Physical Exams And Pathology Exams
Sometimes, positive lymph nodes can be felt during a physical exam. However,;a pathologists exam of the lymph nodes removed during a biopsy or surgery is needed to determine lymph node status.
During a physical exam, your health care provider will feel under your arm to check if the lymph nodes are enlarged. If the lymph nodes feel enlarged, its likely the breast cancer has spread. However, the cancer may have spread to the lymph nodes even if they dont feel enlarged.
The pathologist will check the nodes under a microscope. Nearly one-third of women with negative lymph nodes based on a physical exam have nodes with cancer found during the pathology exam . And, some women with enlarged nodes during a physical exam have cancer-free nodes .
When Can Metastatic Breast Cancer Occur
Most often, metastatic breast cancer arises months or years after a person has completed treatment for early or locally advanced breast cancer. This is sometimes called a distant recurrence.
Some people have metastatic breast cancer when they are first diagnosed . This is called de novo metastatic breast cancer.
Advanced Or Metastatic Breast Cancer: Stage Iv
Stage IV;breast cancers indicate the presence of distant metastasis to other parts of the body, such as the liver or bones.
About 5%;of women, in 2017 have a stage IV breast cancer at the time of initial diagnosis.
The long term survival rate for stage IV breast cancer tends to be low, but is improving all the time.;;In 2012 the National Cancer Institute statistics show the 5-year survival rate for Stage IV breast cancer to be around 22%.
However, a more recent study shows that 37% of women survive for 3 years after a Stage IV breast cancer diagnosis.
Also, it is important to remember that each case is individual and there is no telling;exact survival rates for any of the stages of breast cancer.
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What Do Cancer Stages And Grades Mean
The stage of a;cancer describes the size of a tumour and how far it has spread from where it originated. The grade describes the appearance of the cancerous cells.
If you’re diagnosed with cancer, you may have more tests to help determine how far it;has progressed. Staging and grading the cancer will allow the doctors to;determine its size, whether it has spread and the best treatment options.
Stage Iii Breast Cancer; Locally Advanced
A stage 3 breast cancer is sometimes referred to as a locally advanced breast cancer.
Stage III breast cancers are actually a heterogeneous group of cancers but account for about 7% of all initial breast cancer diagnosis.
Basically, a stage III breast cancer is one in which there is:-
- a primary tumor of greater than 5cm in diameter with no apparent metastasis
- OR the tumor is between 2cm and 5cm in diameter with evidence of rather significant metastasis.
Another way of looking at it is that stage III breast cancers either have a large but operable breast tumor .; Or sometimes Stage III breast cancers present with a medium-size breast tumor which is more difficult to fully treat and cure with surgery alone.
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How Breast Cancer Spreads
Breast cancer can spread through the lymphatic system, the bloodstream, or by local invasionfor instance, when cancer cells actually invade nearby tissues, such as the chest wall or ribs.
When breast cancers spread and enter the lymphatic system, they usually first arrive at nearby lymph nodes and may still be early-stage.
Metastatic breast cancer is the same thing as stage 4 breast cancer;and is considered the most advanced stage. It refers to breast cancers that have spread beyond the breast and nearby lymph nodes to other regions of the body, which are called distant metastases.
While treatment options for metastatic breast cancer;are similar no matter where cancer has spread, some treatments are used for specific sites of metastasis as well .
How Fast Can Breast Cancer Spread
Metastasis occurs when breast cancer cells begin to grow in another body part.
It is hard to say exactly how quickly breast cancer can grow, including the timeframe, as the disease affects each person differently.
Cancer occurs due to mutations in human cells. Mutations do not follow normal, predictable patterns of cell division, so it is difficult to predict the progression.
Tumors appear when damaged cells replicate over and over to form a clump of abnormal cells. Breast cancer cells can break off and move through the lymph or blood vessels to other areas of the body.
If breast cancer cells begin to grow in another body part, this is called metastasis. Breast cancer is most likely to metastasize to the lymph nodes, lungs, and bones.
Regardless of the location of the new tumor, doctors still consider it to be breast cancer.
Breast cancer growth and its chances of spreading depend on the following:
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Surgery As A First Treatment
You may have the whole breast removed . You may be able to have a new breast made . Do speak to your surgeon, they will tell you whether a reconstruction is suitable for you.;
You might be able to have breast conserving surgery. This may be possible if you have drug treatment first and the tumour shrinks enough to allow your surgeon to remove just the area of cancer. Before your surgery;the lymph nodes in the armpit;are checked for cancer;cells.;
After the surgery you usually have radiotherapy to the breast area.;
You might have treatment with chemotherapy for a few months. If your cancer cells have receptors for a protein called HER2 you might have a targeted cancer drug called trastuzumab as well as chemotherapy. You may have this for up to a year.
You usually have hormone therapy for at least 5 years if your cancer cells have hormone receptors.
Stage 3 Breast Cancer
Stage 3 means that the cancer has spread from the breast to lymph nodes close to the breast or to the skin of the breast or to the chest wall.
It is also called locally advanced breast cancer.
The stage of a cancer tells you how big it is and how far it has spread. It helps your doctor decide which treatment you need.
Staging for breast cancer is very complex. Many different factors are considered before doctors can confirm your final stage. For example, they also use a sample of your cancer to test for:
- receptors for the female hormones
- HER2 status
- the grade of your cancer
You may also have a CT scan to check that the cancer has not spread to other parts of your body.
Do speak to your breast doctor or nurse if you have any questions about staging.;
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How Common Is Breast Cancer Recurrence
Most local recurrences of breast cancer occur within five years of a lumpectomy. You can lower your risk by getting radiation therapy afterward. You have a 3% to 15% chance of breast cancer recurrence within 10 years with this combined treatment. Based on genetic testing, your provider may recommend additional treatments to further reduce your risk.
Recurrence rates for people who have mastectomies vary:
- There is a 6% chance of cancer returning within five years if the healthcare providers didnt find cancer in axillary lymph nodes during the original surgery.
- There is a one in four chance of cancer recurrence if axillary lymph nodes are cancerous. This risk drops to 6% if you get radiation therapy after the mastectomy.
Warning Signs And Words To Know
The most common symptom or warning sign of breast cancer is a lump in the breast. But both Cance and Cruz said not all lumps are cancerous.;Women should also watch for nipple discharge and changes in breast shape or size.;
Cance says vocabulary such as local, regional or distant may be used to;describe a patient’s diagnosis. Local refers to the area where;the cancer is confined within the breast. Regional may be used;when the lymph nodes, primarily those in the armpit, are involved. The term distant is used when the cancer is found in other parts of the body as well, according to Cance.
Another term typically introduced after a breast cancer diagnosis is T-N-M.;T represents the tumor size;;N relates to the involvement of nearby lymph nodes;;and M refers to whether the cancer has spread;beyond the breast, according to Memorial Sloan Kettering Cancer Center.
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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.
Breast Cancer Tumor Grade
The tumors grade is a measurement of how much the cancer cells look like healthy cells. Tumor grading will give the oncologist a better idea of how quickly the cancer is likely to grow and spread.
To describe how abnormal the cancer cells and tissue are, the pathologist will assess the following three features:
For each feature, the pathologist assigns a score of 1 to 3; a score of 1 means the cells and tumor tissue look the most like healthy cells and tissue, and a score of 3 means the cells and tissue look the most abnormal. The scores for each feature are added together to get a total score between 3 and 9.
Three grades of breast cancer are possible:
- A total score between 3 to 5: G1 .
- A total score between 6 to 7: G2 .
- A total score between 8 to 9: G3 .
The grade is determined after a biopsy.;
Less Lymph Node Surgery Equivalent Survival
The trial, called ACOSOG Z0011, was designed to compare whether sentinel lymph node biopsy alone provided equivalent survival benefits to ALND after breast-conserving surgery among a subset of women who also received radiation and systemic therapy. The research team enrolled 891 participants into the study from 1999 to 2004.
Women who had stage I or II cancer and metastases in only one or two sentinel nodes were eligible to join the study. All women had undergone SLNB at the time of breast-conserving surgery.
Half of the trial participants received no further surgery, and the other half underwent ALND. Almost 90% of women in both groups had radiation therapy after surgery, and almost all received some type of systemic therapy.
In the initial results from the trial, published in 2010 and 2011, women who had only SLNB did not have worse overall survival than women who underwent full ALND. The two groups also had similar rates of disease-free survival and cancer recurrence in the lymph nodes.
These early results were absolutely practice changing, and at this point the overwhelming majority of surgeons are not doing a full axillary lymph node dissection in patients with one or two positive nodes, said Larissa Korde, M.D., head of Breast Cancer Therapeutics in NCIs Division of Cancer Treatment and Diagnosis.
However, the cancer research community had lingering concerns about the trial, the authors of the new paper explained.
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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What Is The Life Expectancy For Stage 3 Breast Cancer
The life expectancy for people with breast cancer is improving, according to the American Cancer Society. It points out that current survival rates are based on people who were diagnosed and treated at least 5 years ago and treatments have advanced over that time.
Your life expectancy with stage 3 breast cancer depends on several factors, such as:
- your age
- the size of the tumors
You should talk with your doctor about how these factors may apply to you.
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Metastatic Breast Cancer: What You Should Know
What does it mean to have metastatic, or stage 4, breast cancer? A Rogel Cancer Center oncologist explains the diagnosis and how its treated.
After hearing a diagnosis of metastatic breast cancer, a rush of questions emerges. But often, its not until long after leaving the doctors office.
Metastatic means the cancer has spread beyond the breast and immediate lymph nodes to other organs or tissues in the body, most often the bones, brain, lungs or liver. Its considered stage 4 breast cancer, which means the cancer has progressed to its most advanced stage.
But even though its moved to other organs, it still behaves like breast cancer and is treated with breast cancer therapies.
More than 154,000 U.S. women are estimated to have metastatic breast cancer, according to the Susan G. Komen organization. Men can have metastatic breast cancer too, but its rare.
To help patients fill in information gaps, N. Lynn Henry, M.D., Ph.D., the breast oncology disease lead for the University of Michigan Rogel Cancer Center, explains the nuances of stage 4 metastatic breast cancer.
What are the differences between metastatic breast cancer, stage 4 breast cancer and advanced cancer?
If any doctor uses the term advanced, ask for clarification, Henry adds.
When does metastatic breast cancer appear?
What are the symptoms?
Symptoms of bone metastases:
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A Lot To Learn About Alnd In Other Patients
Its important for doctors and patients to understand that these results can only be applied to women whose breast cancer and treatment regimen match those of the participants in the trial, the papers authors cautioned.
The results should not be used to direct the care of women with palpable axillary lymph nodes, women who had breast tumors larger than 5 cm in diameter, women with three or more positive sentinel lymph nodes, women who received chemotherapy or hormone therapy before surgery, and women who underwent mastectomy instead of breast-conserving surgery with radiation, they wrote.
We still have a lot to learn about ALND in other settings, commented Dr. Giuliano.
One trial, currently underway in Europe, is examining whether ALND can be skipped in some women who have a mastectomy for early-stage breast cancer, but results are not expected for years.
But for now, according to Edward Livingston, M.D., and Hsiao Ching Li, M.D., of the University of Texas Southwestern Medical Center, authors of an accompanying editorial, The ACOSOG Z0011 trial has shattered a century of belief that all cancer containing axillary lymph nodes must be removed in women with breast cancer.
Staging And Grading Of Breast Cancer
Knowing the stage and grade of the cancer helps your doctors plan the best treatment for you.
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Your specialist doctor needs certain information about the cancer to advise you on the best treatment for you. This includes:
- the stage of the cancer
- the grade of the cancer
- whether the cancer has;receptors; for hormones or a protein called HER2.
This information comes from the results of all the tests you have had, including:
- the biopsy, when the tissue was examined
- other tests that were done on the cells.
Your specialist doctor and nurse will talk to you about this. They will explain how it helps you and your doctor decide on your treatment plan.
We understand that waiting to know the stage and grade of your cancer can be a worrying time. We’re here if you need someone to talk to. You can:
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Stage 2 Breast Cancer
What is Stage 2 breast cancer?
Stage 2 breast cancer cells or tumors are larger than Stage 1 cancers, and may have spread to nearby lymph nodes. There are two types of Stage 2 breast cancer:
- Stage 2A Generally speaking, Stage 2A breast cancer can indicate one of the following:
- No tumor can be found in your breast, but cancer larger than 2 millimeters can be found in one to three underarm lymph nodes or near the breastbone.
- The tumor measures 2 centimeters or smaller, and has spread the nearby axillary lymph nodes.
- The cancer has not spread to area lymph nodes, however, the tumor measures between 2 and 5 centimeters.
What are the treatment options for Stage 2 breast cancer?
Stage 2 breast cancer treatment timeline
Again, it depends on what treatments or follow-up therapies are needed. Generally, the treatment timeline for Stage 2 breast cancer can last three to six months. Again, certain treatments like hormone therapies designed to stop the cancer from coming back can last for one to 10 years.