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.
Looking For More Of An Introduction
If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:
ASCO AnswersFact Sheet:Read a 1-page fact sheet that offers an introduction to breast cancer. This free fact sheet is available as a PDF, so it is easy to print.
ASCO Answers Guide:Get this free 52-page booklet that helps you better understand breast cancer and its treatment options. The booklet is available as a PDF, so it is easy to print.
Cancer.Net Patient Education Video:View a short video led by an ASCO expert in breast cancer that provides basic information and areas of research.
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Stage 2 Breast Cancer
Stage 2 breast cancer is divided into two groups:
- Stage 2A
- Stage 2B
Stage 2A can mean:
No cancer is seen in the breast but cancer is found in one to three lymph nodes under the arm or near the breastbone
The cancer in the breast is 2cm or smaller and cancer is found in one to three lymph nodes under the arm or near the breastbone.
The cancer in the breast is larger than 2cm but smaller than 5cm and no cancer is found in the lymph nodes under the arm.
Stage 2B can mean:
The cancer in the breast is larger than 2cm but smaller than 5cm. Cancer is found in one to three lymph nodes under the arm or near the breastbone
The cancer in the breast is larger than 5cm and no cancer is found in the lymph nodes under the arm.
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What Are The Chances Of Breast Cancer Recurrence After Treatment For Stage 2 Breast Cancer
In women who have breast-conserving treatment, the chance of recurrence is about 3-15% in 10 years, depending on tumor characteristics and margins. Distant recurrence in those who had mastectomy is most influenced by axillary lymph node involvement. When axillary lymph nodes are not cancerous, the recurrence rate is 6% in 5 years. When axillary lymph nodes are cancerous, the recurrence rate is 23% in 5 years with mastectomy but no radiation.
What Does Breast Cancer Staging Mean For My Prognosis
Most people confronting breast cancer are concerned about what the future will hold their prognosis. Its understandable to be concerned: Will the treatment be effective? Can you expect a shortened lifespan?
Staging the breast cancer can put a number to a tumors characteristics and behavior, but these are only parts of your entire prognosis. Your overall health matters, too.
Its important to remember that breast cancer stage is not fixed. Your breast cancer stage can improve with treatment, Tran says. For instance, if the tumor responds to endocrine therapy or chemotherapy, the grade can actually go down.
Your surgeon, oncologist and primary care provider can discuss each step of your treatment with you and give you an idea of what to expect. Tran says that, whereas generations ago, a particular breast cancer stage was associated with a high or low five-year survival probability, the outlook is vastly different today.
Most people with breast cancer live beyond five years, and with successful treatment, it is possible to live many years and eventually die from other causes. And, continuing advancements in diagnosis and treatment offer hope for the future.
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Rare Forms Of Invasive Ductal Carcinoma
While invasive ductal carcinoma is generally common, below are four types of invasive ductal carcinoma that are less common:
Medullary ductal carcinoma: This type of cancer is rare and accounts for 3 percent to 5 percent of breast cancers. It is called medullary because, under a microscope, it resembles part of the brain called the medulla. Medullary carcinoma may occur at any age, but it typically affects women in their late 40s and early 50s. Medullary carcinoma is more common in women who have a BRCA1 gene mutation. Medullary tumors are often triple-negative, which means they test negative for estrogen and progesterone receptors and for the HER2 protein. Medullary tumors are less likely to involve the lymph nodes, are more responsive to treatment, and may have a better prognosis than more common types of invasive ductal cancer.
Surgery is typically the first-line treatment for medullary ductal carcinoma. A lumpectomy or mastectomy may be performed, depending on the location of the tumor. Chemotherapy and radiation therapy for breast cancer may also be used.
Surgery is typically recommended to treat mucinous ductal carcinoma. A lumpectomy or mastectomy may be performed, depending on the size and location of the tumor. Adjuvant therapy, such as radiation therapy, hormonal therapy and chemotherapy, may also be required. Because most mucinous carcinomas test negative for receptors for the protein HER2, they arent typically treated with trastuzumab .
Other Types Of Breast Cancer
There are some other less common types of invasive breast cancer.
Invasive lobular breast cancer
Inflammatory breast cancer
This is when cancer cells grow along and block the tiny channels in the skin of the breast. The breast then becomes inflamed and swollen. Inflammatory breast cancer is rare.
Pagets disease of the breast
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Certain Benign Changes In The Breast
Some changes in the breast seem to increase risk of breast cancer. They include
Changes in the breast that required a biopsy to rule out cancer
Conditions that change the structure, increase the number of cells, or cause lumps or other abnormalities in breast tissue, such as complex fibroadenoma Fibroadenomas of the Breast Fibroadenomas of the breast are small, smooth, solid, rounded noncancerous lumps composed of fibrous and glandular tissue. Fibroadenomas read more , hyperplasia , atypical hyperplasia in the milk ducts or milk-producing glands, sclerosing adenosis , or papilloma
Dense breast tissue, seen on a mammogram
Having dense breast tissue also makes it harder for doctors to identify breast cancer.
For women with such changes, the risk of breast cancer is increased only slightly unless abnormal tissue structure is detected during a biopsy or they have a family history of breast cancer.
What Are The Stages Of Breast Cancer
There are two different staging systems for breast cancer. One is called anatomic staging while the other is prognostic staging. The anatomic staging is defined by the areas of the body where the breast cancer is found and helps to define appropriate treatment. The prognostic staging helps medical professionals communicate how likely a patient is to be cured of the cancer assuming that all appropriate treatment is given.
The anatomic staging system is as follows:
Stage 0 breast disease is when the disease is localized to the milk ducts .
Stage I breast cancer is smaller than 2 cm across and hasnt spread anywhere including no involvement in the lymph nodes.
Stage II breast cancer is one of the following:
- The tumor is less than 2 cm across but has spread to the underarm lymph nodes .
- The tumor is between 2 and 5 cm .
- The tumor is larger than 5 cm and has not spread to the lymph nodes under the arm .
Stage III breast cancer is also called locally advanced breast cancer. The tumor is any size with cancerous lymph nodes that adhere to one another or to surrounding tissue . Stage IIIB breast cancer is a tumor of any size that has spread to the skin, chest wall, or internal mammary lymph nodes .
Stage IV breast cancer is defined as a tumor, regardless of size, that has spread to areas away from the breast, such as bones, lungs, liver or brain.
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What Is The Best Treatment For Breast Cancer
Treatment options which may be considered include surgery, chemotherapy, radiotherapy and hormone treatment. Often a combination of two or more of these treatments is used. The treatments used depend on:
- The cancer itself its size and stage , the grade of the cancer cells, and whether it is hormone responsive or contains HER2 receptors AND
- The woman with the cancer your age, whether or not you have had your menopause, your general health and personal preferences for treatment.
You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects and other details about the various possible treatment options for your type of cancer.
You should also discuss with your specialist the aims of treatment. For example:
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Additional Diagnostic Screening Studies May Be Necessary
When the initial screening process detects something abnormal there is a kind of in between state whereby more investigations may be necessary. Properly speaking, this is still part of the screening process, even though much of that information will be useful for staging purposes.
And, indeed, in quite a few proliferative breast lesions it remains unclear whether or not the neoplasm is actually benign or a potential breast cancer, even after biopsy.
So, just because the doctors need to take additional images or request a biopsy, this does not mean that they are staging for breast cancer.
It simply means something abnormal and potentially harmful has been detected at initial screening, and medics need to figure out exactly what it is. In the majority of cases, follow-up imaging studies and biopsies turn out to be benign breast lesions.
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M Categories For Breast Cancer
M followed by a 0 or 1 indicates whether the cancer has spread to distant organs — for example, the lungs, liver, or bones.
M0: No distant spread is found on x-rays or by physical exam.
cM0: Small numbers of cancer cells are found in blood or bone marrow , or tiny areas of cancer spread are found in lymph nodes away from the underarm, collarbone, or internal mammary areas.
M1: Cancer has spread to distant organs as seen on imaging tests or by physical exam, and/or a biopsy of one of these areas proves cancer has spread and is larger than 0.2mm.
What Is Stage Iv Breast Cancer
Stage IV is the most advanced stage of breast cancer. It has spread to nearby lymph nodes and to distant parts of the body beyond the breast. This means it possibly involves your organs such as the lungs, liver, or brain or your bones.
Breast cancer may be stage IV when it is first diagnosed, or it can be a recurrence of a previous breast cancer that has spread.
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Breast Cancer Screening Recommendations For Men
Screening for breast cancer in men has not been sufficiently studied to determine efficacy. A breast exam could be a useful screening tool for men with BRCA mutations or a strong family history of breast cancer. Men who are at high risk for breast cancer should discuss options with their healthcare provider.
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Is There A Breast Cancer Cure
There is currently no cure for metastatic breast cancer, or breast cancer that has spread to distant parts of the body. However, early stages of breast cancer that remain localized are highly treatable 99 percent of people who receive treatment in the earliest stages of breast cancer live for 5 years or longer after diagnosis, according to the
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Less Commonly Occurring Breast Cancer
Medullary carcinoma: Medullary carcinoma is an invasive breast cancer that forms a distinct boundary between tumor tissue and normal tissue. Only 5% of breast cancers are medullary carcinoma.
Mutinous carcinoma: Also called colloid carcinoma, mutinous carcinoma is a rare breast cancer formed by the mucus-producing cancer cells. Women with mutinous carcinoma generally have a better prognosis than women with more common types of invasive carcinoma.
Tubular carcinoma: Tubular carcinomas are a special type of infiltrating breast carcinoma. Women with tubular carcinoma generally have a better prognosis than women with more common types of invasive carcinoma. Tubular carcinomas account for around 2% of breast cancer diagnoses.
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.
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Breast Examination After Treatment For Breast Cancer
The incision line may be thick, raised, red and possibly tender for several months after surgery. Remember to examine the entire incision line.
If there is redness in areas away from the scar, contact your physician. It is not unusual to experience brief discomforts and sensations in the breast or nipple area .
At first, you may not know how to interpret what you feel, but soon you will become familiar with what is now normal for you.
After breast reconstruction
Following breast reconstruction, breast examination for the reconstructed breast is done exactly the same way as for the natural breast. If an implant was used for the reconstruction, press firmly inward at the edges of the implant to feel the ribs beneath. If your own tissue was used for the reconstruction, understand that you may feel some numbness and tightness in your breast. In time, some feeling in your breasts may return.
After radiation therapy
After radiation therapy, you may notice some changes in the breast tissue. The breast may look red or sunburned and may become irritated or inflamed. Once therapy is stopped, the redness will disappear and the breast will become less inflamed or irritated. At times, the skin can become more inflamed for a few days after treatment and then gradually improve after a few weeks. The pores in the skin over the breast also may become larger than usual.
What to do
Special Forms Of Breast Cancer And Carcinoma In Situ
Though they are not specific types of tumors, some special forms of breast cancer are discussed below.
Inflammatory breast cancer is an aggressive form of locally advanced breast cancer.
The main symptoms of IBC are swelling and redness in the breast. Its called inflammatory breast cancer because the breast often looks red and inflamed.
About 1-5 percent of breast cancers are IBC .
Learn more about IBC.
Paget disease of the breast is a rare carcinoma in situ in the skin of the nipple or in the skin closely surrounding the nipple. Its usually found with an underlying breast cancer.
About 1-4 percent of breast cancers also involve Paget disease of the breast .
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