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|
*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.
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.
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.
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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Other Information About Staging
Along with the numerical stages, breast cancer is classified using the American Joint Committee on Cancer TNM system, which takes into account:
- The size of the tumor ,
- Spread to nearby lymph nodes ,
- Spread or metastasis to distant sites ,
- Estrogen receptor status,
- Status called Her2 protein ,
- The grade of the cancer , or how much the cells look like normal cells
“The grade for breast cancer is how aggressive it looks under the microscope,” Henry says. The grade is also assigned a number, with one being the least aggressive and three being the most. Since both the stage and grade are numbered systems, patients sometimes confuse the two, she says.
When meeting with a breast cancer patient, Henry says she talks about the stage, the grade, and other factors to advise the best form of treatment.
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 hasn’t 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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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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Grade And Rate Of Growth
Predicting the cancer cells speed and way of growing is an important consideration in categorizing a patients breast cancer.
Rate of growth S-phase fraction and Ki67 tests will likely be performed to measure cell growth. These tests are not always accurate, so other factors will also be used to make decisions.
Patterns of cell growth How a cancer grows is measured on a scale of one to three, one for a cancer that grows slowly or predictably and three for a cancer that is more irregular in its growth pattern.
Necrosis/dead cells The presence of dead cells is one sign that the tumor has aggressive growth.
Lymphatic invasion If the tumor cells have gotten into the fluid channels of the breast, they are categorized this way. These cancers have an increased risk of spreading beyond the breast to lymph nodes and/or to other organs within the body.
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Cancer Spread In The Lymph Nodes
Sometimes doctors aren’t sure if a cancer has spread to another part of the body or not. So they look for cancer cells in the lymph nodes near the cancer.
Cancer cells in these nodes is a sign that the cancer has started to spread. This is often called having positive lymph nodes. It means that the cells have broken away from the original cancer and got trapped in the lymph nodes. But it isn’t always possible to tell if they have gone anywhere else.
What Do Cancer Stages And Grades Mean
The stage of a cancer describes the size of a tumour and how far it has spread from where it originated. The grade describes the appearance of the cancerous cells.
If youre diagnosed with cancer, you may have more tests to help determine how far it has progressed. Staging and grading the cancer will allow the doctors to determine its size, whether it has spread and the best treatment options.
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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?
Additional Markers For Breast Cancer Staging
Additional markers specific to breast cancer will further define your stage, which may be helpful in choosing targeted treatments to fight the cancer.
- ER: The cancer has an estrogen receptor. Estrogen is a hormone, and some cancers have receptors that respond to estrogen.
- PR: The cancer has a progesterone receptor. Progesterone is also a hormone.
- HER2: The cancer makes the protein HER2 .
- G: Grade of cancer refers to how different the cells look from normal. Grade 1 indicates that the cells look fairly normal, while grade 2 cells are growing a little faster, and grade 3 cells look markedly different than normal breast tissue.
These markers, along with the TNM measurements, define your stage.
A cancer recurrence refers to cancer that returns in the same breast, and it requires new staging. This new stage is marked by an R at the end to indicate restaging. If it develops in the other breast, its considered a new cancer.
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Why Breast Cancer Is Staged
Breast cancer stages are used to guide therapy, says Yolanda Bryce, MD, a radiologist at Memorial Sloan Kettering Cancer Center. They help oncologists communicate about and help patients understand the type and severity of cancer they have, Henry says.
Different stages have different survival rates, but it’s important not to get too hung up on the statistics, because situations vary depending on the individual, Bryce says.
“There’s so much innovation and so much advancement in the field that clinical picture doesn’t necessarily look like the published numbers,” she says.
How quickly breast cancer progresses from one stage to the next varies widely. Some cancers can take a few months to progress, and others can take years, Bryce says.
Here’s a guide on the different stages of breast cancer and what each stage may mean for you.
Reducing The Cancer Burden
Between 30 and 50% of cancers can currently be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies. The cancer burden can also be reduced through early detection of cancer and appropriate treatment and care of patients who develop cancer. Many cancers have a high chance of cure if diagnosed early and treated appropriately.
N Categories For Breast Cancer
N followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are involved.
Lymph node staging for breast cancer is based on how the nodes look under the microscope, and has changed as technology has gotten better. Newer methods have made it possible to find smaller and smaller groups of cancer cells, but experts haven’t been sure how much these tiny deposits of cancer cells influence outlook.
Its not yet clear how much cancer in the lymph node is needed to see a change in outlook or treatment. This is still being studied, but for now, a deposit of cancer cells must contain at least 200 cells or be at least 0.2 mm across for it to change the N stage. An area of cancer spread that is smaller than 0.2 mm doesn’t change the stage, but is recorded with abbreviations that indicate the type of special test used to find the spread.
If the area of cancer spread is at least 0.2 mm , but still not larger than 2 mm, it is called a micrometastasis . Micrometastases are counted only if there aren’t any larger areas of cancer spread. Areas of cancer spread larger than 2 mm are known to influence outlook and do change the N stage. These larger areas are sometimes called macrometastases, but are more often just called metastases.
NX: Nearby lymph nodes cannot be assessed .
N0: Cancer has not spread to nearby lymph nodes.
N1c: Both N1a and N1b apply.
N3: Any of the following:
Can Breast Cancer Be Prevented
A lot of breast cancers are detected at an early stage, by breast screening. However, a small number are not. Some women may have developed breast cancer before they have their first mammogram and some may develop breast cancer between mammograms. All women of every age should be breast aware. That is, get to know how your breasts and nipples normally look and feel. Try to recognise any changes that occur before and after your periods. See your GP if you notice any changes, lumps, or other abnormalities in your breasts or nipples. Don’t wait until your next scheduled screening appointment.
There is some evidence that regular exercise may reduce your risk of breast cancer by as much as a third. If you have been through the menopause, it is particularly important you are not overweight or obese. This is because being overweight causes more oestrogen to be produced, which can increase the risk of breast cancer.
Studies have shown that women who breast-feed their children are less likely to develop breast cancer than those who do not. The most likely reason for this is that women do not produce an egg as regularly while they are breast-feeding and oestrogen levels remain stable.
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Does Breast Cancer Affect Women Of All Races Equally
All women, especially as they age, are at some risk for developing breast cancer. The risks for breast cancer in general arent evenly spread among ethnic groups, and the risk varies among ethnic groups for different types of breast cancer. Breast cancer mortality rates in the United States have declined by 40% since 1989, but disparities persist and are widening between non-Hispanic Black women and non-Hispanic white women.
Statistics show that, overall, non-Hispanic white women have a slightly higher chance of developing breast cancer than women of any other race/ethnicity. The incidence rate for non-Hispanic Black women is almost as high.
Non-Hispanic Black women in the U.S. have a 39% higher risk of dying from breast cancer at any age. They are twice as likely to get triple-negative breast cancer as white women. This type of cancer is especially aggressive and difficult to treat. However, it’s really among women with hormone positive disease where Black women have worse clinical outcomes despite comparable systemic therapy. Non-Hispanic Black women are less likely to receive standard treatments. Additionally, there is increasing data on discontinuation of adjuvant hormonal therapy by those who are poor and underinsured.
In women under the age of 45, breast cancer is found more often in non-Hispanic Black women than in non-Hispanic white women.
Why Does Cancer Stage Matter
Staging helps your doctor plan the best treatment. This may include choosing a type of surgery and whether or not to use chemotherapy or radiation therapy. Knowing the cancer stage lets your entire health care team talk about your diagnosis in the same way.
Doctors can also use staging to:
Understand the chance that the cancer will come back or spread after the original treatment.
Help forecast the prognosis, which is the chance of recovery
Help determine which cancer clinical trials may be open to you.
See how well a treatment worked
Compare how well new treatments work among large groups of people with the same diagnosis
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Breast Cancer Staging And Prognosis
Breast cancer staging describes how far the cancer has spread within the breast and other parts of the body. It is an important factor in making treatment decisions.
Breast cancer staging is based on tumour size, the extent that cancer has spread to other parts of the body and other clinical factors. Your doctor will assign a stage to your cancer after your physical exam, mammogram, and other diagnostic tests, such as a biopsy .
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.
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