How Is Breast Cancer Staged

How Quickly Do Breast Cancer Tumors Grow

Breast cancer cells are mutated cells they dont grow the way healthy cells do. Instead, they grow at different rates than other cells in the body. Different types of cancers also grow at different rates. That makes predicting how quickly a breast cancer tumor will grow difficult.

Most breast cancer tumors have been growing for several years before theyre found. The cells will need to divide as many as 30 times before the tumor is detectable. With each division taking 1 to 2 months, a tumor could be growing 2 to 5 years before its found.

But there are things a healthcare professional can do to determine if the cancerous tumor is growing quickly. Some tumor gradings will include information that indicates how likely the tumor is to grow and spread.

This information is usually gathered with a biopsy. In this medical procedure, a professional will remove a tissue sample from the affected area. That tissue will be sent to a lab where a specialist will review it.

Cancerous cells that are highly aggressive will look very different from normal, healthy cells. The greater the difference between the two types of cells, the higher the chances the cancer is aggressive. But cancer cells that look more like the other cells may be less aggressive.

If the biopsy suggests the cancer is likely to spread, youll be monitored closely for metastases. Cancer cells can spread via the lymph system, bloodstream, or directly into nearby tissues and organs.

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

Life Expectancy By Stage

Even when divided by stage, its hard to determine life expectancy for someone with breast cancer because of the following:

• There are many types of breast cancer, and they vary in their level of aggressiveness. Some have targeted treatment, while others dont.
• Successful treatment may depend on age, other health problems, and treatments you choose.
• Survival rates are estimates based on people diagnosed years ago. Treatment is advancing quickly, so you may have a better life expectancy than people diagnosed even five years ago.

Thats why you shouldnt take general statistics to heart. Your doctor can give you a better idea of what to expect based on your personal health profile.

The Surveillance, Epidemiology, and End Results Program doesnt track breast cancer survival rates by type or in stages 0 to 4. A relative survival rate compares people with breast cancer to people in the general population.

Following are SEER based on women diagnosed between 2009 and 2015:

Your doctor will consider all this when recommending treatment. Most people need a combination of therapies.

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What Is The Survival Outlook For Breast Cancer

According to the National Cancer Institute , the percentage of patients surviving five years after diagnosis is:

• 99 percent for breast cancer that is still local to the breast
• 86 percent for breast cancer that has spread just outside the breast
• 29 percent for breast cancer that has spread to more distant parts of the body

The NCI also lists the five-year survival rate for breast cancer overall as 90.6 percent for women and 83 percent for men.

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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How Breast Cancer Is Diagnosed

There are many tests used for diagnosing breast cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of earlier medical tests

The series of tests needed to evaluate a possible breast cancer usually begins when a person or their doctor discovers a mass or abnormal calcifications on a screening mammogram, or a lump or nodule in the breast during a clinical or self-examination. Less commonly, a person might notice a red or swollen breast or a mass or nodule under the arm.

The following tests may be used to diagnose breast cancer or for follow-up testing after a breast cancer diagnosis.

Systems That Describe Stage

There are many staging systems. Some, such as the TNM staging system, are used for many types of cancer. Others are specific to a particular type of cancer. Most staging systems include information about:

• Where the tumor is located in the body
• The size of the tumor
• Whether the cancer has spread to nearby lymph nodes
• Whether the cancer has spread to a different part of the body
• Tumor grade, which refers to how abnormal the cancer cells look and how likely the tumor is to grow and spread

The TNM Staging System

The TNM system is the most widely used cancer staging system. Most hospitals and medical centers use the TNM system as their main method for cancer reporting. You are likely to see your cancer described by this staging system in your pathology report, unless you have a cancer for which a different staging system is used. Examples of cancers with different staging systems include brain and spinal cord tumors and blood cancers.

In the TNM system:

• The T refers to the size and extent of the main tumor. The main tumor is usually called the primary tumor.
• The N refers to the the number of nearby lymph nodes that have cancer.
• The M refers to whether the cancer has metastasized. This means that the cancer has spread from the primary tumor to other parts of the body.

Primary tumor

• MX: Metastasis cannot be measured.
• M0: Cancer has not spread to other parts of the body.
• M1: Cancer has spread to other parts of the body.

Other Ways to Describe Stage

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Physical Emotional And Social Effects Of Cancer

In general, cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Supportive care treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies.

• Music therapy, meditation, stress management, and yoga for reducing anxiety and stress.

• Meditation, relaxation, yoga, massage, and music therapy for depression and to improve other mood problems.

• Meditation and yoga to improve general quality of life.

• Acupressure and acupuncture to help with nausea and vomiting from chemotherapy.

Breast Cancer: Types Of Treatment

Have questions about breast cancer? Ask here.

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with breast cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for early-stage and locally advanced breast cancer. Standard of care means the best treatments known. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug and how often it should be given, a new combination of standard treatments, or new doses of standard drugs or other treatments. Some clinical trials also test giving less drug or radiation treatment or doing less extensive surgery than what is usually done as the standard of care. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

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Stage 3 Breast Cancer Treatment Options

Treatment for stage 3 breast cancers typically involves a combination of surgery along with chemotherapy to shrink the tumor before surgery and radiation after surgery to treat the chest wall and/or lymph nodes. Lymph nodes will also likely be removed during surgery.

Targeted therapies, including hormone therapy, can also be used depending on your cancers specific characteristics.

Breast Cancer Staging: What You Need To Know

• Frequently Asked Questions

When youve first been diagnosed with breast cancer, a big question on your mind will likely be: How bad is it? Doctors determine how advanced cancer is through the diagnosis and staging process, labeling your cancer with a stage between 0 and 4.

The higher the stage, the more advanced the cancer is. Treatment options will typically be more aggressive for more advanced cancers, and prognosis, or outlook, is worse.

Verywell / Jessica Olah

Breast cancers are uncontrolled growths that develop in and around the breast tissue. More advanced cancers have likely also spread to other tissues.

Breast cancer is one of the most common cancers in females. More than 280,000 females are diagnosed with breast cancer each year in the United States. Thankfully, about 90% of females diagnosed with breast cancer are still alive five years later.

When first diagnosed with cancer, youll undergo testing and analysis. Doctors will use those results, along with guidelines set out by the American Joint Committee on Cancer , to determine cancers stage.

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Diagnostic Tests That Inform The Clinical Stage

Many methods are used to detect and stage cancer. Some of the common tests include:

Biopsy: The doctor uses a needle to extract breast tissue or fluid, which is then sent to a lab. There, various techniques are used to examine different attributes, such as hormone receptor or HER2 status.

Tumor markers: Rapidly dividing cancerous cells interrupt some of the normal mechanisms of cell growth. This causes the cell to overproduce certain molecules. Lab tests detect these compounds, known as tumor markers, in blood or tissue samples.

Imaging techniques: Several different scans are used to examine characteristics of your cancer. Below are some of the noninvasive imaging techniques you might encounter:

• MRI scans use magnets and radio waves to generate detailed pictures of your tissues.
• CT scans use X-rays to look at your organs. Nuclear scans trace the flow of an injected safe radioactive dye in your body.
• PET scans are similar to nuclear scans but specifically examine glucose consumption in the bodysince cancer cells use more glucose than normal cells.
• Ultrasound imaging uses sound waves to see inside your body.

The Number Staging System

Breast cancer can also be divided into four number stages. We have put these into a table to make them easier to understand. You can .

This information is about stage 1 to 3 breast cancer.

Stage 1 breast cancer is when the cancer is 2cm or smaller. There may be no cancer cells in the lymph nodes in the armpit or tiny numbers of cancer cells are found. Sometimes the cancer cannot be found in the breast, but cancer cells have spread to lymph nodes in the armpit.

Stage 2 breast cancer is when the cancer is up to or bigger than 5cm. It may or may not have spread to the lymph nodes under the arm. Sometimes the cancer cannot be found in the breast. But cancer cells have spread to 1 to 3 lymph nodes in the armpit or near the breast bone.

Stage 3 breast cancer is sometimes called locally advanced breast cancer. The cancer has spread to the lymph nodes in the armpit and sometimes to other lymph nodes nearby. It may have spread to the skin of the breast or to the chest muscle. The skin may be red, swollen or have broken down. Sometimes the cancer cannot be found in the breast or is small but has spread to 4 to 9 lymph nodes in the armpit.

Stage 4 breast cancer is also called secondary or metastatic breast cancer. This is when the cancer has spread to other parts of the body, such as the bones, the liver or lungs. We have separate information about secondary breast cancer.

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Factors Influencing How Quickly Breast Cancer Tumors Grow

Several factors may influence how quickly breast cancer tumors grow. These factors include:

• Your age. People under 40 are likely to have more aggressive breast cancer.
• Menopause status. If you havent completed menopause, the hormones of menstruation may impact cancer growth.
• History of breast cancer. A family or personal history of this cancer may increase the risk of an aggressive type.
• The type of breast cancer. Some types are more aggressive than others.
• Hormone treatment. If you had hormone replacement therapy with menopause, the chances of an aggressive form of cancer are higher.

Breast Cancer In Situ Dcis And Lcis

Many breast cancers being found are very early cancers known as breast cancer in situ or noninvasive cancer. Most of the cancers are found by mammography. These very early cells changes may become invasive breast cancer. Two types of breast cancer in situ are:

• Ductal carcinoma in situ , which means that abnormal cells are found only in the lining of a milk duct of the breast. These abnormal cells have not spread outside the duct. They have not spread within the breast, beyond the breast, to the lymph nodes under the arm or to other parts of the body.There are several types of DCIS. If not removed, some types may change over time and become invasive cancers. Some may never become invasive cancers. DCIS is sometimes call intraductal carcinoma.
• Lobular carcinoma in situ , which means that abnormal cells are found in the lining of a milk lobule. Although LCIS is not considered to be actual breast cancer at this noninvasive stage, it is a warning sign of increased risk of developing invasive cancer.LCIS is sometimes found when a biopsy is done for another lump or unusual change that is found on a mammogram.

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What Are The Stages Of Breast Cancer

Breast cancer staging uses Roman numerals 0, I, II, III and IV, with 0 being noninvasive cancer cells in one spot and IV being invasive breast cancer that has spread into other areas of the body. The five numerals have A and B subcategories that look at other factors such as lymph node involvement and metastases .

The American Joint Committee on Cancer uses the letters T, N and M to characterize three different aspects of breast tumors.

T: Tumor

This designation looks at the tumor, its size and whether or not the cancer has invaded surrounding tissue.

The T designation has several categories:

• TX means the tumor is not assessed.
• T0 means there is no evidence of invasive breast cancer.
• T1, T2 and T3 refer to the size of the tumor and consider if and how far it has invaded surrounding breast tissue.

N: Nodes

• An important aspect of staging breast cancer has to do with whether the cancer has spread to one or more nearby lymph nodes fluid channels in the breast. The N value describes if and how the cancer has infiltrated one or more lymph nodes near the breast. NX means lymph nodes have not been evaluated.
• N0 means there is no cancer detected in the nearby lymph nodes.
• N1, N2 and N3 mean that breast cancer is in the lymph nodes. The higher the number, the more advanced the lymph node involvement. These cancers have an increased risk of spreading beyond the breast to lymph nodes and to other organs within the body, says Tran.

M: Metastasis