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Staging Of Breast Cancer Tnm

What Is Stage Ii Breast Cancer

Stages of Cancer: Tumor Staging and Grading TNM System Nursing NCLEX Review

Stage II describes cancer that is in a limited region of the breast but has grown larger. It reflects how many lymph nodes may contain cancer cells. This stage is divided into two subcategories.

Stage IIA is based on one of the following:

  • Either there is no tumor in the breast or there is a breast tumor up to 20 millimeters , plus cancer has spread to the lymph nodes under the arm.
  • A tumor of 20 to 50 millimeters is present in the breast, but cancer has not spread to the lymph nodes.

Stage IIB is based on one of these criteria:

  • A tumor of 20 to 50 millimeters is present in the breast, along with cancer that has spread to between one and three nearby lymph nodes.
  • A tumor in the breast is larger than 50 millimeters, but cancer has not spread to any lymph nodes.

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.

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.

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Adoption Of The Prognostic Stage

For the 8th edition, the AJCC committee created the prognostic staging protocol. This integrates biomarkers into the TNM staging system, making use of the results from large cohort studies, which shows that not only pathologic stage, but also different biomarkers could affect survival . The biomarkers indicate tumor grade, hormone receptor status, and HER2. Multigene panel status is also incorporated into the staging system in limited sub-groups. The 8th edition defines clinical and pathologic prognostic stages that combine anatomic staging with tumor grade, hormone receptor status, and HER2 status .

Pathologic Prognostic Stage is assigned to patients who received surgery as initial treatment.

Additionally, pT1, pT2, pN0, M0, ER+, and HER2 cancers are assigned as Pathologic Prognostic Stage group IA when Oncotype DX recurrence score is less than 11.

The Ajcc Staging Categories For Breast Cancer

Breast Cancer

The letters TNM describe three aspects of the staging process:-

  • The size of the primary breast tumor
  • Presence or absence of metastasis to regional lymph nodes
  • The presence or absence of distantmetastases

The TNM scores classify the tumor from Stage 0 to Stage IV . Modifications to this classification can include P factors from the Pathologist.

the American Joint Committee on Cancer reviews and develops the TNM classifications and the latest guidelines are from 2010.

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Other Tests On The Breast Cancer Cells

Your doctor also uses other information about your breast cancer. This information helps to work out your overall stage, your outlook and treatment plan. These includes:

  • receptors for the female hormones
  • the grade of the cancer

They also look at the levels of the protein HER2. Some breast cancers have large amounts of human epidermal growth factor receptor 2 . They are called HER2 positive cancers. HER2 makes the cancer cells grow and divide. Breast cancers that are HER2 positive generally grow more quickly.

The grade describes how a cancer cell looks under the microscope and whether they are similar or very different to normal cells.

Please remember staging for breast cancer is very complex. Many different factors are considered before doctors can confirm your final stage. Do speak to your breast doctor or nurse if you have any questions about your stage.

Stage Groups For Breast Cancer

Doctors assign the stage of the cancer by combining the T, N, and M classifications , the tumor grade, and the results of ER/PR and HER2 testing. This information is used to help determine your prognosis . The simpler approach to explaining the stage of breast cancer is to use the T, N, and M classifications alone. This is the approach used below to describe the different stages.

Most patients are anxious to learn the exact stage of the cancer. If you have surgery as the first treatment for your cancer, your doctor will generally confirm the stage of the cancer when the testing after surgery is finalized, usually about 5 to 7 days after surgery. When systemic treatment is given before surgery, which is typically with medications and is called neoadjuvant therapy, the stage of the cancer is primarily determined clinically. Doctors may refer to stage I to stage IIA cancer as “early stage” and stage IIB to stage III as “locally advanced.” Stage 0: Stage zero describes disease that is only in the ducts of the breast tissue and has not spread to the surrounding tissue of the breast. It is also called non-invasive or in situ cancer . Stage IA: The tumor is small, invasive, and has not spread to the lymph nodes . Stage IB: Cancer has spread to the lymph nodes and the cancer in the lymph node is larger than 0.2 mm but less than 2 mm in size. There is either no evidence of a tumor in the breast or the tumor in the breast is 20 mm or smaller .

Stage IIA: Any 1 of these conditions:

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Uicc Stage And Ajcc Prognostic Stage Groups

The TNM system is used to record the anatomical extent of disease. It is useful to condense these categories into groups. Carcinoma in situ is categorized stage 0 often tumors localized to the organ of origin are staged as I or II depending on the extent, locally extensive spread, to regional nodes are staged as III, and those with distant metastasis staged as stage IV. However, in some tumor types stage groups do not conform to this simplified schema. The stage group is adopted with the intention that categories within each group are more or less homogeneous in respect of survival, and that the survival rates are distinctive between groups.The Union for International Cancer Control uses the term Stage to define the anatomical extent of disease. The American Joint Committee on Cancer uses the term Prognostic Stage Group which may also include additional prognostic factors in addition to anatomical extent of disease.

What Is Stage Iv Breast Cancer

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Stage IV is the most advanced stage of breast cancer. 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.

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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.

Hormone Receptor And Her2 Expression

Evaluating the expression of estrogen receptors and progesterone receptors in breast cancer is important, because selective ER modulators slow the progression of ER-positive and PR-positive tumors . Furthermore, breast cancer is related to several oncogenes including HER2. The presence of HER2 is associated with a poor prognosis in untreated patients . However, HER2 targeting agents improve the prognosis for patients with HER2 positive tumors . A high Ki-67 level reflects rapidly dividing tumor cells, although there is no universal cut-off for measuring Ki-67 levels . According to the ER/PR and HER2 status and with additional information about Ki-67, the 8th edition identifies four subtypes: luminal A , luminal B , HER2 , and basal . The luminal A type has the best prognosis, with excellent response to endocrine therapies. The luminal B type is less responsive to endocrine therapies and has worse prognosis than the luminal A type. The HER2 type responds to HER2 targeting agents and proper treatment improves the prognosis. The basal type, also known as a triple-negative tumor, has the worst prognosis .

cT1N0M0 cancer.

MRI shows that cancer measures 1.3 cm . There is no suspicious lymph node enlargement. Pathology shows 0.9-cm grade-2 carcinoma, but no hormone receptor or HER2 overexpression is noted. Therefore, anatomic stage is IA , but it is triple negative cancer thus, Clinical and Pathologic Prognostic Stages are higher, IB.

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I The Clinical Classification Of Regional Lymph Nodes

Lymph flow from the deep subcutaneous and intra-mammary vessels moves centrifugally toward the axillary and internal mammary lymph nodes. The majority of the lymph flows to the axillary nodes.

Section 6 has described the examination of the sentinel lymph node and the search for micro-metastases, which are important in clinical staging for breast cancer .

The clinical nodal or N classification reflects what is clinically palpatable or shows on imaging studies.

  • cNX: It is not possible to assess regional lymph nodes
  • cN0: No regional lymph node metastases
  • cN1: Metastasis to movable ipsilateral Level I, II axillary lymph nodes
  • cN2: Metastasis to ipsilateral Level I, II axillary lymph nodes that are clinically fixed or matted or in clinically detected ipsilateral internal mammary nodes in the absence of clinically evident axillary node metastases
  • Breast Cancer Staging And Tnm Classifications

    Breast Cancer Staging

    NOTE: In January 2018 The American Joint Committee on Cancer updated their 8th Edition of the staging classifications for breast tumors.

    You can find a summary of the main changes, including amendments to the TNM categories, for staging breast cancer by clicking HERE. We will also be fully updating our staging articles on this site to include all the new information.

    Breast cancer is typically described in stages, according to the presence and size of the tumor and its metastasis in the axillary lymph nodes, and other factors. T refers to the tumor size. For breast tumors, bigger than 2cm changes the T category. N refers to node status, which changes as the tumor spreads into lymph nodes. M refers to metastasis, which indicates that the cancer has spread to places beyond the breast. The TNM classifications were developed by the American Joint Committee on Cancer.

    This page is still OK for reading, but it is getting fairly old So we have created a new version of this page with more up-to-date information on TNM classifications.

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    The Ajcc Poster Summary Of Tnm Breast Cancer Staging

    The American Joint Committee on Cancer has also produced a two-page PDF poster to summarize breast cancer staging for patients.

    At the end of this section, there is a list of key references to the literature, with links to access the articles. There are also some helpful links to patient websites and to sources of further information.

    Changes In The Anatomic Stage

    The AJCC committee maintained the anatomic stages for countries in which the tests for biomarkers were unavailable and for uniformity in terminology with past studies and different researchers. In the 8th edition, the fundamental rules for anatomic staging have not been changed, but several previous ambiguous definitions have been clarified.

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    Changes To The Tnm Classification Systems In The 7th Edition Ajcc Cancer Staging Manual

    The newest edition of the American Joint Committee on Cancer, Cancer Staging Manual has only minor changes from the 6th edition.

    Within the P or pathology categories, only ductal and lobular carcinoma in situ , and isolated Pagets disease of the nipple are classified as pTis. So-called precursorbreast neoplasm such as atypical ductal or lobular hyperplasia are no longer included.

    Some new guidelines are also given reflecting the classification of micro metastasis in the regional lymph nodes. Now, small clusters of cancer cells no larger than 0.2 mm, or non confluent or nearly confluent clusters of cells not exceeding 200 cells in a single histologic lymph node cross section, may be classified as isolated tumor cells ).

    And finally, Stage I breast tumors have now been subdivided into Stage IA and Stage IB, with stage IB including small tumors with lymph node micro metastases .

    M Categories For Breast Cancer

    Staging cancers: TNM and I-IV systems

    M followed by a 0 or 1 indicates whether the cancer has spread to distant organs — for example, the lungs, liver, or bones.

    M0: No distant spread is found on x-rays or by physical exam.

    cM0: Small numbers of cancer cells are found in blood or bone marrow , or tiny areas of cancer spread are found in lymph nodes away from the underarm, collarbone, or internal mammary areas.

    M1: Cancer has spread to distant organs as seen on imaging tests or by physical exam, and/or a biopsy of one of these areas proves cancer has spread and is larger than 0.2mm.

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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:

    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.

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