Neoadjuvant Therapy And Breast Cancer Staging
If you will get neoadjuvant therapy , your breast cancer will be staged differently from someone who has surgery as a first treatment.
Neoadjuvant therapy can shrink tumors in the breast and lymph nodes, changing the original tumor size and lymph node status. So, your breast cancer is staged using information from physical exams, imaging and biopsies done before neoadjuvant therapy, rather than information from the tumor removed during surgery.
The stages shown in the table below are only used to classify breast cancers in people who have surgery as their first treatment.
If you will get neoadjuvant therapy, talk with your health care provider about how your breast cancer will be staged.
What Are Breast Cancer Stages
The stage of a cancer describes the size of the cancer and how far it has spread.
Your breast cancer may be described as stage 1, stage 2, stage 3 or stage 4.
An early form of breast cancer called DCIS is sometimes referred to as stage 0 breast cancer.
The stage takes into account:
- The size of the cancer
- Whether the lymph nodes are affected
- If the cancer has spread to other parts of the body
The stage of your cancer may not be fully known until after you have had surgery.
What Is Stage Ii
In stage II, cancer cells have spread or have been found in lymph nodes or axillary lymph nodes, located around the armpit near the breastbone. Like stage I, it’s also separated into two groups, Stage IIA and IIB, depending on how large of a tumor is found and where and how much the cancer cells have spread.
“We basically need to know how big and if the tumor or cancer cells have spread to any lymph nodes, this will help us understand how and where to treat the patient,” Cruz said. “But as with any stage, even if it’s spread, I tell my patients to remain calm so we can discuss how to fight against the cancer.”
In stage IIA, if a tumor isn’t found, cancer cells are commonly found in one to three axillary lymph nodes, Cruz said. If there is a tumor, it’s usually not larger than two millimeters and has also spread to the lymph nodes.
In stage IIB, either a tumor or small cancer cells have spread to the lymph nodes. If it hasn’t spread to the lymph nodes, the tumor is usually larger than five millimeters.
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How Long Does It Take For Stage 1 Breast Cancer To Develop Into Stage 2
It is not possible to determine exactly how long it will take for newly diagnosed breast cancer to progress from stage 1 to stage 2. It can happen within months if it is an aggressive high-grade tumor, or it can take longer. It’s important to know that stage 1 breast cancer could have already been present for a while before being detected, so it may progress quickly.
The Stages Of Breast Cancer And Your Treatment Options
Compared to most other cancers, staging breast cancer is more complex. And when it comes to treating breast cancer, there isnt a one-size-fits-all approach. Your treatment plan should be created especially for you and be coordinated across specialists and thats where your cancer care team comes in.
At HealthPartners, we believe cancer treatment and care is best managed by a group of doctors and specialists in whats known as multidisciplinary conferences. This is where breast surgeons, oncologists, radiologists, pathologists and other members of your care team gather to discuss the best treatment sequence for you.
Below we dive into the treatment options your care team might recommend at various breast cancer stages.
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What Is Stage Iii
“In this stage, I tell my patients the real war against the cancer begins,” Cruz said. “Spreading is much more advanced.”
According to Cruz, stage III is unique in that it has three subcategories: IIIA, IIIB and IIIC.
IIIA has tumors all larger than five millimeters and has spread to lymph nodes. Cruz said the higher number of lymph nodes with cancer cells, the more advanced it is.
In stage IIIB, the tumor has spread to the chest wall and skin of the breast. In many cases, this spreading can result in swelling or ulcers. The cancer cells have also spread to nine lymph nodes.
There is advanced spreading in stage IIIC: the cancer has spread to the chest wall, skin of the breast, 10 or more lymph nodes and the collarbone.
“In stage III, yes there is advanced spreading. Yes it is harder to treat, but not untreatable,” Cruz said. “That’s what we tell our patients, although the spreading is scary, we can still fight it.”
What Are Risk Factors For Breast Cancer Recurrence
Anyone with a breast cancer diagnosis can have a recurrence. Your risk of cancer recurrence depends on several factors:
- Age: Women who develop breast cancer before age 35 are more likely to get breast cancer again.
- Cancer stage: Cancer stage at the time of diagnosis correlates with the risk of the cancer being able to recur. Several factors determine cancer stage: tumor size, cancer grade and cancer spread to lymph nodes or other parts of the body. Cancer grade indicates how unusual cancer cells look in comparison to healthy cells.
- Cancer type: Aggressive cancers like inflammatory breast cancer and triple-negative breast cancer are harder to treat. Theyre more likely to come back and spread.
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What Is Stage 0
Stage 0 is the least invasive stage of breast cancer and usually detected early in patients, according to the American Cancer Society. In this stage, cancer cells or non-cancerous abnormal cells are only in the part of the breast in which they formed and haven’t spread.
“At this stage of breast cancer, we tell patients not to be too worried. Stage 0 is extremely treatable and we ask people not to shed a tear over the diagnosis just yet,” said Cruz.
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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.
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What Should A Person With Stage 0 Or Stage 1 Breast Cancer Expect Regarding Treatment
Even though Stage 0 breast cancer is considered non-invasive, it does require treatment, typically surgery or radiation, or a combination of the two. Chemotherapy is usually not part of the treatment regimen for earlier stages of cancer.
Stage 1 is highly treatable, however, it does require treatment, typically surgery and often radiation, or a combination of the two. Additionally, you may consider hormone therapy, depending on the type of cancer cells found and your additional risk factors. Like stage 0, Chemotherapy is often not necessary for earlier stages of cancer.
Material on this page courtesy of National Cancer Institute
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.
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Regional Relapse Following Breast Cancer Treatment Carries A Poorer Prognosis
Most localized breast cancers are treated by either breast conserving surgery with radiation therapy, or by mastectomy.
A medical study from 2010 estimates that around 40% of all women with breast cancer will suffer a recurrence.
The prognosis following a breast cancer recurrence is influenced by a number of factors. These include:-
- The Disease Free Interval: This is the time elapsed from diagnois and treatment of the first breast cancer to the recurrence
- The location of the recurrence: Whether the recurrence is in the same breast , or if it recurs in the contralateral breast, regional lymph nodes, or the chest wall .
Patients with breast cancer relapses are typically generally treated with either a salvage mastectomy, or radiation to the chest wall, regional lymph nodes, or both.
Systemic therapy may be implemented at this point. However, this will be determined on an individual basis, based on the likelihood of distant metastasis, characteristics of the tumor, and other factors.
Discussion On The Figures And Bar Graphs
As we can see outlook for breast cancer according to stage has improved immensely since these statistics first started appearing on the internet.
The estimated 5 year survival rates from Dr. Halls early data for Stage I was only 85%. By 2002 this figure has risen to 88% and for 2012 almost a 100% survival rate.
For Stage II the outlook is also much improved. From the 2002 data the survival rate was between 74% and 81%. Again by the latest data the relative percentage survival rate is 93%.
Furthermore Stage III in 2002 had a percentage survival rate of 41% to 49%. However, the 2012 data shows that this percentage has risen to 72%
Sadly, the survival percentage for stage IV breast cancer remains fairly low. 15% 5-year survival rate in 2002 to 22% 5-year relative survival rate in 2012.
NOTE: Just a word of caution on statistics. The first two graphs are percentage survival rates. So, if the figure is, for example, 93% for Stage II breast cancer, this means that 93 out of 100 patients with a Stage II diagnosis will be alive 5 years later.
On the other hand, relative survival rates in the lower table, compares breast cancer sufferers with the general population. So, if the relative survival rate for Stage II breast cancer is 93% this means that people with that diagnosis are 93% as likely to be alive 5 years later as the general population with similar life factors.
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Treatment For Stage 1 Breast Cancer
Doctors can offer a variety of for stage 1 breast cancer, although surgery is the primary treatment.
A lumpectomy or mastectomy are both viable surgical options for people with stage 1 breast cancer. A doctor will decide what surgery is most appropriate depending on the location of the primary tumor, how large it is, the size of the breast, family history, genetics, and the persons preference.
The doctor may also carry out a biopsy on one or more lymph nodes.
After removing the tissue, they will send it to a laboratory for further tests. The results will help inform decisions on the next stage of treatment.
Radiation therapy is a standard treatment for stage 1 breast cancer. However, the decision will depend on factors such the age of the person, the type of cancer, the size of the tumor, and whether there are cancer cells in the lymph nodes.
If the breast cancer is ER+ or PR+, hormone therapy may be effective. Hormone therapy works by preventing the growth of estrogen, which helps cancer grow, by blocking estrogen from attaching to tissue and fuelling cancer growth, or both.
Hormone therapy can reach cancer cells in the breast, as well as other areas of the body, and it can reduce the risk of cancer returning.
also has subcategories known as 2A and 2B.
Stage 2A breast cancer is invasive cancer:
Tnm System For Breast Cancer
Doctors also group cancers by the letters T, N, or M. Each of those letters tells you something about your cancer.
âTâ stands for tumor, or the lump of cancer found in the breast itself. The higher the number assigned after it, the bigger or wider the mass.
âNâ stands for nodes, as in lymph nodes. These small filters are found throughout the body, and they’re especially dense in and around the breast. They’re meant to catch cancer cells before they travel to other parts of the body. Here, too, a number tells you whether the cancer has spread to lymph nodes near the breast and, if so, how many.
âMâ stands for metastasis. The cancer has spread beyond the breast and lymph nodes.
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Survival Of Breast Cancer Based On Stage
Statistics are given below for the overall survival rates for breast cancer based on certain stages of disease development.
I made this page many years ago, when there was nothing like this data available on the internet. Recently this page has been up-dated with the most recent statistics that we can find. Prognosis will be even better than the numbers here suggest because modern targeted treatments have improved a lot.
Breast cancer staging is determined by many factors and these include:-
- The presence and size of a tumor
- Whether the tumor is node negative or positive, this means whether lymph nodes are involved or not
- If the cancer has metastasized beyond the breast
If breast cancer is diagnosed and it is determined that there is no metastasis to the lymph nodes then the chances of survival are extremely good.
Once breast cancer has spread to the lymph nodes the mode of treatment tends to shift to the chemotherapy medicines, and the odds of survival are somewhat lower.
Stage 1 Breast Cancer
Stage 1 breast cancer is divided into two groups:
- Stage 1A
- Stage 1B
Stage 1A means the cancer is 2cm or smaller and has not spread outside the breast.
Stage 1B can mean:
No cancer is seen in the breast, but a very tiny area of breast cancer is found in the lymph nodes under the arm
The cancer in the breast is 2cm or smaller and a very tiny area of breast cancer is found in the lymph nodes under the arm .
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Life Expectancy By Stage
Even when divided by stage, its hard to determine life expectancy for someone with breast cancer because of the following:
- There are many types of breast cancer, and they vary in their level of aggressiveness. Some have targeted treatment, while others dont.
- Successful treatment may depend on age, other health problems, and treatments you choose.
- Survival rates are estimates based on people diagnosed years ago. Treatment is advancing quickly, so you may have a better life expectancy than people diagnosed even five years ago.
Thats why you shouldnt take general statistics to heart. Your doctor can give you a better idea of what to expect based on your personal health profile.
The Surveillance, Epidemiology, and End Results Program doesnt track breast cancer survival rates by type or in stages 0 to 4. A relative survival rate compares people with breast cancer to people in the general population.
Following are SEER based on women diagnosed between 2009 and 2015:
|Localized: Has not spread beyond the breast||98.8%|
Your doctor will consider all this when recommending treatment. Most people need a combination of therapies.
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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What Causes Breast Cancer Recurrence
The goal of cancer treatments is to kill cancer cells. But, cancer cells are tricky. Treatments can reduce tumors so much that tests dont detect their presence. These weakened cells can remain in the body after treatment. Over time, the cells get stronger. They start to grow and multiply again.
Even surgery to remove a cancerous tumor isnt always 100% effective. Cancer cells can move into nearby tissue, lymph nodes or the bloodstream before surgery takes place.
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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