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, in which 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 below.
How Is A Local Recurrence After Lumpectomy Diagnosed
After a diagnosis of early stage breast cancer, any remaining breast tissue should be evaluated annually with scans .
Most local recurrences within the breast after lumpectomy are detected on routine annual breast imaging, which usually takes the form of mammography and ultrasound, and on occasions MRI.
If you have a local recurrence or new primary breast cancer, you may find symptoms similar to an initial breast cancer. This includes:
- A new lump in the breast, armpit area or around the collarbone
- A change in breast size or shape
- Changes to the nipple, such as sores or crusting, an ulcer or inverted nipple
- Clear or bloody nipple discharge
- Changes to the skin including redness, puckering or dimpling
- Breast tenderness or pain
Once a local recurrence has been diagnosed, we do tests to see whether there are signs of cancer elsewhere in the body. These may include a chest X-ray, CT scan, bone scan or PET scan, and blood tests , then we have to figure out how best to treat the tumour in the breast. Usually in these cases we do a mastectomy, as the prior less drastic surgery and radiation didnt take care of it.
Dilemmas Of Stage Iv Breast Cancer
Indeed, there are many serious and personal questions involving stage IV breast cancer. So, overall survival is less likely, and gains from intensive breast cancer treatment are unfortunately rather modest. A serious consideration is, therefore, quality of life during the course of treatment.
These decisions tend to be a dynamic process, based on individual cases, between patients and physicians. Respect needs to be given to the expectations for treatment, the status of the disease and the patient wishes.
Read Also: What Is Stage 3 Breast Cancer
How Is The Stage Determined
The staging system most often used for breast cancer is the American Joint Committee on Cancer TNM system. The most recent AJCC system, effective January 2018, has both clinical and pathologic staging systems for breast cancer:
- The pathologic stage is determined by examining tissue removed during an operation.
- Sometimes, if surgery is not possible right away or at all, the cancer will be given a clinical stage instead. This is based on the results of a physical exam, biopsy, and imaging tests. The clinical stage is used to help plan treatment. Sometimes, though, the cancer has spread further than the clinical stage estimates, and may not predict the patients outlook as accurately as a pathologic stage.
In both staging systems, 7 key pieces of information are used:
- The extent of the tumor : How large is the cancer? Has it grown into nearby areas?
- The spread to nearby lymph nodes : Has the cancer spread to nearby lymph nodes? If so, how many?
- The spread to distant sites : Has the cancer spread to distant organs such as the lungs or liver?
- Estrogen Receptor status: Does the cancer have the protein called an estrogen receptor?
- Progesterone Receptor status: Does the cancer have the protein called a progesterone receptor?
- HER2 status: Does the cancer make too much of a protein called HER2?
- Grade of the cancer : How much do the cancer cells look like normal cells?
In addition, Oncotype Dx® Recurrence Score results may also be considered in the stage in certain situations.
What Is Inflammatory Breast Cancer
Inflammatory breast cancer is a rare and very aggressive disease in which cancer cells block lymph vessels in the skin of the breast. This type of breast cancer is called inflammatory because the breast often looks swollen and red, or inflamed.
Inflammatory breast cancer is rare, accounting for 1 to 5 percent of all breast cancers diagnosed in the United States. Most inflammatory breast cancers are invasive ductal carcinomas, which means they developed from cells that line the milk ducts of the breast and then spread beyond the ducts.
Inflammatory breast cancer progresses rapidly, often in a matter of weeks or months. At diagnosis, inflammatory breast cancer is either stage III or IV disease, depending on whether cancer cells have spread only to nearby lymph nodes or to other tissues as well.
Additional features of inflammatory breast cancer include the following:
- Compared with other types of breast cancer, inflammatory breast cancer tends to be diagnosed at younger ages.
- Inflammatory breast cancer is more common and diagnosed at younger ages in African American women than in white women.
- Inflammatory breast tumors are frequently hormone receptor negative, which means they cannot be treated with hormone therapies, such as tamoxifen, that interfere with the growth of cancer cells fueled by estrogen.
- Inflammatory breast cancer is more common in obese women than in women of normal weight.
Don’t Miss: Chemo Alternatives Breast Cancer
Types Of Breast Cancer
There are several types of breast cancer, and any of them can metastasize. Most breast cancers start in the ducts or lobules and are called ductal carcinomas or lobular carcinomas:
- Ductal carcinoma. These cancers start in the cells lining the milk ducts and make up the majority of breast cancers.
- Lobular carcinoma. This is cancer that starts in the lobules, which are the small, tube-like structures that contain milk glands.
Less common types of breast cancer include:
Inflammatory breast cancer is a faster-growing type of cancer that accounts for about 1% to 5% of all breast cancers.
Pagets disease is a type of cancer that begins in the ducts of the nipple.
Breast cancer can develop in women and men. However, breast cancer in men is rare. Less than 1% of all breast cancers develop in men.
Incidence Rates Of Inflammatory Breast Cancer
The rarity of inflammatory breast cancer means that large progressive research studies are few and far between.
Hence, the level of progress and knowledge for IBC does not match that of other types of breast cancer.
The incidence rate of IBC varies from country to country and amongst different ethical groups. However, the general incidence rate of IBC is only around 1% to 5% of all newly diagnosed breast cancers in American women.
According to one medical study, the incidence of IBC is higher in North African countries, particularly Algeria, Egypt, Tunisia and Morocco.
In the above mentioned African countries, incidence rates are between 10% and 15%. In comparison, the lowest incidence rates of IBC are in North America.
Also Check: Breast Cancer What To Expect
Treatment Of Breast Cancer Stages I
The stage of your breast cancer is an important factor in making decisions about your treatment.
Most women with breast cancer in stages I, II, or III are treated with surgery, often followed by radiation therapy. Many women also get some kind of systemic drug therapy . In general, the more the breast cancer has spread, the more treatment you will likely need. But your treatment options are affected by your personal preferences and other information about your breast cancer, such as:
- If the cancer cells have hormone receptors. That is, if the cancer is estrogen receptor -positive or progesterone receptor -positive.
- If the cancer cells have large amounts of the HER2 protein
- How fast the cancer is growing
- Your overall health
- If you have gone through menopause or not
Talk with your doctor about how these factors can affect your treatment options.
Treatment Of Stage Iii Breast Cancers
Sometimes large breast cancers invade into muscles or attach to major arteries, veins or nerve trunks, which makes them impossible to surgically remove completely.
So, for these patients, the treatment usually starts with radiation or chemo to try to shrink it first, before surgery. But even a large tumor that has not attached itself onto muscle can, sometimes, be completely removed. There is no direct relationship between tumor size and whether or not it may be treated surgically or not.
Obviously, Stage 3 breast cancers that surgeons can completely remove do tend to have a significantly better prognosis than inoperable stage 3 breast cancers. However, some breast tumors, particularly those that are ER-positive, respond very well to chemotherapy. So well, in fact, that they actually downstage.
So, it is difficult to predict the overall prognosis for stage 3 breast cancer, as it will vary from individual to individual. If the response to chemotherapy is favorable, the overall survival rate is around 72%.
Also Check: Her2 Positive Breast Cancer Stage 3
Time For Treatment And Prognosis
If you would like to know how long does it take to cure stage 2 breast cancer, your best chance is if you get an early diagnosis. Even then, you will only get a rough time estimate. There is no time-limit on how long stage 2 breast cancer treatment should take. Stage 2 breast cancer survival rate is relatively low due to late diagnosis. Timely and accurate treatment does a lot to lower stage 2 breast cancer recurrence rates.
Ask your doctor or healthcare provider for your stage 2 breast cancer prognosis. They are well informed and understand the various factors involved. Having seen the results any tests they asked you to undergo, the medical care provider is very well placed to give you a detailed prognosis. The prognosis should include timelines and outcomes of any treatment you will be receiving.
How Treatment Can Impact Survival Of Early Stage Breast Cancer
In most cases, the earlier breast cancer is first diagnosed and treated, the better the chance of survival. Cancer cells often become more difficult to treat and may develop drug resistance once they spread. The aim of treatment for Stage 1 and 2 breast cancer is to remove the breast cancer, and any other cancer cells that remain in the breast, armpit or other parts of the body but cannot be detected. Having treatment at this stage can also reduce the risk of the cancer coming back.
Also Check: Cancer Dormancy
Starting With Neoadjuvant Therapy
Most often, these cancers are treated with neoadjuvant chemotherapy. For HER2-positive tumors, the targeted drug trastuzumab is given as well, often along with pertuzumab . This may shrink the tumor enough for a woman to have breast-conserving surgery . If the tumor doesnt shrink enough, a mastectomy is done. Nearby lymph nodes will also need to be checked. A sentinel lymph node biopsy is often not an option for stage III cancers, so an axillary lymph node dissection is usually done.
Often, radiation therapy is needed after surgery. If breast reconstruction is planned, it is usually delayed until after radiation therapy is done. For some, additional chemo is given after surgery as well.
After surgery, some women with HER2-positive cancers will be treated with trastuzumab for up to a year. Many women with HER2-positive cancers will be treated first with trastuzumab followed by surgery and then more trastuzumab for up to a year. If after neoadjuvant therapy, any residual cancer is found at the time of surgery, ado-trastuzumab emtansine may be used instead of trastuzumab. It is given every 3 weeks for 14 doses. For women with hormone receptor-positive cancer that is in the lymph nodes, who have completed a year of trastuzumab, the doctor might also recommend additional treatment with an oral targeted drug called neratinib for a year.
Can You Tell When Exactly My Breast Cancer Started
Often times, one of the most frequently asked questions I get when someone is diagnosed with breast cancer is when did it begin? says Roesch. And the general rule is that we really cant tell for sure when the cancer popped up. We can look at the subtype of breast cancer to perhaps get a better understanding if it was weeks vs. months for example, but theres no way to tell for sure.
You May Like: Stage 2 Breast Cancer Treatments
What Kind Of Treatment Will I Need
There are many ways to treat melanoma. The main types of treatment are:
Most early stage melanomas can be treated with surgery alone. More advanced cancers need other treatments.
The treatment plan thats best for you will depend on:
- The stage of the cancer
- The results of lab tests on the cancer cells
- The chance that a type of treatment will cure the melanoma or help in some way
- Your age
Dont Miss: How Aggressive Is Merkel Cell Carcinoma
Survival Rates And Mortality Rates
Survival depends on mortality. You start with 100 percent of the people in the group.
100 percent mortality rate = survival rate
Say, the mortality rate in the group of people is 5 percent. Survival would be 95 percent .
Similarly, the number of people in a group who survive depends on the number of people who die. Say, 500 people are in the group and 1 person dies. This means 499 people survived .
Read Also: Final Stages Of Breast Cancer
Stage Ii Breast Cancer
There are basically four sub-categories of breast cancer within the category of stage II. Breast tumors in the Stage II classification are:
- A breast tumor that is 2cm in diameter or less. BUT the cancer cells have already spread to the lymph nodes.
- OR a breast tumor that is larger than 5 cm but has not yet spread to the lymph nodes.
- OR breast tumors in between 2 cm and 5 cm in diameter -whether there is evidence of spread to the lymph nodes or not.
There are actually quite a number of specific subcategories and letters and numbers to indicate a more precise description of the breast cancer at Stage II. .
In summary, stage II breast cancer is of intermediate size and threatening to spread. Without a doubt, staging for stage II breast cancers requires a thorough investigation of potential metastases.
Survival Rates for Stage II Breast Cancer
The average survival rate for stage II breast cancers is about 93% after five years and about 75% after 10 years. The rate of local recurrence is about 16% for stage II breast tumors. Furthermore, only about 16% of stage II breast cancers either have or will develop lymph node metastasis.
A baseline bone scan is unlikely to detect bone metastasis with stage 2 tumors, but they are usually necessary just to be sure.
Treatment for Stage II Breast Cancer
What Is Stage Ii Breast Cancer
Stage II describes cancer that is in a limited region of the breast but has grown larger. It reflects how many lymph nodes may contain cancer cells. This stage is divided into two subcategories.
Stage IIA is based on one of the following:
- Either there is no tumor in the breast or there is a breast tumor up to 20 millimeters , plus cancer has spread to the lymph nodes under the arm.
- A tumor of 20 to 50 millimeters is present in the breast, but cancer has not spread to the lymph nodes.
Stage IIB is based on one of these criteria:
- A tumor of 20 to 50 millimeters is present in the breast, along with cancer that has spread to between one and three nearby lymph nodes.
- A tumor in the breast is larger than 50 millimeters, but cancer has not spread to any lymph nodes.
Recommended Reading: Low Grade Breast Cancer Treatment
What Is Invasive Lobular Breast Cancer
Invasive breast cancer that begins in the lobules of the breast and spreads to surrounding normal tissue. It can also spread through the blood and lymph systems to other parts of the body.
Invasive lobular breast cancer is the second most common type of breast cancer. Over 10% of invasive breast cancers are invasive lobular carcinomas.
Though mammograms are helpful and important, they are less likely to detect invasive lobular breast cancer than other types of breast cancers. Invasive lobular cancer doesnt always appear clearly on a mammogram, instead an MRI might be needed.
How Quickly Breast Cancer Spreads
Metastasis, the spread of breast cancer to other parts of the body, is responsible for the majority of breast cancer deaths. This makes it important to know how fast a breast cancer spreads.
Breast cancer usually spreads first to lymph nodes under the arm. This is called lymph node-positive breast cancer. Breast cancer is considered early-stage and potentially curable even with the involvement of lymph nodes.
When a cancer spreads to regions such as the bones, brain, lungs, or liver, it is considered stage IV or metastatic breast cancer. This means it is no longer curable.
Most breast cancers have the potential to spread. Carcinoma in situ or stage 0 breast cancer is considered non-invasive because of its limited spread. It is potentially 100% curable with surgery.
All other stages of breast cancer are considered invasive and have the potential to spread. Spread to lymph nodes, even when early stage, is very important because it indicates the cancer’s potential to spread beyond the breasts.
Recommended Reading: Nipple Piercing And Breast Cancer