shaped structures found throughout the body. They filter lymph and store white blood cells that help fightinfection and disease. Groups of lymph nodes are found near the breast in theaxilla , above thecollarbone, and in the chest.

The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma and is more often found in both breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen.

For more information about breast cancer, see:

• Childhood Breast Cancer Treatment

Inflammatory Breast Cancer Treatment

Inflammatory breast cancer is an uncommon and aggressive type of breast cancer caused by cancer cells blocking lymph vessels in the skin.

All IBC cases are classified as at least stage 3 breast cancer. If the cancer is metastatic , its considered stage 4.

Treatments for IBC depend on what stage the cancer is in.

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Breast Cancer Staging Guidelines

The TNM system is the most widely used cancer staging system and looks at the following cancer characteristics:

• Tumor The size of the tumor and whether it has grown into nearby tissue.
• Node Whether the cancer has spread to nearby lymph nodes. And if so, how many.
• Metastasis Indicates whether the cancer has spread to distant organs, like the lungs or liver.

But when it comes to breast cancer staging, the TNM system was expanded to include additional cancer characteristics, including:

• Estrogen-receptor status or progesterone-receptor status Whether the cancer has estrogen or progesterone receptors. A positive status means the cancer can use either hormone to grow.
• HER2 status Whether the cancer produces HER2, a protein that promotes the growth of cancer cells.
• Grade Indicates how much the cancer cells look like healthy cells.
• Oncotype DX recurrence score Indicates how likely a group of genes may respond to treatment, depending on ER, PR and HER2 status.

The Grading System Is Used To Describe How Quickly A Breast Tumor Is Likely To Grow And Spread

The grading system describes a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Low-grade cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells. To describe how abnormal the cancer cells and tissue are, the pathologist will assess the following three features:

• How much of the tumor tissue has normal breast ducts.
• The size and shape of the nuclei in the tumor cells.
• How many dividing cells are present, which is a measure of how fast the tumor cells are growing and dividing.

For each feature, the pathologist assigns a score of 1 to 3 a score of 1 means the cells and tumor tissue look the most like normal cells and tissue, and a score of 3 means the cells and tissue look the most abnormal. The scores for each feature are added together to get a total score between 3 and 9.

Three grades are possible:

• Total score of 3 to 5: G1 .
• Total score of 6 to 7: G2 .
• Total score of 8 to 9: G3 .

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How Is Breast Cancer Diagnosed

Your healthcare provider will perform a breast examination and ask about your family history, medical history and any existing symptoms. Your healthcare provider will also recommend tests to check for breast abnormalities. These tests may include:

• Mammogram. These special X-ray images can detect changes or abnormal growths in your breast. A mammogram is commonly used in breast cancer prevention.
• Ultrasonography. This test uses sound waves to take pictures of the tissues inside of your breast. Its used to help diagnose breast lumps or abnormalities.
• Positron emission tomography scanning: A PET scan uses special dyes to highlight suspicious areas. During this test, your healthcare provider injects a special dye into your veins and takes images with the scanner.
• Magnetic resonance imaging : This test uses magnets and radio waves to produce clear, detailed images of the structures inside of your breast.

If your healthcare provider sees anything suspicious on the imaging tests, they may take a biopsy of your breast tissue. Theyll send the sample to a pathology lab for analysis.

Receptor Status Of Breast Cancer Cells

Breast cancer cells are tested to determine whether they have any of the following receptors:

• Estrogen receptors: estrogen receptor-positive or estrogen receptor-negative status
• Progesterone receptors: progesterone receptor-positive or progesterone receptor-negative status
• HER2 : human epidermal growth factor receptor 2-positive or human epidermal growth factor receptor 2-negative status

The type of treatment thats recommended for stage 1 breast cancer will depend on a variety of factors, such as:

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What Is Chemotherapy

Chemotherapy, often called chemo for short, uses medicines to stop or slow the growth of breast cancer cells. Chemotherapy is considered systemic therapy because it travels through the bloodstream and affects the whole body.

Breast cancer cells grow and divide faster than healthy, normal cells. Chemotherapy affects rapidly dividing cells, such as cancer cells, more than it affects healthy cells. Still, chemotherapy medicines are powerful and can damage healthy cells, especially cells that grow and divide quickly.

Chemotherapy medicines may be given:

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  intravenously, which means theyre delivered directly into your bloodstream through an IV, a port, or a catheter

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  orally, as a pill or capsule that you take by mouth

There are a number of chemotherapy medicines used to treat breast cancer. In many cases, a chemotherapy regimen will use a combination of two or more medicines.

Depending on the breast cancer’s characteristics, chemotherapy medicines may be combined with other treatments, such as hormonal therapy, radiation therapy, targeted therapy, or immunotherapy.

What Is Stage 0 Dcis

Stage 0 breast cancer, ductal carcinoma in situ is a non-invasive cancer where abnormal cells have been found in the lining of the breast milk duct. In Stage 0 breast cancer, the atypical cells have not spread outside of the ducts or lobules into the surrounding breast tissue. Ductal Carcinoma In Situ is very early cancer that is highly treatable, but if its left untreated or undetected, it can spread into the surrounding breast tissue.

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Survival Rates Of Stage 1 And Stage 2 Breast Cancer

According to data from the Australian Institute of Health and Welfare, the earlier breast cancer is first diagnosed, the better the outcome. The survival rates of people diagnosed with breast cancer have also improved over time due to earlier detection and improvements in treatment. Most people with early stage breast cancer can be treated successfully.

You may wish to discuss your prognosis and treatment options with your doctors. However, it is not possible to predict the exact course of your cancer and how long you will live. The length of survival can vary from person to person. Factors that influence this include:

• Response to treatment
• The type of breast cancer that you have
• The rate of tumour growth
• Other factors such as your age, medical history and overall health.

When Is Chemotherapy Used

Not all women with breast cancer will need chemo, but there are several situations in which chemo may be recommended:

• After surgery : Adjuvant chemo might be given to try to kill any cancer cells that might have been left behind or have spread but canât be seen, even on imaging tests. If these cells were allowed to grow, they could form new tumors in other places in the body. Adjuvant chemo can lower the risk of breast cancer coming back.
• Before surgery : Neoadjuvant chemo might be given to try to shrink the tumor so it can be removed with less extensive surgery. Because of this, neoadjuvant chemo is often used to treat cancers that are too big to be removed by surgery when first diagnosed . Also, by giving chemo before the tumor is removed, doctors can see how the cancer responds to it. If the first set of chemo drugs doesnt shrink the tumor, your doctor will know that other drugs are needed. It should also kill any cancer cells that have spread but canât be seen. Just like adjuvant chemo, neoadjuvant chemo can lower the risk of breast cancer coming back.

For certain types of breast cancer, if there are tumor cells still found at the time of surgery , you may be offered more chemotherapy after surgery to reduce the chances of the cancer coming back .

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