What Are The Stages Of Breast Cancer
Staging system
The most widely used system in the U.S. is the American Joint Committee on Cancer TNM system. Medical professionals developed a new eighth edition of this staging system for 2018 that includes results of testing for certain biomarkers, including the HER2 protein, estrogen receptor , and progesterone , and the results of gene expression assays, in addition to the factors described below.
Besides the information gained from the imaging tests, this system also uses the results from surgical procedures. After surgery, a pathologist looks at the cells from the breast cancer as well as from the lymph nodes. They incorporate this information into the staging, as it tends to be more accurate than the physical exam and X-ray findings alone.
The TNM system uses letters and numbers to describe certain tumor characteristics in a uniform manner. This allows healthcare providers to stage cancer and aids communication among healthcare providers. The following is an abbreviated example of the TNM staging system.
T: This describes the size of the tumor. A number from 0 to 4 follows. Higher numbers indicate a larger tumor or greater spread:
- T1: Tumor is 2 cm or less across
- T2: Tumor is 2 cm-5 cm
- T3: Tumor is more than 5 cm
- T4: Tumor of any size growing into the chest wall or skin
N: This describes the spread to lymph nodes near the breast. A number from 0 to 3 follows.
M: This letter is followed by a 0 or 1, indicating whether cancer has spread to other organs.
Tumor Size And Breast Cancer Staging
Doctors determine the stage of cancer as part of their diagnosis. To confirm the breast cancer stage, they assess several different factors, including tumor size.
Doctors use multiple tests and examinations to evaluate the specific characteristics of a persons breast cancer. They use this information to assign values to the TNM staging system, where:
- T refers to the size of the main, or primary, tumor.
- N refers to whether cancer has spread to nearby lymph nodes.
- M refers to whether the cancer is metastatic, which means if it has spread to distant parts of the body.
The overall stages of cancer range from 0 to 4. Stage 0 means the breast cancer is at a very early stage and has not yet spread. Stage 4 refers to late stage breast cancer, which means it has spread to other parts of the body.
While every persons breast cancer is different, its stage generally indicates an individuals treatment options and outlook.
People with early stage breast cancer are likely to have smaller tumors that doctors can easily treat. Larger tumors tend to indicate later stage breast cancer, which may be more difficult to treat.
Doctors measure the size of the primary breast cancer tumor at its widest point. They usually give the size in millimeters or centimeters .
According to the , doctors use the following system to grade tumor size:
Tumor size is just one of several factors that doctors consider when determining the stage of a persons breast cancer. Other factors include the following:
How A Breast Cancers Stage Is Determined
Your pathology report will include information that is used to calculate the stage of the breast cancer that is, whether it is limited to one area in the breast, or it has spread to healthy tissues inside the breast or to other parts of the body. Your doctor will begin to determine this during surgery to remove the cancer and look at one or more of the underarm lymph nodes, which is where breast cancer tends to travel first. He or she also may order additional blood tests or imaging tests if there is reason to believe the cancer might have spread beyond the breast.
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Treatment Of Breast Cancer By Stage
This information is based on AJCC Staging systems prior to 2018 which were primarily based on tumor size and lymph node status. Since the updated staging system for breast cancer now also includes estrogen receptor , progesterone receptor , and HER2 status, the stages may be higher or lower than previous staging systems. Whether or not treatment strategies will change with this new staging system are yet to be determined. You should discuss your stage and treatment options with your doctor.
The stage of your breast cancer is an important factor in making decisions about your treatment options. In general, the more the breast cancer has spread, the more treatment you will likely need. But other factors can also be important, such as:
- If the cancer cells have hormone receptors
- If the cancer cells have large amounts of the HER2 protein
- If the cancer cells have a certain gene mutation
- Your overall health and personal preferences
- If you have gone through menopause or not
- How fast the cancer is growing and if it is affecting major organs like the lungs or liver
Talk with your doctor about how these factors can affect your treatment options.
Stage 0 cancers are limited to the inside of the milk duct and are non-invasive .
Ductal carcinoma in situ is a stage 0 breast tumor.
Why Is Staging Important
During your initial diagnosis, you and your cancer team will work together to develop a treatment plan. Staging allows you to answer the following questions:
- How does this cancer typically progress?
- Which treatments may work?
Some of the staging may be even more in-depth, but in general, its designed to prepare a more tailored approach to your disease. Your care team will be able to explain any new terms and what they mean for you.
Expert cancer care
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What Is Cancer Staging
Staging is a way of describing how extensive the breast cancer is, including the size of the tumor, whether it has spread to lymph nodes, whether it has spread to distant parts of the body, and what its biomarkers are.
Staging can be done either before or after a patient undergoes surgery. Staging done before surgery is called the clinical stage, and staging done after surgery is called the pathologic stage. Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor recommend the best kind of treatment and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.
This page provides detailed information about the system used to find the stage of breast cancer and the stage groups for breast cancer, such as stage IIA or stage IV.
Remission And Risk Of Recurrence
Complete remission means all signs of cancer are gone.
Sometimes, cancer cells left behind after treatment eventually form new tumors. Cancer can recur locally, regionally, or in distant sites. While this can happen anytime, its most likely within the first five years.
After you finish treatment, regular monitoring should include doctor visits, imaging tests, and blood testing to look for signs of cancer.
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Research Related To Breast Cancer Classification And Implications For Clinical Practice
Researcher: Dr. Sunil Lakhani, University of Queensland
Dr Lakhani recently published practice-changing findings that contributed to a new classification of a rare breast cancer, called metaplastic breast tumours, by the World Health Organisation. Learn more about his research here.
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 use diagnostic information such as medical imaging including mammogram and/or ultrasound, and other diagnostic tests, such as a biopsy of the breast tissue and draining lymph nodes to determine the stage of the cancer.
Once the stage of the cancer has been determined, it is expressed on a scale of 0 to IV. Stage 0 refers to pre-invasive breast cancers, including ductal carcinoma in situ . Stage I and II are referred to as early breast cancer. Stage III is referred to as locally advanced breast cancer. Stage IV is called advanced or metastatic breast cancer. See above for more information.
Stage 0 refers to pre-invasive breast cancers, including ductal carcinoma in situ . This means that there are abnormal cells present, but they are contained inside the milk duct in the case of DCIS, or lobule , in the case of lobular carcinoma in situ .
Invasive breast cancer occurs when cancer cells within the milk duct or lobules break or invade through normal breast tissue. It can be Stage I, II, III or IV.
Stages Of Breast Cancer: How Theyve Changed Over Time
In the past, only the size of a tumor and the status of nearby lymph nodes were used to determine the stage of someones breast cancer. It was a fairly simple system based purely on anatomy, and was therefore easy for people to memorize.
- If a tumor was two centimeters wide or smaller, it was considered stage I.
- If a tumor was larger than that or the cancer was detectable in nearby lymph nodes, it was considered stage II.
- If a tumor had spread to the skin of the breast or not far beyond the adjacent lymph nodes, it was considered stage III.
- And if a tumor had spread anywhere else in the body, it was automatically considered stage IV.
But all of that changed in 2017. Advancements in tumor biology and prognostic biological markers such as estrogen receptor , progesterone receptor , and HER2/neu allowed clinicians to understand why similarly staged patients had significantly different outcomes. This led the American Joint Commission on Cancer to revise its staging manual for breast cancer.
Today, we know that what truly determines a breast cancers stage is not only its size and the amount of lymph node involvement, but also what type of breast cancer it is and how aggressive it looks under a microscope.
How hormones influence breast cancer stages
So, a patient with only three cancerous lymph nodes who has a hormone-sensitive tumor thats two centimeters wide could still be considered stage I despite the lymph node involvement.
How grades influence breast cancer stages
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Examples Using The Full Staging System
Because there are so many factors that go into stage grouping for breast cancer, it’s not possible to describe here every combination that might be included in each stage. The many different possible combinations mean that two women who have the same stage of breast cancer might have different factors that make up their stage.
Here are 3 examples of how all of the factors listed above are used to determine the pathologic breast cancer stage:
The Number Staging System
Breast cancer can also be divided into four number stages. We have put these into a table to make them easier to understand. You can .
This information is about stage 1 to 3 breast cancer.
Stage 1 breast cancer is when the cancer is 2cm or smaller. There may be no cancer cells in the lymph nodes in the armpit or tiny numbers of cancer cells are found. Sometimes the cancer cannot be found in the breast, but cancer cells have spread to lymph nodes in the armpit.
Stage 2 breast cancer is when the cancer is up to or bigger than 5cm. It may or may not have spread to the lymph nodes under the arm. Sometimes the cancer cannot be found in the breast. But cancer cells have spread to 1 to 3 lymph nodes in the armpit or near the breast bone.
Stage 3 breast cancer is sometimes called locally advanced breast cancer. The cancer has spread to the lymph nodes in the armpit and sometimes to other lymph nodes nearby. It may have spread to the skin of the breast or to the chest muscle. The skin may be red, swollen or have broken down. Sometimes the cancer cannot be found in the breast or is small but has spread to 4 to 9 lymph nodes in the armpit.
Stage 4 breast cancer is also called secondary or metastatic breast cancer. This is when the cancer has spread to other parts of the body, such as the bones, the liver or lungs. We have separate information about secondary breast cancer.
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M Refers To Metastasis
Metastasis is the spread of cancer to other areas of the body, otherwise known as distant spread. Some breast cancer cells have the ability to invade lymphatic and/or blood vessels where they can circulate to distant organs and tissues e.g. bones, liver, lungs and brain. Imaging such as CT scans and bone scans can be performed if the tumour is high risk and/or metastases are suspected.
Until recently breast cancer staging used only these measures to classify the stage of the cancer but in January 2018 the system was updated to take into account additional tumour biology factors that can affect outcomes.
These are:
T Categories For Breast Cancer
T followed by a number from 0 to 4 describes the main tumor’s size and if it has spread to the skin or to the chest wall under the breast. Higher T numbers mean a larger tumor and/or wider spread to tissues near the breast.
TX: Primary tumor cannot be assessed.
T0: No evidence of primary tumor.
Tis: Carcinoma in situ
T1 : Tumor is 2 cm or less across.
T2: Tumor is more than 2 cm but not more than 5 cm across.
T3: Tumor is more than 5 cm across.
T4 : Tumor of any size growing into the chest wall or skin. This includes inflammatory breast cancer.
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How Does Tumor Size And Location Affect Treatment
Its important for your doctor and entire healthcare team to know the cancers stage in order to plan treatment. Treatment for breast cancer takes into account the tumors size, location, and spread, if there is any.
For example, cancers that are considered early stage may be treated with localized treatments, like surgery and radiation. This cancer may have a better prognosis.
For advanced-stage cancers, a doctor may use systemic treatments. These include chemotherapy, hormone therapy, targeted therapy, and more. Radiation may also be used for advanced-stage cancer, but other treatments will likely be used in conjunction.
What Is The Survival Outlook For Breast Cancer
According to the National Cancer Institute , the percentage of patients surviving five years after diagnosis is:
- 99 percent for breast cancer that is still local to the breast
- 86 percent for breast cancer that has spread just outside the breast
- 29 percent for breast cancer that has spread to more distant parts of the body
The NCI also lists the five-year survival rate for breast cancer overall as 90.6 percent for women and 83 percent for men.
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What Is Stage Iii Breast Cancer
In stage III breast cancer, the cancer has spread further into the breast or the tumor is a larger size than earlier stages. It is divided into three subcategories.
Stage IIIA is based on one of the following:
- With or without a tumor in the breast, cancer is found in four to nine nearby lymph nodes.
- A breast tumor is larger than 50 millimeters, and the cancer has spread to between one and three nearby lymph nodes.
In stage IIIB, a tumor has spread to the chest wall behind the breast. In addition, these factors contribute to assigning this stage:
- Cancer may also have spread to the skin, causing swelling or inflammation.
- It may have broken through the skin, causing an ulcerated area or wound.
- It may have spread to as many as nine underarm lymph nodes or to nodes near the breastbone.
In stage IIIC, there may be a tumor of any size in the breast, or no tumor present at all. But either way, the cancer has spread to one of the following places:
- ten or more underarm lymph nodes
- lymph nodes near the collarbone
- some underarm lymph nodes and lymph nodes near the breastbone
Diagnostic Tests That Inform The Clinical Stage
Many methods are used to detect and stage cancer. Some of the common tests include:
Biopsy: The doctor uses a needle to extract breast tissue or fluid, which is then sent to a lab. There, various techniques are used to examine different attributes, such as hormone receptor or HER2 status.
Tumor markers: Rapidly dividing cancerous cells interrupt some of the normal mechanisms of cell growth. This causes the cell to overproduce certain molecules. Lab tests detect these compounds, known as tumor markers, in blood or tissue samples.
Imaging techniques: Several different scans are used to examine characteristics of your cancer. Below are some of the noninvasive imaging techniques you might encounter:
- MRI scans use magnets and radio waves to generate detailed pictures of your tissues.
- CT scans use X-rays to look at your organs. Nuclear scans trace the flow of an injected safe radioactive dye in your body.
- PET scans are similar to nuclear scans but specifically examine glucose consumption in the bodysince cancer cells use more glucose than normal cells.
- Ultrasound imaging uses sound waves to see inside your body.
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Breast Cancer Survival Rates
While it is not possible to predict the exact course of disease for any individual, survival rates for breast cancer have improved remarkably over time due to earlier detection and improved treatment methods. The five-year survival rate is currently 91% on average for Australians diagnosed with breast cancer.
Whilst every case is different, breast cancer survival rates can also vary significantly depending on the stage of the cancer. According to data from the Australian Institute of Health and Welfare , generally the earlier the stage when the breast cancer is first diagnosed, the higher the chance for better outcome.
Most patients with early or locally advanced breast cancer can be treated successfully. The poorest prognosis is for metastatic breast cancer . However, there are different treatment options available, and there are people who continue to live full and meaningful lives, despite having metastatic breast cancer.