How Is Breast Cancer Stage Determined

How Is Breast Cancer Diagnosed

Magnetic resonance imaging may be used to diagnose breast cancer.

Doctors often use additional tests to find or diagnose breast cancer. They may refer women to a breast specialist or a surgeon. This does not mean that she has cancer or that she needs surgery. These doctors are experts in diagnosing breast problems.

• Breast ultrasound. A machine that uses sound waves to make detailed pictures, called sonograms, of areas inside the breast.
• Diagnostic mammogram. If you have a problem in your breast, such as lumps, or if an area of the breast looks abnormal on a screening mammogram, doctors may have you get a diagnostic mammogram. This is a more detailed X-ray of the breast.
• Magnetic resonance imaging . A kind of body scan that uses a magnet linked to a computer. The MRI scan will make detailed pictures of areas inside the breast.
• Biopsy. This is a test that removes tissue or fluid from the breast to be looked at under a microscope and do more testing. There are different kinds of biopsies .

What Other Factors Are Used In Cancer Staging

For some cancer types, factors other than the TNM categories can be included in the cancer’s stage. They may include:

Grade. The grade describes how much cancer cells look like healthy cells. A pathologist will look at the cancer cells under a microscope. A pathologist is a doctor who specializes in evaluating cells, tissues, and organs to diagnose disease. They will compare the cancer tissue with healthy tissue. Healthy tissue often contains many types of cells groups together.

If the cancer looks like healthy tissue and has different cell groupings, it is called a differentiated or a low-grade tumor. If the cancer looks very different from healthy tissue, it is called a poorly differentiated or a high-grade tumor. The cancer’s grade may help predict how quickly cancer will spread.

Cancer grade is recorded by the pathologist using the letter “G” with a number from 1 to 3 for most cancers and from 1 to 4 in some. In general, the lower the tumor’s grade, the better the prognosis. Different types of cancer have different methods to assign a cancer grade.

Tumor genetics. Researchers have found ways to figure out the genes involved in many types of cancer. These genes may help predict if a cancer will spread or what treatments will work best. This information may help doctors target treatment to each person’s cancer. Learn more about personalized and targeted therapies.

Grouping Breast Cancer Stages

There are five stages of breast cancer. These stages are determined based on the tumor size, lymph node involvement and whether the cancer has spread to another part of the body.

Stage 0

Non-invasive or in situ cancer . In Stage 0 there is no evidence of cancer cells breaking out of the part of the breast in which they started. Pagets disease is typically stage 0.

Stage I

Invasive breast cancer with small tumor size and limited nodal involvement.

Stage II

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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 circumstances.

Grading For Breast Cancer

Tumour grading describes how active the cells are and how quickly the tumour is likely to grow. To determine tumour grade, a pathologist will study the tumour tissue removed during a biopsy under a microscope.

• Grade 1 Cancer cells look a little different to normal cells. These tumours are usually slow-growing.
• Grade 2 Cancer cells do not look like normal cells. They tend to grow faster than grade 1 cancer cells.
• Grade 3 Cancers cells look very different from normal cells. They tend to grow and spread rapidly.

The breast cancers grade is used to help predict your likely outcome and determine which treatments are likely to be the most effective.

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Brief Overview Of The 7th Edition

The 7th edition of the AJCC staging system was mainly based on anatomical staging, which used the extent of the primary tumor , status of the regional lymph nodes , and metastasis status . This has remained largely unchanged in the 8th edition. The T stage is based on the size and degree of loco-regional invasion by the primary tumor and is categorized from T1 to T4. The N stage is determined by the extent of nodal involvement including axillary, internal mammary, and ipsilateral supraclavicular lymph nodes. Distant metastases are evaluated to determine the M stage. The 7th edition used nine stages based on different combinations of T, N, and M status .

More Information About The Tnm Staging System

The T category describes the original tumor:

• TX means the tumor can’t be assessed.
• T0 means there isn’t any evidence of the primary tumor.
• Tis means the cancer is “in situ” .
• T1, T2, T3, T4: These numbers are based on the size of the tumor and the extent to which it has grown into neighboring breast tissue. The higher the T number, the larger the tumor and/or the more it may have grown into the breast tissue.

The N category describes whether or not the cancer has reached nearby lymph nodes:

• NX means the nearby lymph nodes can’t be assessed, for example, if they were previously removed.
• N0 means nearby lymph nodes do not contain cancer.
• N1, N2, N3: These numbers are based on the number of lymph nodes involved and how much cancer is found in them. The higher the N number, the greater the extent of the lymph node involvement.

The M category tells whether or not there is evidence that the cancer has traveled to other parts of the body:

• MX means metastasis can’t be assessed.
• M0 means there is no distant metastasis.
• M1 means that distant metastasis is present.

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Questions To Ask The Health Care Team

• What tests will I need to have to determine my cancer’s stage?

• What is the stage of the cancer that I have? What does this mean?

• How did you determine the cancer’s stage?

• What is the cancer’s grade?

• Does the tumor have any genetic mutations?

• Are biomarkers used in determining the stage of my cancer or in defining my treatment? If so, what are those biomarkers, what are the results, and what does that mean?

• What does the stage, grade, and biomarker testing mean for my treatment plan or my prognosis?

Determining Breast Cancer Stage

In breast cancer, stage is based on the size and location of the primary tumor, the spread of cancer to nearby lymph nodes or other parts of the body, tumor grade, and whether certain biomarkers are present.

The TNM system, the grading system, and the biomarker status are combined to find out the breast cancer stage.

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Determining The True Stage Of Breast Cancer

All the diagnostic tests and scans up to this point have been critical for helping your doctors understand your disease. But the exact stage of cancer cant be determined until surgery happens which is sometimes referred to surgical staging or pathological staging.

Breast surgery is usually the first step in Stages 0-2, and sometimes Stage 3 breast cancer. Surgery allows your surgeon to see whats happening inside your body. It also allows them to remove cancerous tissues which is an important step in preventing the cancer from spreading and determining next steps for your treatment.

If surgery cant be done right away or at all, a clinical stage is given instead based on diagnostic imaging test results, biopsy pathology results, and a physical exam.

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Appearance Of Cancer Cells

The appearance, or differentiation, of the cancer cells is another factor in cancer staging. Doctors grade cancer cells according to how similar they appear to noncancerous cells under a microscope.

Doctors 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 than normal cells and tend to grow faster.

Here is an overview of each breast cancer stage:

• Stage 0: This cancer is noninvasive and is only present inside the milk duct. This stage includes ductal carcinoma in situ .
• Stage 1: These are small tumors that either have not spread to the lymph nodes or are only affecting 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.

• targeted therapy

Early detection and diagnosis of breast cancer can significantly improve a persons outlook.

According to the ACS, the 5-year relative survival rate for localized breast cancer is 99%. This statistic means that people with this type of cancer are 99% as likely to survive for at least 5 years after diagnosis as those without the condition.

• lymph node involvement

Stage 1 Breast Cancer

Stage 1 breast cancer is divided into two groups:

• Stage 1A
• Stage 1B

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 .

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What Is The Survival Rate For Each Type

Survival rates for breast cancer can give estimates of survival over a certain period of time. This is based on other people who have had a similar cancer type and stage. It can help give a sense of how treatable your cancer may be. However, everyone is unique, and it cant predict what your experience will be.

Localized breast cancer that hasnt spread beyond the breast has nearly a 100% 5-year survival rate. When breast cancer starts to spread outside of the breast, this number begins to decrease. Overall, breast cancer survival is improving as people are diagnosed earlier and treatments improve. Your own healthcare providers are the best people to talk to about what these estimates mean for you.

What Is The Most Aggressive Type Of Breast Cancer

Any breast cancer that is metastatic, or stage IV, is aggressive because it has already spread beyond the breast. Some other breast cancer types are considered more aggressive than others, including inflammatory breast cancer and triple-negative breast cancer. These may be more likely to spread, less responsive to treatment, or at higher risk of returning after treatment.

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Breast Cancer: Understanding The Stages

Breast cancer is defined by 5 different stages. Defined by stages 0 4, each stage helps doctors and other medical professionals to determine the best course of action when it comes to taking care of your health and the cancer.

How do they determine what stage someone might be in?

Doctors determine the stage someone with breast cancer might be in by measuring the spread of the disease upon diagnosis. Each stage depends on how large the tumor is, where it has spread and whether its affected the lymph nodes or not. Lymph nodes are located in different areas of our immune system that help us fight infection and diseases.

Stage 0 Ductal carcinoma in situ

The abnormal cells are still located in your milk ducts and havent affected the fatty tissue in your breast. The tumors may be very small still inside the breast glands and have not spread to the lymph nodes.

Stage 1

This stage is broken up into Stage 1A and Stage 1B. 1A is defined as no tumor in the actual breast but a small cluster has formed in the lymph nodes. 1B is defined as having a tumor the size of a peanut in the breast.

Stage 2

Similar to stage 1, this stage is broken up into 2A and 2B. The difference between the two different stages depend on the size of the tumor and whether or not it has spread to the lymph nodes.

Stage 2A can be either the following:

Stage2B means that the tumor is between 2 and 5 cm in size and has spread to the surrounding lymph nodes OR the tumor is larger than 5 cm

Stage 3

How A Breast Cancers Stage Is Determined

Your pathology report will include information that is used to calculate the stage of the breast cancer that is, whether it is limited to one area in the breast, or it has spread to healthy tissues inside the breast or to other parts of the body. Your doctor will begin to determine this during surgery to remove the cancer and look at one or more of the underarm lymph nodes, which is where breast cancer tends to travel first. He or she also may order additional blood tests or imaging tests if there is reason to believe the cancer might have spread beyond the breast.

The breast cancer staging system, called the TNM system, is overseen by the American Joint Committee on Cancer . The AJCC is a group of cancer experts who oversee how cancer is classified and communicated. This is to ensure that all doctors and treatment facilities are describing cancer in a uniform way so that the treatment results of all people can be compared and understood.

In the past, stage number was calculated based on just three clinical characteristics, T, N, and M:

• the size of the cancer tumor and whether or not it has grown into nearby tissue
• whether cancer is in the lymph nodes
• whether the cancer has spread to other parts of the body beyond the breast

Numbers or letters after T, N, and M give more details about each characteristic. Higher numbers mean the cancer is more advanced. Jump to more detailed information about the TNM system.

Jump to a specific breast cancer stage to learn more:

• Stage IV

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What Stage Is My Breast Cancer Currently At

Determining the stage of a breast cancer is determined by the combination of the following:

• TNM system: This gives information about the size of the cancer and where the cancer has spread. T describes the size of the tumor, N describes spread to lymph nodes, and M describes metastasis to other sites in the body.

• Receptor status: This describes ER, PR, and HER2 status.

• Grade: Grade describes what the cancer cells look like when compared to normal cells.

Thats a lot of information to take in. But knowing this level of detail about breast cancers will help your cancer care team determine the best treatment for your unique situation.

What Are Some Of The Cancer Type

Breast and prostate cancers are the most common types of cancer that have their own grading systems.

Breast cancer. Doctors most often use the Nottingham grading system for breast cancer . This system grades breast tumors based on the following features:

• Tubule formation: how much of the tumor tissue has normal breast duct structures
• Nuclear grade: an evaluation of the size and shape of the nucleus in the tumor cells
• Mitotic rate: how many dividing cells are present, which is a measure of how fast the tumor cells are growing and dividing

Each of the categories gets a score between 1 and 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 the three categories are then added, yielding a total score of 3 to 9. Three grades are possible:

• Total score = 35: G1
• Total score = 67: G2
• Total score = 89: G3

• Gleason X: Gleason score cannot be determined
• Gleason 26: The tumor tissue is well differentiated
• Gleason 7: The tumor tissue is moderately differentiated
• Gleason 810: The tumor tissue is poorly differentiated or undifferentiated

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