Is Stage 3 Breast Cancer Metastatic

Stage 3 Breast Cancer

Stage 3 means that the cancer has spread from the breast to lymph nodes close to the breast or to the skin of the breast or to the chest wall.

It is also called locally advanced breast cancer.

The stage of a cancer tells you how big it is and how far it has spread. It helps your doctor decide which treatment you need.

Staging for breast cancer is very complex. Many different factors are considered before doctors can confirm your final stage. For example, they also use a sample of your cancer to test for:

• receptors for the female hormones
• HER2 status
• the grade of your cancer

You may also have a CT scan to check that the cancer has not spread to other parts of your body.

Do speak to your breast doctor or nurse if you have any questions about staging.

How Does Staging Relate To Types Of Breast Cancer

In addition to cancer stage, doctors will determine the tumor grade and subtype.

Tumors are graded on a scale of 1 to 3, based on how abnormal the cells appear compared to normal cells. The higher the grade, the more aggressive the cancer, meaning that it tends to be growing quickly.

The subtype is important because treatment and outlook will vary depending on which subtype of breast cancer that you have. Subtypes include:

• triple-negative

A Note About Statistics

Survival rates are statistics, and as such tend to tell us how the average person will do with an average triple-negative breast cancer but people and tumors arent statistics. Some people will do better and some people will do worse.

Very importantly, statistics are usually several years old. In order to calculate five-year survival rates, a person would have to have been diagnosed at least five years prior. And still there is lag time. The treatment of triple-negative breast cancer is changing, and new drugs have been approved.

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Phase Iii Keynote 355 Trial

The much anticipated KEYNOTE-355 trial was presented at the inaugural virtual ASCO annual meeting in June 2020. This trial investigated pembrolizumab/chemo vs chemo in patients with treatment-naïve, metastatic TNBC. Patients were excluded if they had active brain metastases or recurrence of disease < 6 mo prior to primary treatment. PD-L1 was assessed with the IHC 22C3 pharmDx CPS assay in a central laboratory. The primary outcome measure was pre-defined as OS and PFS in the PD-L1 positive population and the ITT population. In this trial, a hierarchial statistical testing method involved statistical testing of OS and PFS in the CPS > 10 group initially, followed by CPS > 1 and then the ITT population. The trial included 566 patients in the chemotherapy/IO arm vs 281 in the chemotherapy arm. In patients with a CPS score of 10 or greater, the median PFS favoured pembrolizumab with a PFS of 9.6 mo vs 5.6 mo . In patients with a CPS score of 1 or greater, the median PFS favoured the pembrolizumab arm with a PFS of 7.6 mo vs 5.6 mo . This was not statistically significant. This was similar to the ITT population where the PFS was 7.5 mo in the pembrolizumab arm and 5.6 mo in the placebo arm . OS data is awaited. This progression free survival improvement led to accelerated FDA approval for pembrolizumab in combination with chemotherapy in the first-line setting in November of 2020.

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Signs Of Breast Cancer Include A Lump Or Change In The Breast

These and other signs may be caused by breast cancer or by other conditions. Check with your doctor if you have any of the following:

• A lump or thickening in or near the breast or in the underarm area.
• A change in the size or shape of the breast.
• A dimple or puckering in the skin of the breast.
• A nipple turned inward into the breast.
• Fluid, other than breast milk, from the nipple, especially if it’s bloody.
• Scaly, red, or swollen skin on the breast, nipple, or areola .
• Dimples in the breast that look like the skin of an orange, called peaudorange.

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More Information About The Tnm Staging System

The T category describes the original tumor:

• TX means the tumor can’t be assessed.
• T0 means there isn’t any evidence of the primary tumor.
• Tis means the cancer is “in situ” .
• T1, T2, T3, T4: These numbers are based on the size of the tumor and the extent to which it has grown into neighboring breast tissue. The higher the T number, the larger the tumor and/or the more it may have grown into the breast tissue.

The N category describes whether or not the cancer has reached nearby lymph nodes:

• NX means the nearby lymph nodes can’t be assessed, for example, if they were previously removed.
• N0 means nearby lymph nodes do not contain cancer.
• N1, N2, N3: These numbers are based on the number of lymph nodes involved and how much cancer is found in them. The higher the N number, the greater the extent of the lymph node involvement.

The M category tells whether or not there is evidence that the cancer has traveled to other parts of the body:

• MX means metastasis can’t be assessed.
• M0 means there is no distant metastasis.
• M1 means that distant metastasis is present.

What Questions Should I Ask My Healthcare Provider

You may want to ask your provider:

• What type of breast cancer recurrence do I have?
• Has the cancer spread outside the breast?
• What stage is the breast cancer?
• What is the best treatment for this type of breast cancer?
• What are the treatment risks and side effects?
• Should I look out for signs of complications?

A note from Cleveland Clinic

Most breast cancer recurrences respond well to treatments. You may be able to try new drugs or combination therapies in development in clinical trials. Your healthcare provider can discuss the best treatment option based on your unique situation.

Last reviewed by a Cleveland Clinic medical professional on 03/24/2021.

References

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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.

How Is Inflammatory Breast Cancer Treated

Inflammatory breast cancer is generally treated first with systemic chemotherapy to help shrink the tumor, then with surgery to remove the tumor, followed by radiation therapy. This approach to treatment is called a multimodal approach. Studies have found that women with inflammatory breast cancer who are treated with a multimodal approach have better responses to therapy and longer survival. Treatments used in a multimodal approach may include those described below.

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Stomach Upset Loss Of Appetite And Weight Loss

Cancer can cause nausea, vomiting, diarrhea, and constipation. Anxiety and lack of sleep can also upset the digestive system.

It can be more difficult to eat a healthy diet as these symptoms occur, setting up a vicious cycle. As women avoid certain foods because of stomach upset, the digestive system may lack the fiber and nutrients it needs to function optimally.

Over time, women may lose their appetite and have difficulty taking in the calories they need. Not eating regularly may cause significant weight loss and nutritional imbalances.

Metastatic Breast Cancer: What You Should Know

What does it mean to have metastatic, or stage 4, breast cancer? A Rogel Cancer Center oncologist explains the diagnosis and how its treated.

After hearing a diagnosis of metastatic breast cancer, a rush of questions emerges. But often, its not until long after leaving the doctors office.

Metastatic means the cancer has spread beyond the breast and immediate lymph nodes to other organs or tissues in the body, most often the bones, brain, lungs or liver. Its considered stage 4 breast cancer, which means the cancer has progressed to its most advanced stage.

But even though its moved to other organs, it still behaves like breast cancer and is treated with breast cancer therapies.

More than 154,000 U.S. women are estimated to have metastatic breast cancer, according to the Susan G. Komen organization. Men can have metastatic breast cancer too, but its rare.

To help patients fill in information gaps, N. Lynn Henry, M.D., Ph.D., the breast oncology disease lead for the University of Michigan Rogel Cancer Center, explains the nuances of stage 4 metastatic breast cancer.

What are the differences between metastatic breast cancer, stage 4 breast cancer and advanced cancer?

If any doctor uses the term advanced, ask for clarification, Henry adds.

When does metastatic breast cancer appear?

What are the symptoms?

Symptoms of bone metastases:

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Stage 3b Breast Cancer

Stage 3B breast cancer means a tumour of any size that has spread to other tissues near the breast such as skin, muscles, or ribs. At this stage, the tumour may or may not have spread to the lymph nodes. However, the cancer has not spread to other distant parts of the body.

Cancer that has spread to the skin of the breast might be inflammatory breast cancer, a rare form of cancer which can be aggressive and challenging to treat.

Staging And Grading Of Breast Cancer

Knowing the stage and grade of the cancer helps your doctors plan the best treatment for you.

On this page

Your specialist doctor needs certain information about the cancer to advise you on the best treatment for you. This includes:

• the stage of the cancer
• the grade of the cancer
• whether the cancer has receptors for hormones or a protein called HER2.

This information comes from the results of all the tests you have had, including:

• the biopsy, when the tissue was examined
• other tests that were done on the cells.

Your specialist doctor and nurse will talk to you about this. They will explain how it helps you and your doctor decide on your treatment plan.

We understand that waiting to know the stage and grade of your cancer can be a worrying time. We’re here if you need someone to talk to. You can:

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Stage 4 Breast Cancer: Prognoses And Solutions

Breast cancer cases have doubled in the last 20 years. Women die more often from this disease than all other cancers. Cancers develop inside our bodies, from our own cells that have mutated for some reason. Scientists all over the world have been fighting over the cause of cancer for decades and have come to the conclusion that the diseases destructive mechanisms are triggered by not one but many factors.

Treatment Options For Stage 3 Cancer

In general, regimens for stage 3 cancers typically start with either surgery or treatment to shrink the tumor before surgery, such as chemotherapy, radiation, or a combination of both.

Stage 3 breast cancer treatment: The first step is typically either chemotherapy or surgery.

Called neoadjuvant chemotherapy, because its given before other treatment, this may help shrink a tumor enough that breast-conserving surgery is possible. If it doesnt shrink enough, the patient may need a mastectomy instead. HER2-positive cancers may also be treated with targeted drugs before surgery.

After surgery, depending on the type of breast cancer, your treatment may continue with radiation. Chemotherapy and/or targeted drugs may be part of your treatment plan after surgery as well.

Stage 3 lung cancer treatment: This is highly dependent on how large the tumor is and which lymph nodes are affected. Generally, treatment begins with chemotherapy and/or radiation. You may have chemotherapy and radiation at the same time, or you may have them one after another. Surgery may follow this treatment if your care team thinks the remaining cancer may be successfully removed. After surgery, additional chemotherapy and/or radiation may be part of your treatment plan.

If chemotherapy, radiation or surgery arent appropriate options, immunotherapy drugs may be.

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Can You Do Anything To Prevent Or Slow The Spread Of Breast Cancer

Like any type of cancer, there are factors that can put you at higher risk. For breast cancer, these include things like smoking, unhealthy diet, lack of exercise and not performing monthly self-breast exams. Its also important to make sure and get your annual mammogram for breast cancer screening.

Other risk factors can include using hormone-based prescriptions, how many children youve had in the past, getting older and at what age you got your period and went through menopause.

In some instances, you cant necessarily prevent breast cancer, but you can sometimes slow it down, stop it from spreading or reduce the size of the tumor, says Dr. Roesch. You can do this by taking your medications as directed, following through with treatments, going to your appointments and being involved in your cancer care.

Youre in control of taking your medication correctly, eating a healthy diet, participating in an exercise program and managing stress. All of these things can contribute to a stronger physical body and better mental attitude both of which can have a positive impact on your breast cancer diagnosis.

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Where Cancer Spreads

Cancer can spread to almost any part of the body, although different types of cancer are more likely to spread to certain areas than others. The most common sites where cancer spreads are bone, liver, and lung. The following list shows the most common sites of metastasis, not including the lymph nodes, for some common cancers:

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How To Find Support

You may be overwhelmed with organizations offering support, or you may be confused as to how to enroll or whether youre eligible. Though some of these support options happen outside of your care teams facility, speak openly with them about what kind of support you need and any questions to start.

Stay connected with your care team: They know you and they know the battle ahead. They also know which resources have been helpful for other patients, and which resources they may be able to offer. They know that factors such as stress, nutrition and sleeping problems affect your health. Theyre there to help you get what you need.

Lean on friends and family: Interactions with friends and family may be different when a cancer diagnosis is involved. Odds are that your support system wants to help, but theyll know the best ways to help if you tell them yourself. Dont be afraid to ask for what you need, whether its company on the ride to an appointment or help with household chores.

Look for support groups: If you have stage 3 cancer, youre joining a host of others who have walked a similar path. Youre not alone. Participating in a support group may help you feel more connected and understood. Both the American Cancer Society and the National Cancer Institute have tools to help you find resources for cancer support in your area.

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 you’re 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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What Is A 5

A relative survival rate compares women with the same type and stage of breast cancer to women in the overall population.For example, if the 5-year relative survival rate for a specific stage of breast cancer is 90%, it means that women who have that cancer are, on average, about 90% as likely as women who dont have that cancer to live for at least 5 years after being diagnosed.

Metastatic Breast Cancer Symptoms And Diagnosis

The symptoms of metastatic breast cancer can vary greatly depending on the location of the cancer. This section covers the symptoms of breast cancer that has spread to the bone, lung, brain, and liver, and the tests used to diagnose metastatic breast cancer.

Bone Metastasis: Symptoms and DiagnosisThe most common symptom of breast cancer that has spread to the bone is a sudden, noticeable new pain. Breast cancer can spread to any bone, but most often spreads to the ribs, spine, pelvis, or the long bones in the arms and legs. Learn more.

Lung Metastasis: Symptoms and DiagnosisWhen breast cancer moves into the lung, it often doesnt cause symptoms. If a lung metastasis does cause symptoms, they may include pain or discomfort in the lung, shortness of breath, persistent cough, and others. Learn more.

Brain Metastasis: Symptoms and DiagnosisSymptoms of breast cancer that has spread to the brain can include headache, changes in speech or vision, memory problems, and others. Learn more.

Liver Metastasis: Symptoms and DiagnosisWhen breast cancer spreads to the liver, it often doesnt cause symptoms. If a liver metastasis does cause symptoms, they can include pain or discomfort in the mid-section, fatigue and weakness, weight loss or poor appetite, fever, and others. Learn more.

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