Breast Cancer Stage: What Do They Mean
Stages are numbers used to describe how far a cancer has advanced and where it has spread in the body. Cancer that has not spread beyond your breast is considered local.
Regional cancer has spread into the breast skin, chest structures, and lymph nodes. When cancer spreads to other parts of the body, it is considered distant since it exists far away from just the breasts.
Your prognosis, or your long-term outcome, relies heavily on what stage your cancer is. Cancer stages are often further broken down into subcategories to provide more specific information.
Staging previously relied only on whether it is invasive or;noninvasive, the tumors size, which lymph nodes contained cancer, and where and how far the cancer had spread.
Breast cancer stages now also take into account the tumors grade and the cancers estrogen receptor, progesterone receptor, and HER2 status.
Estrogen receptor, progesterone receptor, and HER2 status all have to do with the specific hormones and/or proteins involved in your cancer. The tumor grade describes what the cancer cells look like.
What Are The Grades Of Breast Cancer
The cells can be graded as 1, 2 or 3, depending on how different they are to normal breast cells and how quickly they are growing. The grade gives your doctor information about how quickly the cancer may grow and spread.;
Grade 1: Low-grade breast cancer
The cancer cells look only slightly abnormal, much like normal breast cells. The cancer is usually slow-growing and less likely to spread than high grade breast cancer.
Grade 2/3: High-grade breast cancer
The cancer cells look fairly or very abnormal and are more likely to grow quickly.;
Staging and grading can be hard to understand, so ask your doctor and nurse for more information if you need it.
What Is Histologic Grade Or Nottingham Grade Or Elston Grade
These grades are similar to what is described in the question above about differentiation. Numbers are assigned to different features seen under the microscope and then added up to assign the grade.
- If the numbers add up to 3-5, the cancer is grade 1 .
- If they add up to 6 or 7, it means the cancer is grade 2 .
- If they add up to 8 or 9, it means the cancer is grade 3 .
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What Is A Cancer Stage
While a grade describes the appearance of cancer cells and tissue, a cancers stage explains how large the primary tumor is and how far the cancer has spread in the patients body.
There are several different staging systems. Many of these have been created for specific kinds of cancers. Others can be used to describe several types of cancer.
Infiltrating/invasive Lobular Breast Carcinoma
Infiltrating lobular carcinoma usually appears as a subtle thickening in the upper-outer breast quadrant.
As the name suggests, these tumours originate mostly in the breast lobules rather than the lining of the breast ducts.
Invasive lobular cancer is a less common type of breast cancer than invasive ductal cancer. This cancer accounts for about 10% of all invasive breast cancer cases.
Prognosis for infiltrating and invasive lobular breast carcinomas will naturally be influenced by tumor size, grade, stage and hormone receptor status..
However, lobular breast cancers, when positive for estrogen and progesterone receptors, tend to respond very well to hormone therapy.
The overall breast cancer survival rates for infiltrating lobular carcinoma, when matched by stage, are a little higher than for ductal carcinoma for the first 5 years.
Survival rates range from about 77% to 93%, but on average, the 5-year survival rate was estimated at about 90%.
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Stage 1 Breast Cancer
What is Stage 1 breast cancer?
Stage 1 breast cancers are still relatively small, and theyve either not yet spread to the lymph nodes or theres only been a tiny bit of spread in the sentinel lymph node which is where the cancer is most likely to spread first. There are two types of Stage 1 breast cancer:
- Stage 1A Stage 1A breast cancer means the tumor is no larger than 2 centimeters, and the cancer has not spread outside the breast or to lymph nodes.
- Stage 1B Stage 1B breast cancer means there are small groups of cancer cells in the lymph nodes. There may or may not be a tumor smaller than 2 centimeters in the breast.
What are the treatment options for Stage 1 breast cancer?
- Surgery Like with Stage 0, a lumpectomy and mastectomy are both options at this stage:
- Lumpectomy This kind of breast conservation surgery is a viable option when the cancerous cells are confined to one area of the breast.
- Mastectomy A mastectomy may be recommended if cancer is found throughout the breast.
Stage 1 breast cancer treatment timeline
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What Is The Significance Of The Stage Of The Tumor
The stage of a cancer is a measurement of the extent of the tumor and its spread. The standard staging system for breast cancer uses a system known as TNM, where:
- T stands for the main tumor
- N stands for spread to nearby lymph nodes
- M stands for metastasis
If the stage is based on removal of the cancer with surgery and review by the pathologist, the letter p may appear before the T and N letters.
The T category is based on the size of the tumor and whether or not it has spread to the skin over the breast or to the chest wall under the breast. Higher T numbers mean a larger tumor and/or wider spread to tissues near the breast. Since the entire tumor must be removed to learn the T category, this information is not given for needle biopsies.
The N category indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are affected. Higher numbers after the N indicate more lymph node involvement by cancer. If no nearby lymph nodes were removed to be checked for cancer spread, the report may list the N category as NX, where the letter X is used to mean that the information is not available .
The M category is usually based on the results of lab and imaging tests, and is not part of the pathology report from breast cancer surgery. In a pathology report, the M category is often left off or listed as MX .
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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.
Side Effects And Complications
All treatments have some side effects that range from mild to severe. Most clear up when treatment ends, but there can be some lasting complications.
Its important to tell your oncologist about all symptoms, even if they seem minor. Your healthcare team will work with you to ease side effects and deal with complications.
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What Are The Signs Of Invasive Breast Cancer
Breast cancer may have no signs or symptoms, especially during the early stages. As the cancer grows, you may notice one or more of the following:
- A lump or thickening in or near the breast or in the underarm that continues after your monthly menstrual cycle
- A mass or lump, which may feel as small as a pea
- A change in the size, shape, or contour of the breast
- A blood-stained or clear fluid from the nipple
- A change in the feel or appearance of the skin on the breast or nipple â dimpled, puckered, scaly, or inflamed
- Redness of the skin on the breast or nipple
- A change in shape or position of the nipple
- An area that is distinctly different from any other area on either breast
- A marble-like hardened area under the skin
You may notice changes when you do a monthly breast self-exam. By doing a regular self-check of your breast, you can become familiar with the normal changes in your breasts.
What Are The Different Grades Of Breast Cancer
There are three grades of invasive breast cancer:
- Grade 1 looks most like normal breast cells and is usually slow growing;
- Grade 2 looks less like normal cells and is growing faster;
- Grade 3 looks different to normal breast cells and is usually fast growing
Sometimes the grade given to a cancer after a biopsy can change after surgery. This is because after surgery theres more tissue for the pathologist to look at, which can give them more detailed information about the cancer.
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Is Inoperable Breast Cancer Still Treatable
Although stage 3C breast cancer is defined as either operable or inoperable, an inoperable diagnosis doesnt necessarily mean that it cant be treated.
The term inoperable may mean that all the cancer in the breast and surrounding tissue cant be removed through simple surgery. When breast cancer is removed, a rim of healthy tissue around the tumor, called a margin, is also removed.
For breast cancer to be successfully removed, there needs to be healthy tissue in all margins of the breast, from your clavicle down to a few inches below the breast mound.
It is possible for inoperable breast cancer to become operable following a treatment to shrink the cancer.
Papillary Dcis Likely To Be Removed Surgically
;Complete removal of benign papillomas has shown to dramatically reduce the appearance of subsequent breast cancer. For malignant papillomas or where there is intracystic carcinoma, there is a high rate or recurrence and associated DCIS. A wide surgical removal is usually recommended. Among women, papillary carcinomas account for 1-2% of all breast cancers. Most commonly occurring with women in the 62-67 age range.
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Oncogene Expression May Negatively Affect Breast Cancer Outcome
A relatively new addition to the discussion of breast cancer survival statistics and prognosis is oncogene expression.
An oncogene is a tiny fragment of genetic material which is carried in a chromosome and can cause normal cells to become malignant.
The oncogene HER-2, in particular, has been linked to more aggressive breast cancers.
Around one-third of all breast tumours produce the HER-2 oncogene, and these patients tend to have higher rates of recurrence and lower overall breast cancer survival rates.
According to a 2013 Canadian scientific study, the overall 5-year survival rate of HER-2 positive breast cancer is 88.6%. Furthermore, the relapse-free survival rate for 5 years is 79.4%.
Tumor Grades: How The Cells Look
The tumor grade, sometimes called the cell grade, is a scale of G1 to G3 that identifies how abnormal the cancer cells look under a microscope.
Cells in grade 1 tumors look almost normal and grow and spread slowly. Grade 3 cells are the most abnormal and grow the fastest. Grade 2 cells fall between grades 1 and 3.
Part of a womans prognosis, or long-term outcome, depends on the cancers stage and the tumors grade. Other factors that affect prognosis include the type of breast cancer a woman has, the hormones or proteins involved, and how quickly tumor cells are dividing and the tumor is growing.
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What Does Cancer Grade Mean
Breast cancers are given a grade according to:
- How different the cancer cells are to normal breast cells;
- How quickly they are growing
The grade of a cancer is different to the;cancer stage.;
A cancers grade is determined when a doctor looks at the cancer cells under a microscope, using tissue from a biopsy or after breast cancer surgery.
What Is A Histologic Grade System
Histology is the study of tissues, including cellular structure and function. Pathologists often assign a histologic grade to a patientâs cancerous breast tumor to identify the type of tumor present and help determine the patientâs prognosis . The Scarff-Bloom-Richardson system is the most common type of cancer grade system used today. To determine a tumorâs histologic grade, pathologists examine the breast cancer cells and their patterns under a microscope. A sample of breast cells may be taken from a breast biopsy,;lumpectomy; or mastectomy.;
Pathologists closely observe three features when determining a cancerâs grade: the frequency of cell mitosis , tubule formation , and nuclear pleomorphism . Each of these features is assigned a score ranging from 1 to 3 . The scores of each of the cellsâ features are then added together for a final sum that will range between 3 to 9.
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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.
What If My Report Mentions Micrometastases In A Lymph Node
This means that there are cancer cells in the lymph nodes that are bigger than isolated tumor cells but smaller than regular cancer deposits. If micrometastases are present, the N category is described as pN1mi. This can affect the stage of your cancer, so it might change what treatments you may need. Talk to your doctor about what this finding may mean to you.
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What Are Some Of The Cancer Type
Breast and prostate cancers are the most common types of cancer that have their own grading systems.
Breast cancer. Doctors most often use the Nottingham grading system for breast cancer . This system grades breast tumors based on the following features:
- Tubule formation: how much of the tumor tissue has normal breast duct structures
- Nuclear grade: an evaluation of the size and shape of the nucleus in the tumor cells
- Mitotic rate: how many dividing cells are present, which is a measure of how fast the tumor cells are growing and dividing
Each of the categories gets a score between 1 and 3; a score of 1 means the cells and tumor tissue look the most like normal cells and tissue, and a score of 3 means the cells and tissue look the most abnormal. The scores for the three categories are then added, yielding a total score of 3 to 9. Three grades are possible:
- Total score = 35: G1
- Total score = 67: G2
- Total score = 89: G3
- Gleason X: Gleason score cannot be determined
- Gleason 26: The tumor tissue is well differentiated
- Gleason 7: The tumor tissue is moderately differentiated
- Gleason 810: The tumor tissue is poorly differentiated or undifferentiated
The Breast Cancer Stages: From 0 To 4
The stage of your cancer will appear on your pathology report, a report that details the size, shape and look of the cancer cells under a microscope. . Most cancers, including invasive breast cancer, have four stages.
Stage 0;is abnormal cells that have not spread beyond the ducts or;lobules;of the breast, such as;DCIS;or;LCIS, respectively.
Stage I;cancer is invasive and spreading beyond where it started.
In Stage IA, the cancer is 2 cm or smaller and has not spread into the lymph nodes or outside of the breast.
In Stage IB, small clumps of cancer cells ranging from 0.2 to 2 mm exist in the lymph nodes. There may not be a tumor in the breast, but if there is, it measures no bigger than 2 cm.
Stage II;cancer also has two subcategories. Stage;IIA;describes a cancer that has spread to 1 to 3 lymph nodes under your arms with or without a tumor up to 2 cm large in the breast, or the breast tumor measures 2 to 5 cm without cancer cells in the;axillary;lymph nodes.
Stage;IIB;refers to a tumor between 2 and 5 cm along with cancer in 1 to 3;axillary;lymph nodes or lymph nodes near the breastbone, or the tumor is larger than 5 cm when no cancer cells exist in the;axillary;lymph nodes.
In Stage;IIIB, the tumor has reached the skin of your breast and/or your chest wall and up to 9 lymph nodes under your arms or near your breastbone.
Inflammatory breast cancer is automatically Stage;IIIB;or a later stage.
Stage;IIIC;involves three behaviors of the cancer:
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