How Stages Are Determined
Stages of breast cancer are defined by a system called TNM:
- T stands for tumor. It describes the size and location of the main tumor.
- N stands forlymph nodes. It describes whether cancer has spread to the nodes. It also tells how many nodes have cancer cells.
- M stands formetastasis. It tells whether the cancer has spread to parts of the body away from the breast.
After Breast Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Breast Or To Other Parts Of The Body
The process used to find out whether the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines thestage of the disease. It is important to know the stage in order to plan treatment. The results of some of the tests used to diagnosebreast cancer are also used to stage the disease.
The following tests and procedures also may be used in the staging process:
When Is Radiation Usually Used To Treat Stage 2 Breast Cancer
According to the American Cancer Society, radiation therapy may be used after lumpectomy to mitigate the risk of cancer cells recurring in the same breast or nearby lymph nodes. After a mastectomy, an oncologist may determine that radiation is necessary if the tumor was larger than 5 cm, if there was lymph node involvement, or if cancer was found outside of surgical margins.
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What Are The Common Signs And Symptoms Of Breast Cancer
The following early signs and symptoms of breast cancer can happen with other conditions that are not cancer related.
- New lump in the breast or underarm
- Thickening or swelling of part of the breast
- Irritation or dimpling of breast skin
- Redness or flaky skin in the nipple area of the breast
- Pulling in of the nipple or pain in the nipple area
- Nipple discharge other than breast milk, including blood
- Any change in the size or the shape of the breast
- Pain in any area of the breast
What Increases The Risk Of Invasive Breast Cancer
Thereâs no way to know if youâll develop an invasive form of breast cancer, but there are things that increase your chances, many of which you canât change.
Older women are at higher risk. About 10% of women diagnosed with invasive breast cancer are under age 45. And 2 out of every 3 women with invasive breast cancer are age 55 or older when theyâre first diagnosed.
Your genetics and family history of breast cancer play roles. Itâs more common among white women than black, Asian, or Hispanic women.
Also, youâre at higher risk if youâre obese, your breasts are dense, you didnât have children, or you became pregnant after the age of 35.
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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:
N3a: either:
N3b: either:
How Is Breast Cancer Treated
There are several breast cancer treatment options, including surgery, chemotherapy, radiation therapy, hormone therapy, immunotherapy and targeted drug therapy. Whats right for you depends on many factors, including the location and size of the tumor, the results of your lab tests and whether the cancer has spread to other parts of your body. Your healthcare provider will tailor your treatment plan according to your unique needs. Its not uncommon to receive a combination of different treatments, too.
Breast cancer surgery
Breast cancer surgery involves removing the cancerous portion of your breast and an area of normal tissue surrounding the tumor. There are different types of surgery depending on your situation, including:
Chemotherapy for breast cancer
Your healthcare provider may recommend chemotherapy for breast cancer before a lumpectomy in an effort to shrink the tumor. Sometimes, its given after surgery to kill any remaining cancer cells and reduce the risk of recurrence . If the cancer has spread beyond your breast to other parts of your body, then your healthcare provider may recommend chemotherapy as a primary treatment.
Radiation therapy for breast cancer
Radiation therapy for breast cancer is typically given after a lumpectomy or mastectomy to kill remaining cancer cells. It can also be used to treat individual metastatic tumors that are causing pain or other problems.
Hormone therapy for breast cancer
Immunotherapy for breast cancer
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Early Warning Signs Of Breast Cancer
Common symptoms of breast cancer include:
- A lump in your breast or underarm that doesnât go away. This is often the first symptom of breast cancer. Your doctor can usually see a lump on a mammogram long before you can see or feel it.
- Swelling in your armpit or near your collarbone. This could mean breast cancer has spread to lymph nodes in that area. Swelling may start before you feel a lump, so let your doctor know if you notice it.
- Pain and tenderness, although lumps donât usually hurt. Some may cause a prickly feeling.
- A flat or indented area on your breast. This could happen because of a tumor that you canât see or feel.
- Breast changes such as a difference in the size, contour, texture, or temperature of your breast.
- Changes in your nipple, like one that:
How Can I Be Sure That My Cancer Will Be Detected Before It Has Spread
While you cant prevent breast cancer altogether, there are certain things you can do to reduce your risk of discovering it at an advanced stage. For example:
- Get routine mammograms. The American Cancer Society recommends having a baseline mammogram at age 35, and a screening mammogram every year after age 40.
- Examine your breasts every month after age 20. Youll become familiar with the contours and feel of your breasts and will be more alert to changes.
- Have your breasts examined by a healthcare provider at least once every three years after age 20, and every year after age 40. Clinical breast exams can detect lumps that mammograms may not find.
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Can Breast Cancer Be Prevented
You may be able to help prevent breast cancer by making healthy lifestyle changes such as:
- Staying at a healthy weight
- Limiting alcohol use
- Limiting your exposure to estrogen by
- Breastfeeding your babies if you can
- Limiting hormone therapy
If you are at high risk, your health care provider may suggest that you take certain medicines to lower the risk. Some women at very high risk may decide to get a mastectomy to prevent breast cancer.
It’s also important to get regular mammograms. They may be able to identify breast cancer in the early stages, when it is easier to treat.
NIH: National Cancer Institute
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Margaret and her granddaughter Aleigha. Being diagnosed with breastcancer in early 2009, I survived 11 months of surgery and treatment and returned to work a very grateful woman. Since then I have semi-retired and was again diagnosed, this time with metastatic breastcancer in January 2016. My mother has stage4 colon cancer, I have stage4 esophageal cancer. My mom has been fighting for almost 3 years, but now it’s spreading and growing. I’ve been fighting for 15 months. I haven’t had a pet scan for 4 months, last one was after finishing radiation. I’m developing familiar symptoms from when my cancer was larger and worse.. Aug 26, 2020 · For women who received a diagnosis between 2009 and 2015, the 5-year survival rate for stage4breastcancer is 27.4 percent. Theres no current cure for stage4cancer. Still, it can be treated …. .
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Stage 1 Breast Cancer
Stage 1 breast cancer is divided into two groups:
Stage 1A means the cancer is 2cm or smaller and has not spread outside the breast.
Stage 1B can mean:
No cancer is seen in the breast, but a very tiny area of breast cancer is found in the lymph nodes under the arm
The cancer in the breast is 2cm or smaller and a very tiny area of breast cancer is found in the lymph nodes under the arm .
Treatment Of Locally Advanced Or Inflammatory Breast Cancer
For information about the treatments listed below, see the Treatment Option Overview section.
- Targeted therapy .
- 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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Inoperable Breast Cancer Is Often Still Treatable
Stage 3C breast cancer is divided into operable and inoperable stage 3C breast cancer. However, the term inoperable is not the same as untreatable.
If your physician uses the word inoperable, it may simply mean that a simple surgery at this time would not be enough to get rid of all the breast cancer that is within the breast and the tissue around the breast. There must be healthy tissue at all of the margins of the breast when it is removed. Keep in mind that the breast tissue goes beyond the breast mound it goes up to the clavicle and down to a few inches below the breast mound. There must also be tissue to close the chest wound after the surgery is performed.
Another treatment method may be used first to shrink the breast cancer as much as possible before surgery is considered.
Breast Cancer Stages From 0 To Iv
Breast cancer stages can be really complex if you get into detail but a good simple overview is this:
- Stage 0: very small tumors. They are usually in situ tumors, only seen under the microscope. There are no signs of spread.
- Stage 1: there is a small tumor that hasnt spread to axillary lymph nodes yet. It can usually be treated through surgery. Occasionally, you may also need radiotherapy or chemotherapy, to make sure there is no cancer left.
- Stage 2: the tumor is slightly larger and there may be tiny malignant cells in your lymph nodes . It may require more aggressive surgery, like mastectomy or surgery to your lymph nodes. Also, you may need radiotherapy or chemotherapy.
- Stage 3: cancer has definitely spread to lymph nodes.
- Stage 4: there are distant metastases to other organs: your liver, bones
In reality, breast cancer stages are a little more complicated than I just described. It used to be like that until 2018, but then they added some other factors. These factors made staging more complex, but also more accurate. Nowadays, staging depends on these 7 items:
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Treatment Of Ductal Carcinoma In Situ
For information about the treatments listed below, see the Treatment Option Overview section.
- Breast-conserving surgery and radiation therapy, with or without tamoxifen.
- Total mastectomy with or without tamoxifen. Radiation therapy may also be given.
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.
Breast Cancer Stages: From 0 To 4
Stage 0 refers to noninvasive breast cancers, such as DCIS.
Stage 1 cancer is invasive and spreading beyond where it started.
In stage 1A, the cancer is 2 centimeters or smaller and has not spread into the lymph nodes or outside of the breast.
In stage 1B, small clumps of cancer cells ranging from 0.2 to 2 millimeters exist in the lymph nodes. There may not be a tumor in the breast, but if there is, it measures no bigger than 2 cm.
Stage 2 cancer also has two subcategories. Stage 2A describes a cancer that has spread to one to three lymph nodes under your arms , with or without a tumor up to 2 cm large in the breast or the breast tumor measures 2 to 5 cm, and there are no cancer cells in the axillary lymph nodes.
Stage 2B refers to a tumor between 2 and 5 cm combined with cancer in the lymph nodes , or the tumor is larger than 5 cm, but no cancer exists in the axillary lymph nodes.
Stage 3 breast cancer includes stages 3A, 3B, and 3C. In stage 3A, the tumor may be any size and has spread to four to nine lymph nodes close to the breastbone or in the axilla. The tumor may also be larger than 5 cm with small clumps of breast cancer cells that have spread to one to three axillary lymph nodes or nodes near the breast bone.
In stage 3B, the tumor has reached the skin of your breast or chest wall and caused swelling or an ulcer, and the cancer may have spread to up to nine lymph nodes under your arms or near your breastbone.
Stage 4
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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.
See the following PDQ summaries for more information about breast cancer:
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How Does Breast Cancer Spread To Lymph Nodes
Just like other cancers, spreads when a few stray cancer cells break free from the original tumor. If those cells get into the lymphatic vessels, they can travel through them to your lymph nodes and possibly other organs.
Any breast cancer can to the lymph nodes, but the bigger a tumor grows, the greater the chance that some of its cells will escape. HER2-positive breast cancers, those with the human epidermal growth factor receptor 2 protein, which promotes the growth of cancer cells, are more likely to travel to lymph nodes than other types.
Once breast cancer cells arrive at a lymph node, they need a special receptor on their surface to gain access. Its comparable to a secret password. Some breast cancers get that password. If they do, they start growing in the lymph nodes, says Brian Czerniecki, M.D., chair of the department of breast oncology at Moffitt Cancer Center in Tampa, FL.
Most of the time breast cancer first spreads to lymph nodes under the arm because of their proximity to your breast. Less often, cancer cells will travel to lymph nodes under the breastbone or collarbone. Knowing which lymph nodes have cancer in them is important, because it helps your doctor choose a treatment for you.
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