What Are The Stages Of Breast Cancer
Breast cancer is staged by the size of the tumor and extent of spread. Breast cancers are also graded from one to three, based on how abnormal the cancer cells look and how fast they grow. One is low grade cancer and three is high grade cancer that grows and spreads rapidly.
The four stages of breast cancer are:
- Stage I: The tumor is relatively small and localized to the original site, with possible spread to the sentinel lymph nodes, which are the first lymph nodes the cancer is likely to spread to.
- Stage II: The tumor has grown and spread to a few nearby lymph nodes.
- Stage III: The tumor has grown into many lymph nodes and other tissue in the breast.
- Stage IV: The cancer has spread to distant parts of the body.
Another highly detailed classification system is the TNM classification system based on tumor size, lymph node involvement and metastatic spread.
How Life Expectancy And Relapse Differ From Positive Tumors
Questions about the survival rate and recurrence rate are very common when someone is diagnosed with triple-negative breast cancer . While prognosis is, on average, poorer than with hormone receptor or human epidermal growth factor receptor 2 positive tumors, triple-negative breast cancer is a very heterogeneous disease. On a positive note, and unlike hormone-positive tumors that commonly recur late , late recurrence is less common with triple-negative tumors. The recent approval of immunotherapy only for triple-negative disease is also optimistic.
We will look at factors that may affect survival or recurrence as well as the statistical rates of both. We will also look at life expectancy with stage 4 triple-negative breast cancers and recent case reports of a few long-time survivors.
How Is Metastatic Breast Cancer Treated
Breast cancer is an incredibly complex disease. That’s why, in the metastatic phase, there are a lot of factors that inform treatment once a patient is diagnosed.;
As with an earlier-stage breast cancer, treatment is influenced by the cancer subtype , says Dr. Tsarwhas. For example, you wouldn’t give someone estrogen-blocking drugs to fight their cancer if they don’t have hormone-sensitive cancer. Certain genetic factors can also affect treatment, he says.;
Where a cancer has spread also informs treatment, Dr. Tsarwhas adds. Cancer in the bones, for instance, tends to grow more slowly, he says, so patients often have time to let hormone therapy and other treatments work. On the other hand, cancer in the liver often requires a “rapid-response event,” due to the organ’s importance. “So sometimes with breast cancer in the liver we need to go to chemotherapy to get a response right away,” says Dr. Tsarwhas. If the cancer has spread to the brain, he says radiation is a better bet since it’s harder to get drugs into the brain.;
Having a BRCA1 or BRCA2 mutationgenetic mutations that impact how cells grow and divide, which have been linked to an increased risk of breast, ovarian, and pancreatic cancercan also affect metastatic breast cancer treatment, says Dr. Tsarwhas. While BRCA status doesn’t affect treatment for earlier stages of breast cancer, metastatic patients with BRCA mutations are often given specific drugs to help slow tumor growth .
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Patient And Tumor Characteristics
Overall, we retrospectively identified 872 consecutive, TP positive, early breast cancer patients treated in routine clinical practice in nineteen Italian cancer centers between January 1998 and December 2011.
Main baseline patient and tumor characteristics are reported in Table 1. Overall, the HER-2 gene was overexpressed in 716 and amplified in 156 tumors . Among the patients enrolled, 366 and 506 patients received adjuvant chemotherapy without and with trastuzumab , respectively. Median age and menopausal status were well balanced between the two cohorts. Conversely, patients in cohort B had more frequently higher stage, grade 3 and high Ki67 tumors, compared with those in cohort A.
Table 1: Descriptive characteristics of the study population .
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Characteristic |
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Abbreviations: Pts, patients; TP ER 1-30, triple positive tumors with ER staining in 1-30% tumor cells; TP ER 31-50, TP tumors with ER staining in 31-50% tumor cells; TP ER 51-70, TP tumors with ER staining in 51-70% tumor cells; TP ER 71-100, TP tumors with ER staining in 71-100% tumor cells; TP PgR 1-30, TP tumors with PgR staining in 1-30% tumor cells; TP PgR 31-50, TP tumors with PgR staining in 31-50% tumor cells; TP PgR 51-70, TP tumors with PgR staining in 51-70% tumor cells; TP PgR 71-100, TP tumors with PgR staining in 71-100% tumor cells; TP30, TP tumors with both ER and PgR staining in more than 30% tumor cells; TP50, TP tumors with both ER and PgR staining in more than 50% tumor cells.
New Medications For Metastatic Breast Cancer
The immunotherapy drugs called checkpoint inhibitors have led to a significant improvement in survival rates for lung cancer and melanoma. In March of 2019 the first immunotherapy drug, Tecentriq was approved for triple-negative breast cancer that is metastatic . As noted above, there are at least a few people who have had excellent responses in clinical trials prior to approval.
PARP inhibitors are also a class of medications that may alter survival rates in the future, particularly among women who have hereditary breast cancer .
For bone metastases, bone-modifying drugs may be effective in treating both metastases, and may reduce the development of further metastases in bone.
Finally, for people who have only a single or a few metastases , treating these metastases locally may be an option. While studies are young, treating oligometastases may improve survival or even lead to long term survival for a minority of people.
In addition, for some people treated with immunotherapy, local radiation may sometimes improve the response of immunotherapy, something known as the abscopal effect. Since immunotherapy is such a recent addition to breast cancer, it’s not known how common this response may be or if it will be seen at all.
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How Are Breast Tumors Tested For Her2
Women newly diagnosed with invasive breast cancers should be tested for HER2.;
A biopsy or surgery sample of the cancer is usually tested with either immunohistochemical stains or Fluorescent in situ hybridization .
See Testing Biopsy and Cytology Specimens for Cancer and Understanding Your Pathology Report: Breast Cancerto get more details about these tests. ;
Cancer Alters Your Life And It Never Really Leaves You
For those beginning their cancer journey, Carol has two bits of advice. “Definitely don’t put off getting anything suspicious checked.” She doubts she would have found the cancer early if she weren’t seeing Dr. Khoo regularly. “Lastly, know that cancer never leaves you. Post-cancer PTSD and anxiety is real, even after treatment ends, and that’s OK.”
Because El Camino Health knows that the emotional toll may continue long after cancer treatment ends, they’ve developed the Survivorship Program to support patients like Carol who may have questions or fears about what’s happening with their mind, body or emotions.
Now at age 33, Carol’s life is basically back to normal, although she still struggles with the possibility that she may not be able to have more children through natural means.
“As much as cancer sucked,” states Carol, “I truly appreciate the many new perspectives it gave me: A glimpse of the lives of the doctors and nurses providing care. The depths of empathy of everyone on a cancer journey. And it forced me to jump off the never-ending achievement treadmill with no regrets. Life is such a gift!”
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Relative Survival Rates For Breast Cancer
The National Cancer Institute gives 5-year relative survival rates for breast cancer based on how far the disease had spread before a doctor found it.
- Localized : 99%
- Regional : 86%
- Distant : 28%
- Unknown stage: 55%
- All stages: 90%
While these numbers can give you a general idea, they are an average for women with any type of breast cancer. They arent specific to the HER2+ type. They also come from data that researchers collected from 2010 to 2016, so they dont reflect more recent treatment advances.
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.
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Faith In The El Camino Health Cancer Care Team
Through it all, Carol drew strength from knowing she had an entire team in her corner fighting her cancer. In fact, she says she can’t begin to describe how much she has grown to love everyone at the El Camino Health Cancer Center.
“The whole team is amazing,” she says. “Dr. Dormady and nurse practitioner Katie are the best! They put up with my questions and quirks with the best humor and love. They understood my desire to be treated but not overtreated.”
“The nurses are like family. I have to give a shoutout to my nurse Hannah. We shared our lives together every week for a whole year. That was the biggest blessing ever. I still drop by with treats when Im in the area as an excuse to say hi.”
Triple Positive Early Breast Cancer: An Observational Multicenter Retrospective Analysis Of Outcome
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Patrizia Vici;, Laura Pizzuti, Isabella Sperduti, Antonio Frassoldati, Clara Natoli, Teresa Gamucci, Silverio Tomao, Andrea Michelotti, Luca Moscetti, Stefania Gori, Editta Baldini, Francesco Giotta, Alessandra Cassano, Daniele Santini, Diana Giannarelli, Luigi Di Lauro, Domenico Cristiano Corsi, Paolo Marchetti, Valentina Sini, Domenico Sergi, Maddalena Barba, Marcello Maugeri-Saccà, Michelangelo Russillo, Lucia Mentuccia, Loretta DOnofrio, Laura Iezzi, Angelo Fedele Scinto, Lucia Da Ros, Ilaria Bertolini, Maria Luisa Basile, Valentina Rossi, Ruggero De Maria and;Filippo Montemurro
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Inoperable Breast Cancer Is Often Still Treatable
Stage 3C breast cancer is divided into operable and inoperable stage 3C breast cancer. However, the term inoperable is not the same as untreatable.
If your physician uses the word inoperable, it may simply mean that a simple;surgery;at this time would not be enough to get rid of all the breast cancer that is within the breast and the tissue around the breast. There must be healthy tissue at all of the margins of the breast when it is removed. Keep in mind that the breast tissue goes beyond the breast mound it goes up to the clavicle and down to a few inches below the breast mound. There must also be tissue to close the chest wound after the surgery is performed.
Another treatment method may be used first to shrink the breast cancer as much as possible before surgery is considered.;
What Is Her2 And What Does It Mean
HER2 is a growth-promoting protein on the outside of all breast cells. Breast cancer cells with higher than normal levels of HER2 are called HER2-positive. These cancers tend to grow and spread faster than other breast cancers, but are much more likely to respond to treatment with drugs that target the HER2 protein.
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What Research Trials Are Underway
There are several new and ongoing studies looking at treatments for triple-negative breast cancer.
Dr. Fancher encouraged people with triple-negative breast cancer to look into trials. Research on clinical trials is really important, she told MNT.
If you triple-negative breast cancer, consider a clinical trial. It helps move the research forward. There are lots of trials out there, and many are having good results.
Dr. Nan spoke about the Keynote 522 clinical trial . This trial is looking at the use of pembrolizumab, a type of immunotherapy, in combination with chemotherapy before and after surgery.
The trial focuses on people with stage 2 or 3 breast cancer who are at high risk, and pembrolizumab has shown some promise. In fact, the trial has shown a 65% effectiveness rate, indicating no residual signs of cancer in the tissue. This is up from 51% previously.
The phase 3 ASCENT clinical trial is looking at the use of sacituzumab govitecan, an antibody drug conjugate. In a phase 2 trial, it had shown promise in people who had previously received treatment for metastatic triple-negative breast cancer. The Food and Drug Administration gave the drug accelerated approval in 2020.
A person should talk with a doctor before joining a clinical trial. They may be able to help the person find a relevant study or recommend ones that will work best for them.
What Is Triple Negative Breast Cancer
In addition to being negative for estrogen and progesterone receptors, triple negative breast cancer cells also lack a protein known as HER2. Human epidermal growth factor receptor-2 is a protein that promotes cell growth and HER2 positive breast cancers have a higher than normal presence of these proteins, because of mutations in HER2 gene.
Triple negative cancers account for approximately 15% of breast cancers. Triple negative breast cancer more often occurs in African-American women younger than 40, or women who have an inherited mutation in BRCA1 gene, which normally is a tumor suppressor gene, which suppresses cell growth.
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Living With Stage : The Breast Cancer No One Understands
Editor’s note: We’re bringing back this piece from October 2014 for Metastatic Breast Cancer Awareness Day and to honor Jody Schoger, featured in the story. Schoger died of metastatic breast cancer in May. Want to learn more about MBC? Look for our tweets at the Northwest Metastatic Breast Cancer Conference this Saturday at Fred Hutch.
A no-nonsense Texan of 60 years, Jody Schoger* has a very no-nonsense way of educating people about her metastatic breast cancer.
âSomeone will say, âWhen are you done with treatment?â and Iâll tell them, âWhen Iâm dead,ââ said Schoger, a writer and cancer advocate who lives near Houston. âSo many people interpret survivorship as going across the board. That everybody survives cancer now. But everybody does not survive cancer.â
An estimated 155,000-plus women in the U.S. currently live with âmets,â or metastatic breast cancer. This type of cancer, also called stage 4 breast cancer, means the cancer has metastasized, or traveled, through the bloodstream to create tumors in the liver, lungs, brain, bones and/or other parts of the body. Between 20 and 30 percent of women with early stage breast cancer go on to develop metastatic disease. While treatable, metastatic breast cancer cannot be cured. The five-year survival rate for stage 4 breast cancer is 22 percent; median survival is three years. Annually, the disease takes 40,000 lives.
What Are The Signs Of Metastatic Breast Cancer
Metastatic breast cancer is stage IV cancer, which has spread to other parts of the body. Cancers are a group of diseases in which some types of cells turn abnormal and proliferate without control. Cancer can start anywhere and spread to any part of the body, but is named by the organ in which it first develops. Men can also develop breast cancer, although it is rare.
If breast cancer spreads to the bone, it is still considered metastatic breast cancer that has spread to the bone; it is not considered to be bone cancer. In metastatic breast cancer, breast cancer cells break from the primary tumor, travel through blood or lymph fluid, settle into other parts of the body and start growing into new metastatic breast tumors.
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Survival Rates For Breast Cancer
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
What Is The Prognosis For Triple Negative Breast Cancer
Triple negative breast cancer can be more aggressive and difficult to treat. ;Also, the cancer is more likely to spread and recur. ;The;stage;of breast cancer and the;grade of the tumor;will influence your prognosis. Research is being done currently to create drug therapies that are specific for triple negative breast cancer.
Interested in learning more? i3Health is hosting an upcoming webinar Metastatic Triple-Negative Breast Cancer: Applying Treatment Advances to Personalized Care. Learn more here.
Material on this page courtesy of Johns Hopkins Medicine
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A Disease No One Gets
Sadly, people donât âgetâ mets. In fact, a recent survey sponsored by Pfizer Oncology shows just how misunderstood it is. Sixty percent of the 2,000 people surveyed knew little to nothing about MBC while 72 percent believed advanced breast cancer was curable as long as it was diagnosed early. Even more disheartening, a full 50 percent thought breast cancer progressed because patients either didnât take the right treatment or the right preventive measures.
âTheyâve built an industry built on four words â early detection equals cure â and that doesnât even begin to define breast cancer,â said Schoger, who helped found Breast Cancer Social Media, a virtual community for breast cancer patients, caregivers, surgeons, oncologists and others. âWomen are blamed for the fate of bad biology.â
The MBC Alliance, a consortium of 29 cancer organizations including the biggest names in breast cancer , addressed this lack of understanding and support as well as what many patient advocates term the underfunding of MBC research in a recently published landmark report.