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.
Treating Stage 1 To Stage 2 Cancer
Doctors perform breast conservation or breast-sparing surgery for these stages of breast cancer. The aim of this surgery is to save as much of the adjacent healthy breast tissue. This procedure includes lumpectomy and partial mastectomy . A patient can opt for breast reconstruction for getting new breasts after the surgical removal of the tumour.
Sometimes, the doctor may advise a procedure known as mastectomy which is the complete removal of one or both breasts. Any affected lymph nodes are also removed. In these stages, a method called Sentinel Node Biopsy is done, to check whether cancer has reached the armpit. In this method, a scan is done and about two or three lymph nodes are taken out and sent for testing. If cancer has spread to the lymph nodes, they are completely removed from the armpit. If cancer has not spread to the armpit, the rest of the lymph nodes are not removed. After the tumour has been surgically removed, some types of systemic treatments are offered to patients. These include:
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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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.
Chance Of Breast Cancer In Birads 4 Reports
The range of findings associated with BIRADS 4 category breast lesions can be highly variable. Indeed, there are three subclasses of BIRADS 4 in light of this variability.
So, the positive predictive value of BIRADS 4 breast abnormalities on a mammogram is between 23% and 34%. This is not all that high at all.
NOT
With experience, a radiologist learns to fine-tune their own diagnostic techniques. So, as a result, radiologists send fewer patients for breast biopsy. Hopefully, only patients who are the most suspicious for breast cancer will have a biopsy.
Category 5 breast lesions, however, are very likely to be breast cancer with a positive predictive value ranging between about 80% and 97%.
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Treatment Costs And Considerations
So youve gone for a screening and a lump has been detected. Whats next and what are the ballpark costs for treatment?
First things first: that lump needs to be looked at. This requires a biopsy, to determine if it is a benign or malignant tumour. Biopsies can cost anywhere from $2,092 if you stay at a public, subsidized hospital and more if you choose an A-class ward in a private one.
How can you pay for this? All Singaporeans have MediSave as well as MediShield Life, a basic health insurance plan that covers hospitalisations and certain outpatient treatments. You do have the option to enhance your MediShield Life coverage with an Integrated Shield Plan that will give you more benefits .
While MediSave does cover treatment such as radiosurgery and chemotherapy as well as hospitalisation, what you have in your account may or may not be sufficient to foot the entire bill. There are also allowable limits on what youre able to claim.
You can find out fee benchmarks here. Most patients prefer to stay in a B class ward, so if youre the type that prefers privacy or more personal treatment, youd be looking at a much higher estimate.
What Are The Stages Of Breast Cancer
There are two different staging systems for breast cancer. One is called anatomic staging while the other is prognostic staging. The anatomic staging is defined by the areas of the body where the breast cancer is found and helps to define appropriate treatment. The prognostic staging helps medical professionals communicate how likely a patient is to be cured of the cancer assuming that all appropriate treatment is given.
The anatomic staging system is as follows:
Stage 0 breast disease is when the disease is localized to the milk ducts .
Stage I breast cancer is smaller than 2 cm across and hasn’t spread anywhere including no involvement in the lymph nodes.
Stage II breast cancer is one of the following:
- The tumor is less than 2 cm across but has spread to the underarm lymph nodes .
- The tumor is between 2 and 5 cm .
- The tumor is larger than 5 cm and has not spread to the lymph nodes under the arm .
Stage III breast cancer is also called “locally advanced breast cancer.” The tumor is any size with cancerous lymph nodes that adhere to one another or to surrounding tissue . Stage IIIB breast cancer is a tumor of any size that has spread to the skin, chest wall, or internal mammary lymph nodes .
Stage IV breast cancer is defined as a tumor, regardless of size, that has spread to areas away from the breast, such as bones, lungs, liver or brain.
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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.
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The Tnm Staging System
The TNM Staging system assigns a number after each letter to signify the size of the tumor , the number of lymph nodes involved and whether the cancer has spread or metastasized . For example, a T1N2M0 tumor is a small primary tumor with two lymph nodes containing evidence of cancer and no sign of metastasis. Once the TNM numbers have been assigned, this information is used to determine stage grouping.
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How Breast Cancer Is Staged
Breast cancer staging ranges from 0 to 4, making a total of 5 possible stages. As of 2018, the standard for staging breast cancer now takes into consideration 7 factors to reach a more exact diagnosis with varying degrees of treatment options. According to Breastcancer.org, the following parameters help your physician to reach a decision on the degree of the cancer, treatment and prognosis.
What Is The First Stage Of Breast Cancer
stage 1 breast cancerStage 1 breast cancercancerbreastbreaststage breast cancerStage 1 breast cancer
- Ductal Carcinoma In Situ
- Invasive Ductal Carcinoma
- IDC Type: Tubular Carcinoma of the Breast.
- IDC Type: Medullary Carcinoma of the Breast.
- IDC Type: Mucinous Carcinoma of the Breast.
- IDC Type: Papillary Carcinoma of the Breast.
- IDC Type: Cribriform Carcinoma of the Breast.
- Invasive Lobular Carcinoma
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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.
Treatment For Stage 2 Breast Cancer
The most common for stage 2 breast cancer is surgery.
Surgery
In most cases, treatment involves removing the cancer. The person may undergo a lumpectomy or mastectomy. The doctors and the individual can decide based on the size and location of the tumor. The surgeon may also remove one or more lymph nodes.
Combination therapy
A doctor may recommend a combination of radiation therapy, chemotherapy, and hormone therapy to people with stage 2A or 2B breast cancer.
Neoadjuvant therapy
In some cases, a doctor may recommend neoadjuvant therapy, which is chemotherapy before surgery to reduce the size of a tumor.
are 3A, 3B, and 3C.
3A breast cancer is an invasive breast cancer where:
- There is no tumor in the breast, or a tumor of any size is growing alongside cancer found in four to nine axillary lymph nodes or the lymph nodes by the breastbone.
- A person has a tumor greater than 5 cm. They also have clusters of breast cancer cells in the lymph nodes that are between 0.22 mm in diameter.
- The tumor is larger than 5 cm. The cancer has also spread to one to three axillary lymph nodes or the lymph nodes near the breastbone.
Stage 3B breast cancer is invasive breast cancer where:
- A tumor of any size has spread into the chest wall or skin of the breast, causing swelling or an ulcer to develop.
- Cancer cells may also be present in to up to nine axillary lymph nodes.
- They may be present in lymph nodes by the breastbone.
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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
- the skin
Does Breast Cancer Affect Women Of All Races Equally
All women, especially as they age, are at some risk for developing breast cancer. The risks for breast cancer in general arent evenly spread among ethnic groups, and the risk varies among ethnic groups for different types of breast cancer. Breast cancer mortality rates in the United States have declined by 40% since 1989, but disparities persist and are widening between non-Hispanic Black women and non-Hispanic white women.
Statistics show that, overall, non-Hispanic white women have a slightly higher chance of developing breast cancer than women of any other race/ethnicity. The incidence rate for non-Hispanic Black women is almost as high.
Non-Hispanic Black women in the U.S. have a 39% higher risk of dying from breast cancer at any age. They are twice as likely to get triple-negative breast cancer as white women. This type of cancer is especially aggressive and difficult to treat. However, it’s really among women with hormone positive disease where Black women have worse clinical outcomes despite comparable systemic therapy. Non-Hispanic Black women are less likely to receive standard treatments. Additionally, there is increasing data on discontinuation of adjuvant hormonal therapy by those who are poor and underinsured.
In women under the age of 45, breast cancer is found more often in non-Hispanic Black women than in non-Hispanic white women.
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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 surgeryand 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.
Grouping Breast Cancer Stages
There are five stages of breast cancer. These stages are determined based on the tumor size, lymph node involvement and whether the cancer has spread to another part of the body.
Stage 0
Non-invasive or in situ cancer . In Stage 0 there is no evidence of cancer cells breaking out of the part of the breast in which they started. Pagets disease is typically stage 0.
Stage I
Invasive breast cancer with small tumor size and limited nodal involvement.
Stage II
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How Is Breast Cancer Treated
If the tests find cancer, you and your doctor will develop a treatment plan to eradicate the breast cancer, to reduce the chance of cancer returning in the breast, as well as to reduce the chance of the cancer traveling to a location outside of the breast. Treatment generally follows within a few weeks after the diagnosis.
The type of treatment recommended will depend on the size and location of the tumor in the breast, the results of lab tests done on the cancer cells, and the stage, or extent, of the disease. Your doctor will usually consider your age and general health as well as your feelings about the treatment options.
Breast cancer treatments are local or systemic. Local treatments are used to remove, destroy, or control the cancer cells in a specific area, such as the breast. Surgery and radiation treatment are local treatments. Systemic treatments are used to destroy or control cancer cells all over the body. Chemotherapy and hormone therapy are systemic treatments. A patient may have just one form of treatment or a combination, depending on her individual diagnosis.
Age At The Time Of Diagnosis Affects Breast Cancer Survival Rates
It has always been known that curiously, young women have a poorer prognosis than older ones
Indeed, one cohort study examined 4,453 women with breast cancer between 1961 and 1991 who were all treated at the same center.
This study found that both ends of the age spectrum fared less well. So, women under the age of 40 years at diagnosis and those over 80 years had a statistically poorer prognosis.
However, for younger women, this may be due to the fact that they often present with higher-grade tumors that tend to be more aggressive and less likely to be hormone receptor-positive. This means that breast cancer may not respond as well to treatment.
So, it is important to bear in mind other factors discussed in this post, such as stage, grade and hormone receptor status play an important role in prognosis.
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