In Situ Vs Invasive Breast Cancers
The type of breast cancer can also refer to whether the cancer has spread or not. In situ breast cancer is a cancer that starts in a milk duct and has not grown into the rest of the breast tissue. The term invasive breast cancer is used to describe any type of breast cancer that has spread into the surrounding breast tissue.
Invasive breast cancer has spread into surrounding breast tissue. The most common types are invasive ductal carcinoma and invasive lobular carcinoma. Invasive ductal carcinoma makes up about 70-80% of all breast cancers.
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The Breast Cancer Stages: From 0 To 4
The stage of your cancer will appear on your pathology report, a report that details the size, shape and look of the cancer cells under a microscope. . Most cancers, including invasive breast cancer, have four stages.
Stage 0 is abnormal cells that have not spread beyond the ducts or lobules of the breast, such as DCIS or LCIS, respectively.
Stage I cancer is invasive and spreading beyond where it started.
In Stage IA, the cancer is 2 cm or smaller and has not spread into the lymph nodes or outside of the breast.
In Stage IB, small clumps of cancer cells ranging from 0.2 to 2 mm exist in the lymph nodes. There may not be a tumor in the breast, but if there is, it measures no bigger than 2 cm.
Stage II cancer also has two subcategories. Stage IIA describes a cancer that has spread to 1 to 3 lymph nodes under your arms with or without a tumor up to 2 cm large in the breast, or the breast tumor measures 2 to 5 cm without cancer cells in the axillary lymph nodes.
Stage IIB refers to a tumor between 2 and 5 cm along with cancer in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone, or the tumor is larger than 5 cm when no cancer cells exist in the axillary lymph nodes.
In Stage IIIB, the tumor has reached the skin of your breast and/or your chest wall and up to 9 lymph nodes under your arms or near your breastbone.
Inflammatory breast cancer is automatically Stage IIIB or a later stage.
Stage IIIC involves three behaviors of the cancer:
When Is Cancer Staged
A few methods are used to stage cancer, named for when in the diagnosis/treatment continuum the staging is performed. These include clinical, pathological and post-therapy staging.
Clinical staging: Determining a cancers stage before treatment is called clinical staging. It may draw on information from a patients health history, physical exam and tests such as imaging, blood tests and previous biopsies. This helps the oncology team plan treatment and form an educated opinion of the prognosis.
Pathological staging: If treatment begins with surgery to remove cancer, doctors will consider any new information gained during the procedure in order to determine the pathological or surgical stage. Because this information adds to what was discovered during the clinical staging, this staging is considered more accurate.
Post-therapy staging: If radiation therapy, hormone therapy, chemotherapy, immunotherapy or other therapies are administered instead of surgery as the initial treatment, the cancer may be assigned a post-therapy or post-neoadjuvant therapy stage. Post-therapy staging means the staging was performed after treatments used instead of surgery. Post-neoadjuvant therapy staging means it was performed after treatment designed to shrink a tumor before surgery.
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Are There Other Systems For Staging Cancer
Other staging systems are used for cancers that dont fit well into the TNM system. In addition to prostate and breast cancer, these include:
Blood cancers: These cancers usually dont form solid tumors that can be measured. Lymphoma, leukemia, multiple myeloma and other cancers that form in blood or lymph cells fall into this group, each of which has its own staging system.
Cancers of the brain and spinal cord: These cancers are typically confined to the central nervous system and dont metastasize throughout the body. Theres no one general system to stage these cancers.
Gynecological cancers: Internationally, a system designed by the International Federation of Obstetrics and Gynecology is used to stage cancers of the female reproductive system. Though this system doesnt follow the TNM categories, it has five similar overall stages, from 0-4.
Childhood cancers: Pediatric oncologists generally use staging systems unique to each pediatric cancer.
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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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Where Does Breast Cancer Spread
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.
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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Neoadjuvant Therapy And Breast Cancer Staging
If you will get neoadjuvant therapy , your breast cancer will be staged differently from someone who has surgery as a first treatment.
Neoadjuvant therapy can shrink tumors in the breast and lymph nodes, changing the original tumor size and lymph node status. So, your breast cancer is staged using information from physical exams, imaging and biopsies done before neoadjuvant therapy, rather than information from the tumor removed during surgery.
The stages shown in the table below are only used to classify breast cancers in people who have surgery as their first treatment.
If you will get neoadjuvant therapy, talk with your health care provider about how your breast cancer will be staged.
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.
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Stage 3 Breast Cancer
Stage 3 breast cancer is divided into three groups:
Stage 3A can mean:
No cancer is seen in the breast, but cancer is found in four to nine lymph nodes under the arm or near the breastbone
The cancer in the breast measures up to 5cm and cancer is found in four to nine lymph nodes under the arm or near the breastbone
The cancer in the breast is larger than 5cm, and cancer is found in up to three lymph nodes under the arm or near the breastbone.
Stage 3B means the cancer in the breast can be any size and has spread to the skin of the breast or chest wall. Cancer is found in up to nine lymph nodes under the arm or near the breast bone.
Stage 3C means the cancer in the breast can be any size, may have spread to the skin of the breast or chest wall and cancer is found in 10 or more lymph nodes under the arm or near the breastbone, or to nodes above or below the collarbone.
The severity of breast cancer is described by five stages, depending on tumour size and location. Stage 0 means pre-cancerous cells are present in the breast . Stage 1 means there is a small tumour in the breast, but no lymph node involvement . Stages 2 and 3 mean either that the tumour is larger or that there are some cancer cells in the lymph nodes of the armpit or other nearby tissues, such as the skin. Stage 4 means the cancer has spread to form tumours in other, distant parts of the body. Severity increases with stage and consequently treatment options vary between stages.
What Is Stage 4 Breast Cancer
Also known as metastatic breast cancer, the cancer in this stage has spread beyond the breast, underarm and internal mammary lymph nodes to other parts of the body near to or distant from the breast. The cancer has spread elsewhere in the body. The affected areas may include the bones, brain, lungs or liver and more than one part of the body may be involved.
At stage 4, TNM designations help describe the extent of the disease. Higher numbers indicate more extensive disease. Most commonly, stage 4 breast cancer is described as:,
- T: T1, T2, T3 or T4 depends on the size and/or extent of the primary tumor.
- N1: Cancer has spread to the lymph nodes.
- M1: The disease has spread to other sites in the body.
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Questions To Ask The Health Care Team
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What tests will I need to have to determine my cancers stage?
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What is the stage of the cancer that I have? What does this mean?
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How did you determine the cancers stage?
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What is the cancers grade?
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Does the tumor have any genetic mutations?
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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?
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What does the stage, grade, and biomarker testing mean for my treatment plan or my prognosis?
Pearls And Other Issues
Breast cancer patients are advised to be followed up for life to detect early recurrence and spread. Yearly or biannual follow-up mammography is recommended for the treated and the other breast. The patient must be informed that they must visit a breast clinic if they have any suspicious manifestations. Currently, there is no role for repeated measurements of tumor markers or doing follow-up imaging other than mammography.
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Breast Cancer: Prevention Measures
Self-awareness is the greatest care one can provide to oneself make note of any significant change you observe, this could be related to the heaviness that you might experience in one of your breasts or could be the presence of a painful lump in your breast. The other factors that might help prevent a breast
cancer are :
Whatever may be the cause, early detection is your best defence. If you suspect any significant lumps in your breasts, dont ignore the signs and go for an early diagnosis to your medical oncologist, who will help confirm the presence of any such disorders.
Types Of Breast Cancer
Medically Reviewed on April 15, 2020
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What You Need To Know
- There are several kinds of breast cancer staging:
- Clinical staging is based on preliminary information such as imaging findings, clinical exam and pathology information.
- Anatomical staging is based on tumor size and the location of lymph node involvement.
- Pathology staging is based on the tumors size, pathological characteristics and lymph node involvement after surgery.
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.
See also our new up-to-date survival rates by stageOR our general survival rates for breast cancer
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
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Stages Of Breast Cancer
The stages of breast cancer range from 0 to IV .
The highest stage is any cancer with metastases , no matter the size of the tumor, the lymph node status or other factors. This is known as metastatic breast cancer and is the most advanced stage of breast cancer.
Most often, the higher the stage of the cancer, the poorer the prognosis will be.
The table below lists the TNM classifications for each stage of breast cancer for people who have surgery as their first treatment.
| When TNM is |
| IV |
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*T1 includes T1mi. **N1 does not include N1mi. T1 N1mi M0 and T0 N1mi M0 cancers are included for prognostic staging with T1 N0 M0 cancers of the same prognostic factor status. ***N1 includes N1mi. T2, T3 and T4 cancers with N1mi are included for prognostic staging with T2 N1, T3 N1 and T4 N1, respectively. |
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Used with permission of the American College of Surgeons, Chicago, Illinois. The original source for this information is the AJCC Cancer Staging Manual, Eighth Edition published by Springer International Publishing. |
How Is The Stage Of Breast Cancer Determined
The stage of a breast cancer is determined by the cancers characteristics, such as how large it is and whether or not it has hormone receptors. The stage of the cancer helps you and your doctor: figure out your prognosis, the likely outcome of the disease. decide on the best treatment options for you.
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