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What Is The Highest Stage Of Breast Cancer

Changing Role Of Caregivers

What Are the Stages of Breast Cancer?

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver’s role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving.

Breast Cancer Staging Process

Breast cancer staging is determined by how large tumors are, how far theyve spread, and other characteristics like the genetics of the tumor. Your cancer stage can be determined before surgery or after surgery .

Cancers clinical stage is determined through a physical exam, biopsy , and imaging tests. These imaging tests may include X-rays, computed tomography , positron-emission tomography , magnetic resonance imaging , or ultrasound.

After surgery, your breast cancer stage will either be confirmed or updated as a pathologic stage, using the features found and any additional information about how far cancer has spread gathered during surgery.

Breast Cancer And Race Highlights

  • Five-year survival rates in breast cancer improved from 76% in white women in 1975-1977 to 92% in 2009-2015.
  • Among black women, the five-year survival improved from 62% in 1975-1977 to 83% in 2009-2015.
  • Breast cancer is the most commonly diagnosed cancer among black women.
  • Breast cancer accounts for the second-highest number of cancer deaths among black women.
  • Inflammatory breast cancer, a rare but aggressive subtype of breast cancer is more common in black women.
  • Breast cancer is the second most common cause of cancer death among black women after lung cancer.
  • Breast cancer death rates are about 40% higher in black women than white women.
  • 54% of breast cancers are diagnosed at local stage, compared to 64% in white women.

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Histopathologic Classification Of Breast Cancer

Table 1 describes the histologic classification of breast cancer based on tumor location. Infiltrating or invasive ductal cancer is the most common breast cancerhistologic type and comprises 70% to 80% of all cases.

Table 1. Tumor Location and Related Histologic Subtype

Tumor Location
Paget disease with intraductal carcinoma
Paget disease with invasive ductal carcinoma
Other
  • Primary lymphoma.
References
  • Breast. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. Springer, 2010, pp 347-76.
  • Yeatman TJ, Cantor AB, Smith TJ, et al.: Tumor biology of infiltrating lobular carcinoma. Implications for management. Ann Surg 222 : 549-59 discussion 559-61, 1995.
  • Chaney AW, Pollack A, McNeese MD, et al.: Primary treatment of cystosarcoma phyllodes of the breast. Cancer 89 : 1502-11, 2000.
  • Carter BA, Page DL: Phyllodes tumor of the breast: local recurrence versus metastatic capacity. Hum Pathol 35 : 1051-2, 2004.
  • Lifestyle Changes Can Reduce The Risk Of Breast Cancer Returning

    Stage 3 Throat Cancer Survival Rate

    Surviving breast cancer diagnosis, treatment and recovery can cause uncertainty and concern that the cancer will come back or that a new cancer will occur. Addressing self-care after breast cancer and tending to your overall well-being can help restore a more positive outlook, and might even reduce your chances of facing cancer again.Does using deodorant increase your breast cancer risk? Learn about breast cancer myths and facts

    We are experts in managing local breast cancer recurrence and metastatic disease, Lange says. As a comprehensive breast center, our patients range from the newly diagnosed to those with advanced metastatic disease.

    Our goal is to find treatment and management options for all patients, using all the healing modalities that evidence-based medicine has proven to be beneficial in the treatment of breast cancer.

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    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.

    What Does It Mean To Have Stage 3 Breast Cancer

    Stage 3 cancer means the breast cancer has extended to beyond the immediate region of the tumor and may have invaded nearby lymph nodes and muscles, but has not spread to distant organs. Although this stage is considered to be advanced, there are a growing number of effective treatment options.

    This stage is divided into three groups: Stage 3A, Stage 3B, and Stage 3C. The difference is determined by the size of the tumor and whether cancer has spread to the lymph nodes and surrounding tissue.

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    What Is Stage 0 Breast Cancer

    Also called carcinoma in situ, stage 0 is the earliest breast cancer stage. At stage 0, the breast mass is noninvasive, and there is no indication that the tumor cells have spread to other parts of the breast or other parts of the body. Often, stage 0 is considered a precancerous condition that typically requires close observation, but not treatment.

    Stage 0 breast cancer is difficult to detect. There may not be a lump that can be felt during a self-examination, and there may be no other symptoms. However, breast self-exams and routine screening are always important and can often lead to early diagnosis of breast cancer, when the cancer is most treatable. Stage 0 disease is most often found by accident during a breast biopsy for another reason, such as to investigate an unrelated breast lump.

    There are two types of stage 0 breast cancer:

    Ductal carcinoma in situ occurs when breast cancer cells develop in the breast ducts. Today, stage 0 DCIS is being diagnosed more often because more women are having routine mammogram screenings. DCIS can become invasive, so early treatment can be important.

    What Is Stage 3 Breast Cancer

    Stage 2 Breast Cancer Defined By Dr. Jay Harness

    Also known as locally advanced breast cancer, the tumor in this stage of breast cancer is more than 2 inches in diameter across and the cancer is extensive in the underarm lymph nodes or has spread to other lymph nodes or tissues near the breast. Stage 3 breast cancer is a more advanced form of invasive breast cancer. At this stage, the cancer cells have usually not spread to more distant sites in the body, but they are present in several axillary lymph nodes. The tumor may also be quite large at this stage, possibly extending to the chest wall or the skin of the breast.

    Stage 3 breast cancer is divided into three categories:

    Stage 3A: One of the following is true:

    • No tumor is found in the breast, but cancer is present in axillary lymph nodes that are attached to either other or other structures, or cancer may be found in the lymph nodes near the breast bone, or
    • The tumor is 2 cm or smaller. Cancer has spread to axillary lymph nodes that are attached to each other or other structures, or cancer may have spread to lymph nodes near the breastbone, or
    • The tumor is 2 cm to 4 cm in size. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breast bone, or
    • The tumor is larger than 5 cm. Cancer has spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.

    Stage 3C:

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    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.

    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.

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    Things You Can Change

    Fortunately, there are risk factors for breast cancer that are under your control. These factors include:

    • Sedentary lifestyle: Women who are not physically active are at an increased risk of developing breast cancer.
    • Obesity: Older women who are overweight or obese have a higher risk of being diagnosed with breast cancer.
    • Hormone replacement therapy: Women who take hormones such as estrogen or progesterone for over five years during menopause are at higher risk of developing breast cancer. Women who take oral contraceptives may also be at higher risk.
    • Alcohol use: A womans risk of breast cancer may increase with the number of alcoholic drinks she consumes.

    How Is Breast Cancer Diagnosed

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    During your regular physical examination, your doctor will take a thorough personal and family medical history. He or she will also perform and/or order one or more of the following:

    • Breast examination: During the breast exam, the doctor will carefully feel the lump and the tissue around it. Breast cancer usually feels different than benign lumps.
    • Digital mammography: An X-ray test of the breast can give important information about a breast lump. This is an X-ray image of the breast and is digitally recorded into a computer rather than on a film. This is generally the standard of care .
    • Ultrasonography: This test uses sound waves to detect the character of a breast lump whether it is a fluid-filled cyst or a solid mass . This may be performed along with the mammogram.

    Based on the results of these tests, your doctor may or may not request a biopsy to get a sample of the breast mass cells or tissue. Biopsies are performed using surgery or needles.

    After the sample is removed, it is sent to a lab for testing. A pathologist a doctor who specializes in diagnosing abnormal tissue changes views the sample under a microscope and looks for abnormal cell shapes or growth patterns. When cancer is present, the pathologist can tell what kind of cancer it is and whether it has spread beyond the ducts or lobules .

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    Ajcc Pathological Prognostic Stage Groups

    The Pathological Prognostic Stage applies to patients with invasive breast cancer initially treated with surgery. It includes all information used for clinical staging, surgical findings, and pathological findings following surgery to remove the tumor. Pathological Prognostic Stage is not used for patients treated with neoadjuvant therapy before surgery to remove the tumor.

    References
  • Barnes DM, Harris WH, Smith P, et al.: Immunohistochemical determination of oestrogen receptor: comparison of different methods of assessment of staining and correlation with clinical outcome of breast cancer patients. Br J Cancer 74 : 1445-51, 1996.
  • Wolff AC, Hammond MEH, Allison KH, et al.: Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update. J Clin Oncol 36 : 2105-2122, 2018.
  • Breast. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. Springer 2017, pp. 589628.
  • Wolff AC, Hammond ME, Hicks DG, et al.: Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol 31 : 3997-4013, 2013.
  • Risk Of Breast Cancer By Age

    A womans risk of developing breast cancer based on her age is as follows:

    • 30 years old: 0.49% or 1 in 204
    • 40 years old: 1.55% or 1 in 65
    • 50 years old: 2.4% or 1 in 42
    • 60 years old: 3.54% or 1 in 28
    • 70 years old: 4.09% or 1 in 24

    About 5% of breast cancer cases occur in women under 40 years old. It may be more difficult to diagnose breast cancer in young women because their breast tissue is denser than that of older women. Young women and their doctors may also be more likely to ignore a breast lump because of their low risk.

    Breast cancer that occurs in young women tends to be more aggressive and less likely to respond to treatment. Women who are diagnosed with breast cancer before age 40 are more likely to have a genetic mutation that puts them at higher risk. Screening for the BRCA gene mutation may begin at age 25.

    Other signs for young women to be aware of include:

    • A lump in the breast
    • Nipple discharge
    • Focal pain
    • Skin changes on the breast

    Mammogram screening is recommended to begin between ages 40 and 50 based on your individual risk factors.

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    Treatment Option Overview For Early/localized/operable Breast Cancer

    Standard treatment options for early, localized, or operable breast cancer may include the following:

    Surgery:

  • Breast-conserving surgery and sentinel lymph node biopsy with or without axillary lymph node dissection for positive SLNs.
  • Modified radical mastectomy with or without breast reconstruction and sentinel node biopsy with or without axillary lymph node dissection for positive SLNs.
  • Postoperative radiation therapy:

  • Axillary nodenegative breast cancer :
  • No additional therapy.
  • Radiation therapy.
  • Axillary nodepositive breast cancer :
  • For one to three nodes, the role of regional radiation therapy to the infra/supraclavicular nodes, internal mammary nodes, axillary nodes, and chest wall is unclear.
  • For four or more nodes or extranodal involvement, regional radiation therapy is advised.
  • Axillary nodenegative or positive breast cancer :
  • Whole-breast radiation therapy.
  • Postoperative systemic therapy:

  • Therapy depends on many factors including stage, grade, molecular status of the tumor . Adjuvant treatment options may include the following:
  • Tamoxifen.
  • Endocrine therapy.
  • Living With Breast Cancer

    Stage 2 Breast Cancer Treatment

    Being diagnosed with breast cancer can affect daily life in many ways, depending on what stage it’s at and the treatment you will have.

    How people cope with the diagnosis and treatment varies from person to person. There are several forms of support available, if you need it.

    Forms of support may include:

    • family and friends, who can be a powerful support system
    • communicating with other people in the same situation
    • finding out as much as possible about your condition
    • not trying to do too much or overexerting yourself
    • making time for yourself

    Find out more about living with breast cancer.

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    Screening For Breast Cancer

    Women aged between 50 and 74 are invited to access free screening mammograms every two years via the BreastScreen Australia Program.

    Women aged 40-49 and 75 and over are also eligible to receive free mammograms, however they do not receive an invitation to attend.

    It is recommended that women with a strong family history of breast or ovarian cancer, aged between 40 and 49 or over 75 discuss options with their GP, or contact BreastScreen Australia on 13 20 50.

    How Much Do Tamoxifen And Raloxifene Lower The Risk Of Breast Cancer

    Multiple studies have shown that both tamoxifen and raloxifene can reduce the risk of developing estrogen receptor-positive breast cancer in healthy postmenopausal women who are at high risk of developing the disease. Tamoxifen lowered the risk by 50 percent. Raloxifene lowered the risk by 38 percent. Overall, the combined results of these studies showed that taking tamoxifen or raloxifene daily for five years reduced the risk of developing breast cancer by at least one-third. In one trial directly comparing tamoxifen with raloxifene, raloxifene was found to be slightly less effective than tamoxifen for preventing breast cancer.

    Both tamoxifen and raloxifene have been approved for use to reduce the risk of developing breast cancer in women at high risk of the disease. Tamoxifen is approved for use in both premenopausal women and postmenopausal women . Raloxifene is approved for use only in postmenopausal women.

    Less common but more serious side effects of tamoxifen and raloxifene include blood clots to the lungs or legs. Other serious side effects of tamoxifen are an increased risk for cataracts and endometrial cancers. Other common, less serious shared side effects of tamoxifen and raloxifene include hot flashes, night sweats, and vaginal dryness.

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