How Is Breast Cancer Stage Determined
The breast cancer staging process helps doctors determine how much cancer there is and where its located. The higher the breast cancer stage number, the more advanced the disease.
Breast cancer staging is so important because it provides cancer care teams which include breast surgeons, oncologists, pathologists, radiologists and many others an agreed upon way to talk about the disease. This makes it easier for them to understand diagnoses and collaborate on treatment plans.
What Are Breast Cancer Stages
The stage of a cancer describes the size of the cancer and how far it has spread.
Your breast cancer may be described as stage 1, stage 2, stage 3 or stage 4.
An early form of breast cancer called DCIS is sometimes referred to as stage 0 breast cancer.
The stage takes into account:
- The size of the cancer
- Whether the lymph nodes are affected
- If the cancer has spread to other parts of the body
The stage of your cancer may not be fully known until after you have had surgery.
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.
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Stage 1 Breast Cancer Treatment Options
Stage 1 breast cancers are usually treated with surgery to remove the mass, potentially with radiation therapy to treat the area.
Hormone therapies and chemotherapy can help reduce the risk that cancer will come back. Lymph nodes will also be biopsied or dissected to detect cancer.
Targeted therapies may also be used for HER2-positive stage 1 cancers.
Breast Cancer Stage: What Do They Mean
Stages are numbers used to describe how far a cancer has advanced and where it has spread in the body. Cancer that has not spread beyond your breast is considered local.
Regional cancer has spread into the breast skin, chest structures, and lymph nodes. When cancer spreads to other parts of the body, it is considered distant since it exists far away from just the breasts.
Your prognosis, or your long-term outcome, relies heavily on what stage your cancer is. Cancer stages are often further broken down into subcategories to provide more specific information.
Staging previously relied only on whether it is invasive or noninvasive, the tumors size, which lymph nodes contained cancer, and where and how far the cancer had spread.
Breast cancer stages now also take into account the tumors grade and the cancers estrogen receptor, progesterone receptor, and HER2 status.
Estrogen receptor, progesterone receptor, and HER2 status all have to do with the specific hormones and/or proteins involved in your cancer. The tumor grade describes what the cancer cells look like.
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Treatment For Stage 4 Breast Cancer
Typically, treatment for stage 4 breast cancer includes a combination of chemotherapy, radiation therapy, and hormone therapy .
Targeted therapy is a treatment that targets the protein that allows cancer cells to grow and this type of therapy may also be an option for people with stage 4 breast cancer.
Sometimes, surgeons will operate to try and remove tumors though this is not usually the first option for treatment.
Doctors, however, may recommend surgery to help with pain relief by treating some of the issues that may develop as a result of having stage 4 breast cancer. These include spinal cord compression, removing single masses caused by metastasis, and fixing any broken bones.
A doctor may also prescribe medication to treat related symptoms such as:
- antidepressants to help mood
- anticonvulsants to manage pain or neurologic conditions
- local anesthetics to manage pain
New treatments and therapies are emerging all the time, and anyone who has breast cancer at any stage can volunteer to try out these new treatments. People considering this should talk to their doctor to see whether any trials are available in their area.
Trials for a new treatment called immunotherapy are currently taking place. Immunotherapy works by raising the bodys natural ability to fight off cancer and has fewer side effects than chemotherapy.
As well as numbers, a zero or an X often follow the letters T, N, and M. According to the AJCC, the meanings are as follows:
These include:
Is It Possible To Prevent Breast Cancer
There is no guaranteed way to prevent breast cancer. Reviewing the risk factors and modifying the ones that can be altered can help in decreasing the risk.
Following the American Cancer Society’s guidelines for early detection can help early detection and treatment.
There are some subgroups of women that should consider additional preventive measures.
Women with a strong family history of breast cancer should be evaluated by genetic testing. This should be discussed with a health care provider and be preceded by a meeting with a genetic counselor who can explain what the testing can and cannot tell and then help interpret the results after testing.
Chemoprevention is the use of medications to reduce the risk of cancer. The two currently approved drugs for chemoprevention of breast cancer are tamoxifen and raloxifene , which also blocks the effect of estrogen on breast tissues. Their side effects and whether these medications are right for an individual need to be discussed with a health care provider.
Aromatase inhibitors are medications that block the production of small amounts of estrogen usually produced in postmenopausal women. They are being used to prevent reoccurrence of breast cancer but are not approved at this time for breast cancer chemoprevention.
For a small group of patients who have a very high risk of breast cancer, surgery to remove the breasts may be an option. Although this reduces the risk significantly, a small chance of developing cancer remains.
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How Do Tamoxifen Raloxifene Anastrozole And Exemestane Reduce The Risk Of Breast Cancer
If you are at increased risk for developing breast cancer, four medications tamoxifen , raloxifene , anastrozole , and exemestane may help reduce your risk of developing this disease. These medications act only to reduce the risk of a specific type of breast cancer called estrogen receptor-positive breast cancer. This type of breast cancer accounts for about two-thirds of all breast cancers.
Tamoxifen and raloxifene are in a class of drugs called selective estrogen receptor modulators . These drugs work by blocking the effects of estrogen in breast tissue by attaching to estrogen receptors in breast cells. Because SERMs bind to receptors, estrogen is blocked from binding. Estrogen is the fuel that makes most breast cancer cells grow. Blocking estrogen prevents estrogen from triggering the development of estrogen-receptor-positive breast cancer.
Anastrozole and exemestane are in a class of drugs called aromatase inhibitors . These drugs work by blocking the production of estrogen. Aromatase inhibitors do this by blocking the activity of an enzyme called aromatase, which is needed to make estrogen.
Stages Of Breast Cancer: Stage Iiib
A stage IIIb breast cancer is one in which the tumor may be of any size but it has grown into the chest wall or the skin of the breast. A stage IIIb designation also applies if there is evidence of either
- axillary lymph node metastasis
- internal mammary node metastasis
presenting in such a way as to suggest that total surgical removal is not possible.
There is a unique type of breast cancer, inflammatory breast cancer, that causes the breast to appear red and swollen. This is because the cancer cells block some of the lymphatic vessels. Inflammatory breast cancers tend to have a poorer prognosis and are generally stage IIIb at least.
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Conditions That Can Raise Your Risk Of Breast Cancer
- Personal history. Women who have dense breasts, a breast disease that is not cancer, or who have had breast cancer before have an increased risk.
- Family history. A woman’s risk of breast cancer increases if her mother, sister, daughter, or two or more other close relatives, such as cousins, have a history of breast cancer, especially if they were diagnosed with breast cancer at age 50 or younger.
- A small number of women who have a family history of breast cancer have inherited changes to certain genes, such as BRCA1 or BRCA2, that increase their breast cancer risk.
- Genetic tests are available to find out if you have the genetic mutations long before any cancer appears.
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The Tnm System For Staging Breast Cancer
The AJCCs addition of the letters T, N, and M for anatomic breast cancer staging adds more information to a breast cancer diagnosis. Heres what they mean:
- T : The tumor grade shows a higher number for a larger size or density.
- N : Nodes refers to lymph nodes and uses the numerals 0 to 3 to give information about how many lymph nodes are involved in the cancer.
- M : This refers to how the cancer has spread beyond the breast and lymph nodes.
The AJCC also added clarifications in staging for ER, PR, and HER2 expression and also genetic information.
Ultimately, this means someone diagnosed with stage 3 breast cancer can receive more information from their breast cancer staging than ever before.
No matter the stage, the best source of information about your individual outlook is your own oncology team.
Make sure you understand your breast cancer stage and subtype so that you can better understand treatment options and individual outlook.
Getting the right treatment and the support you need can help you navigate the challenges of being diagnosed with stage 3 breast cancer.
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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.
Stage Iv Breast Cancer
Stage IV, also called metastatic, is the most advanced stage of breast cancer. In this stage, the cancer has spread to nearby lymph nodes and to other parts of the body, such as the lungs, liver, brain, or bones.
If the cancer has spread to the bone, patients may have bone pain or back pain, and if it has spread to the liver, patients may have pain on the right side of their abdomen, Bryce says. Some of the changes in the skin and nipple listed earlier under stage II may also occur in stage IV.
When the cancer has spread to other, distant parts of the body, the five-year survival rate is 28%. “With the treatments that we have available to us today, most patients, unfortunately, are not cured of their cancer” if it is stage IV, Henry says. But, she adds, “We can still treat, we can still manage, we can still help people feel good for as long as possible.”
Also, many new treatments are emerging. “People are living longer even with stage IV disease,” Bryce says. A 2018 study found that the effectiveness of breast cancer treatment on survival increased substantially from 1975 to 2015.
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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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Warning Signs And Words To Know
The most common symptom or warning sign of breast cancer is a lump in the breast. But both Cance and Cruz said not all lumps are cancerous. Women should also watch for nipple discharge and changes in breast shape or size.
Cance says vocabulary such as local, regional or distant may be used to describe a patient’s diagnosis. Local refers to the area where the cancer is confined within the breast. Regional may be used when the lymph nodes, primarily those in the armpit, are involved. The term distant is used when the cancer is found in other parts of the body as well, according to Cance.
Another term typically introduced after a breast cancer diagnosis is T-N-M. T represents the tumor size N relates to the involvement of nearby lymph nodes and M refers to whether the cancer has spread beyond the breast, according to Memorial Sloan Kettering Cancer Center.
What Investigations Are Necessary For Staging Breast Cancer
Breast cancer staging almost always involves a bone scan, as breast cancer is highly prone to metastasize to the bones.
During this test, medics inject a small amount of a radioactive substance into the bloodstream, where it eventually collects in the bones. A radiation scanner is then able to detect accumulations of tracer substance in the bones.
If breast cancer spreads beyond the breast, 25% of the time it goes into bones first.
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What Are The Statistics On Male Breast Cancer
Breast cancer is rare in men but typically has a significantly worse outcome. This is partially related to the often late diagnosis of male breast cancer, when the cancer has already spread.
Symptoms are similar to the symptoms in women, with the most common symptom being a lump or change in skin of the breast tissue or nipple discharge. Although it can occur at any age, male breast cancer usually occurs in men over 60 years of age.
Stages Of Breast Cancer
Staging describes or classifies a cancer based on how much cancer there is in the body and where it is when first diagnosed. This is often called the extent of cancer. Information from tests is used to find out the size of the tumour, what part of the breast has cancer, whether the cancer has spread from where it first started and where the cancer has spread. Your healthcare team uses the stage to plan treatment and estimate the outcome .
The most common staging system for breast cancer is the TNM system. For breast cancer there are 5 stages stage 0 followed by stages 1 to 4. Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the more the cancer has spread. Talk to your doctor if you have questions about staging.
When describing the stage of breast cancer, sometimes doctors group them as follows:
In situ breast cancer The cancer cells are only in the duct or lobule where they started and have not grown into nearby breast tissue . It is stage 0.
Early stage breast cancer The tumour is smaller than 5 cm and the cancer has not spread to more than 3 lymph nodes. It includes stages 1A, 1B and 2A.
Locally advanced breast cancer The tumour is larger than 5 cm. The cancer may have spread to the skin, the muscles of the chest wall or more than 3 lymph nodes. It includes stages 2B, 3A, 3B and 3C. Inflammatory breast cancer is also considered locally advanced breast cancer.
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