The Tnm Staging System
The breast cancer staging system, called the TNM system, is overseen by the American Joint Committee on Cancer . The AJCC is a group of cancer experts who oversee how cancer is classified and communicated. This is to ensure that all doctors and treatment facilities are describing cancer in a uniform way so that the treatment results of all people can be compared and understood.
In the past, stage number was calculated based on just three clinical characteristics, T, N, and M.
The T category describes the original tumor:
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HER2 status: are the cancer cells making too much of the HER2 protein?
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Oncotype DX score, if the cancer is estrogen-receptor-positive, HER2-negative, and there is no cancer in the lymph nodes
Adding information about tumor grade, hormone-receptor status, HER2 status, and possibly Oncotype DX test results has made determining the stage of a breast cancer more complex, but also more accurate.
In general, according to experts, the new staging system classifies triple-negative breast cancer at a higher stage and classifies most hormone receptor-positive breast cancer at a lower stage.
You also may see or hear certain words used to describe the stage of the breast cancer:
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Distant: The cancer is found in other parts of the body as well.
The updated AJCC breast cancer staging guidelines have made determining the stage of a cancer a more complicated but accurate process. So, the characteristics of each stage below are somewhat generalized.
Stage 2 Breast Cancer
Stage 2 breast cancer is divided into two groups:
- Stage 2A
- Stage 2B
Stage 2A can mean:
No cancer is seen in the breast but cancer is found in one to three lymph nodes under the arm or near the breastbone
The cancer in the breast is 2cm or smaller and cancer is found in one to three lymph nodes under the arm or near the breastbone.
The cancer in the breast is larger than 2cm but smaller than 5cm and no cancer is found in the lymph nodes under the arm.
Stage 2B can mean:
The cancer in the breast is larger than 2cm but smaller than 5cm. Cancer is found in one to three lymph nodes under the arm or near the breastbone
The cancer in the breast is larger than 5cm and no cancer is found in the lymph nodes under the arm.
Diagnosis Of Stage 4 Breast Cancer
If you are diagnosed with breast cancer, you may have further tests to determine the extent that the cancer has spread throughout the body. This is called staging. It helps you and your doctors decide on the best treatment options for you.
In addition the numbered staging system, the TNM staging system is also commonly used for breast cancer staging.
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What Does Stage 3 Mean
Because stage 3 breast cancer has spread outside the breast, it can be harder to treat than earlier stage breast cancer, though that depends on a few factors.
With aggressive treatment, stage 3 breast cancer is curable however, the risk that the cancer will grow back after treatment is high.
Doctors further divide stage 3 cancer into the following stages:
What Does This Mean If You’ve Been Diagnosed With De Novo Metastatic Breast Cancer
First, there is now evidence that local treatment to the breast should not be offered with the hope of lengthening life. Sometimes there are good reasons to recommend breast surgery or radiation to manage discomfort caused by the tumor. Secondly, the study confirmed the value of ongoing chemotherapy and targeted therapies in this situation.
It is easy to find this study disappointing and discouraging. However, this study confirmed the value of the existing standard of care and helps us understand what works and what does not work. No one wants to put anyone through surgery, radiation, or any treatment that will be stressful and maybe painful unless there is a good chance of it being helpful.
Although we all continue to hope for new and better ways to treat metastatic breast cancer, we now know that adding local treatment will not bring a benefit. Sometimes continuing on with the standard course of care is truly the best choice.
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Treatment Options For Stage 4 Cancer
Stage 4 cancer is challenging to treat, but treatment options may help control the cancer and improve pain, other symptoms and quality of life. Systemic drug treatments, such as targeted therapy or chemotherapy, are common for stage 4 cancers.
Often, a clinical trial may be an option, offering new treatments to help you fight stage 4 cancer.
Below are the prevailing treatment options for the five most common cancers.
Treatment of stage 4 breast cancer: For cancer that has spread beyond the breast and nearby lymph nodes, systemic drug treatments are typically used. These include:
- Hormone therapy
- Chemotherapy
- Immunotherapy
They may be used alone or in combination, and they may also be determined by the hormone receptor and the HER2 status of the cancer.
Surgery and radiation may be treatment options in specific cases to help improve symptoms caused by a growing tumor, not to get rid of the cancer. The tumor may be removed with surgery or shrunk by radiation therapy if, for example, its:
- Blocking a blood vessel
- Causing a wound
- Affecting the spinal cord
Treatment of stage 4 lung cancer: In general, stage 4 lung cancer is also treated with systemic drug therapies.
Stage 4 lung cancer that has spread to one distant area tends to be treated differently than lung cancer that has spread more widely. For stage 4A cancers, treatment tends to focus on the one site where the cancer has spread.
There may also be clinical trials assessing new treatments for stage 4 melanoma.
When Can Metastatic Breast Cancer Occur
Some people have metastatic breast cancer when they are first diagnosed with breast cancer . This is called de novo metastatic breast cancer.
Most often, metastatic breast cancer arises years after a person has completed treatment for early or locally advanced breast cancer. This may be called a distant recurrence.
A diagnosis of metastatic breast cancer is not your fault. You did nothing to cause the cancer to spread.
Metastatic breast cancers come from breast cancer cells that remained in the body after treatment for early breast cancer. The breast cancer cells were always there but were dormant and could not be detected. For some unknown reason, the cancer cells began to grow again. This process is not well-understood.
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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.
Re: Are All Stage 4 Cancer Diagnosis Cases Terminal
Hi CJS, Have sent you a reply on my thread as you messaged me on there. Just want to reiterate how sorry I am that you are going through this. My heart goes out to you and I totally relate to the fact that you are grieving for your Dad and seeing elements of your Mum’s health that remind you of your Dad. As you know I lost my Dad then my Mum 5 months later and I felt exactly the same. My Mum didn’t know her proper diagnosis, she didn’t want to and it was so hard to try and keep it from her and act like everything was OK. Don’t be hard on yourself, you don’t have to be strong all the time, allow yourself to cry, shout, be angry whatever you feel let it out, it’s not good to keep it in. Take care and keep posting when you need to, it helps. Hope x
Hello CJS,
I am one of the enquiry nurses and Jenn our moderator asked us if we could help. I am sorry to hear about your mum and can understand this is a difficult time for you both.
In quite a few cancers, stage 4 means the cancer has spread to another part of the body to form secondary cancers . As a general rule cancers that have spread are difficult to treat and are unlikely to be cured in the long term, although treatment can help to shrink or control them. Occasionally a cancer that has spread can be cured, but this would depend on the circumstances. An example might be if there was a single secondary cancer that could be removed or destroyed and if no other secondary cancers ever develop in the future.
Best wishes,
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What Does Stage 4 Cancer Mean
A cancer diagnosis is something we all fear, but its likely that you or someone you know has already experienced it.
One of the most terrifying things about cancer is that its outwith your control.
The truth is, its hard to predict exactly how things will go with cancer, but if anyone can get close itll be your oncologist.
Theyll likely tell you the stage your cancer is at, and give you some more information on this. When youre there and its about you, though, its all too easy to forget everything they said and thats absolutely fine.
Hopefully they should be there for you whenever you need to come back and ask any extra questions, but if youd like to know more about the stages of cancer, this guide should give you a brief overview.
What Should A Person With Stage 4 Breast Cancer Expect From Treatment
Treatment options vary widely depending on where you live, your access to specialists and sub-specialists, and your willingness to try therapies that are still in the experimental phase.
Seek out oncology specialists who specialize in Stage 4 breast cancer. Discuss with your treatment team what clinical trials may be available for your clinical situation.
During this time, be sure to surround yourself with a support system of friends and family.
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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.
Lymph Node Status And Breast Cancer Treatment
After the tissue from your biopsy has been examined, your Rocky Mountain Cancer Centers oncologist will go over the results . The pathology report will show how many lymph nodes were removed and how many were involved . This is referred to as lymph node status.
Breast cancer that has not spread to nearby lymph nodes, is referred to as node-negative status. If the report indicates that cancer is present in the lymph nodes, this is referred to as node-positive status. Positive results also mean that the cancer may have already or could possibly spread to other organs, such as the bones, lungs, liver, and brain. In order to determine that, your RMCC oncology team would need to conduct further tests.
The pathology report will also show how much cancer is in each node. Cancer cells can range from small in size and few in number to large in size and many in number. This information may be reported as:
- Microscopic , meaning only a few cancer cells are in the node and that a microscope is needed to find them.
- Gross , meaning there is a lot of cancer in the node and that it can be seen or felt without the use of a microscope.
- Extracapsular extension, meaning the cancer has spread outside the wall of the node.
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Staging And Grading For Stage 4 Cancer
Most cancers are staged using some form of the TNM system. Doctors may also use the TNM system to help determine the extent of certain cancers in each stage. The TNM system stands for:
- T , or the size of the original tumor
- N , or whether the cancer is present in the lymph nodes
- M , or whether the cancer has spread to other parts of the body
Not all cancers are staged using the TNM system, though. Some cancers, especially liquid cancers, are staged through different established protocols. The Binet and Rai systems, for example, are used to stage certain types of leukemia. Female reproductive system cancers, such as cervical cancer, are staged with a separate staging system created by the International Federation of Gynecology and Obstetrics .
As your care team gathers information about your cancer for the purposes of staging, they may need to order several tests, including:
Your care team may likely also need to perform a biopsy, a procedure that involves removing a sample of cells and analyzing it for signs of cancer. Imaging scans may be able to tell your care team where your cancer is, but looking at the cancer cells specifically tell them how fast they are likely to growor what grade they are.
Grading is different from staging and is done for most, but not all, cancers.
The grade of your cancer is part of how your cancer care team stages your cancer and determines your prognosis, or outlook.
Abemaciclib Palbociclib And Ribociclib And Hormone Therapy
The CDK4/6 inhibitors FDA-approved for metastatic breast cancer treatment are:
- Abemaciclib
- Palbociclib
- Ribociclib
CDK4 and CDK6 are enzymes important in cell division. CDK4/6 inhibitors are a class of drugs designed to interrupt the growth of cancer cells.
Although the CDK4/6 inhibitors abemaciclib, palbociclib and ribociclib have not been compared directly to one another, studies show similar results with each drug .
A CDK4/6 inhibitor in combination with hormone therapy can be used to treat hormone receptor-positive, HER2-negative metastatic breast cancers. Compared to treatment with hormone therapy alone, this combination can give people more time before the cancer spreads and increase overall survival .
The CDK4/6 inhibitor abemaciclib may also be used alone to treat hormone receptor-positive, HER2-negative cancers that have progressed during past hormone therapy and chemotherapy .
Abemaciclib, palbociclib and ribociclib are pills.
The table below lists some possible side effects for CDK4/6 inhibitors.
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For a summary of research studies on the use of CDK4/6 inhibitors in treating metastatic breast cancer, visit the Breast Cancer Research Studies section. |
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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:
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 foundBreast 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.
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What Can I Expect While Living With Metastatic Breast Cancer
Your care team will monitor you every few months to check if the cancer is responding to treatment, and also to see if you are having any side effects. The process of restaging the cancer includes:
- History/physical exam.
- Blood tests.
- Imaging tests, including CTs and bone scan or PET scan.
Before your scans or tests, its normal to feel anxiety. It may help to bring a friend or family member to the appointment with you.
What Does Stage 3 Breast Cancer Mean
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Can Stage 4 Breast Cancer Go Into Remission
Stage 4 breast cancer can go into remission, meaning that it isnt detected in imaging or other tests. Pathological complete remission indicates a lack of cancer cells in tissues removed after surgery or biopsy.
But its rare to take tissue samples while treating stage 4 breast cancer. This could mean that although treatment has been effective, it hasnt completely destroyed the cancer.
Advances in stage 4 breast cancer treatments are helping to increase the length of remission.