T Categories For Breast Cancer
T followed by a number from 0 to 4 describes the main tumors 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.
Survivorship Care After Invasive Lobular Carcinoma Treatment
Because of better diagnostic tests and advances in cancer treatments, more people are living longer than ever after being diagnosed with any type of cancer, including breast cancer. Experts estimate that there are more than 3.8 million breast cancer survivors in the United States.
Still, because of treatments theyve received, many breast cancer survivors have a higher risk of developing other diseases as they age, including high blood pressure, heart disease, and osteoporosis. To make sure breast cancer survivors are regularly screened for these and other diseases, experts have developed the idea of survivorship care planning.
Survivorship care plans are written documents made up of two parts.
The first part is a treatment summary, a record of all the breast cancer treatments youve received.
The second part is basically a roadmap of what you can expect in the years after treatment, including any late or long-term side effects you might have, and a schedule of how youll be monitored for these side effects and other health conditions. This part of the survivorship care plan usually includes:
the tests youll have
which doctors will order the tests
a schedule of when the tests will be done
resources, if you need more information
What Is Pt1c Breast Cancer
For example, if the cancer above was actually a maximum diameter of 1.2 cm and the lymph nodes were negative for metastatic cancer cells, then the pathologic stage would be pT1c, pNo, cM0 of stage I breast cancer This may all sound very confusing, but your doctor can help you figure out what your stage means.
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What Does T2 N0 M0 Mean
T2, N0, M0. there is a tumor in the breast within 2-5 cm. the cancer has not spread outside the breast no lymph nodes are involved. the cancer has not spread to distant sites.
What are T1 and T2 in breast cancer?
T0: no evidence of primary tumour. T1 : the tumor is 2 cm or less in diameter. T2: The tumor is more than 2 cm but not more than 5 cm in diameter. T3: the tumor is more than 5 cm in diameter.
Is a 5mm breast lump big?
In T1a breast cancer, the size of the tumor is less than or equal to 5 millimeters in T1b, the tumor size is greater than 5 mm, but less than or equal to 10 mm. Nodal spread T1a and T1b breast cancers have excellent long-term outcomes, with more than 95% of women alive at 10 years.
What stage of breast cancer is dangerous?
Stage IV. Stage IV describes invasive breast cancer that has spread beyond the breast and nearby lymph nodes to other organs in the body, such as the lungs, distant lymph nodes, skin, bones, liver or the brain. You may hear the words advanced and metastatic to describe stage IV breast cancer.
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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Why Is Staging Important
During your initial diagnosis, you and your cancer team will work together to develop a treatment plan. Staging allows you to answer the following questions:
- How does this cancer typically progress?
- Which treatments may work?
Some of the staging may be even more in-depth, but in general, its designed to prepare a more tailored approach to your disease. Your care team will be able to explain any new terms and what they mean for you.
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What Is The Survival Outlook For Breast Cancer
According to the National Cancer Institute , the percentage of patients surviving five years after diagnosis is:
- 99 percent for breast cancer that is still local to the breast
- 86 percent for breast cancer that has spread just outside the breast
- 29 percent for breast cancer that has spread to more distant parts of the body
The NCI also lists the five-year survival rate for breast cancer overall as 90.6 percent for women and 83 percent for men.
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M Categories For Breast Cancer
M followed by a 0 or 1 indicates whether the cancer has spread to distant organs — for example, the lungs, liver, or bones.
M0: No distant spread is found on x-rays or by physical exam.
cM0: Small numbers of cancer cells are found in blood or bone marrow , or tiny areas of cancer spread are found in lymph nodes away from the underarm, collarbone, or internal mammary areas.
M1: Cancer has spread to distant organs as seen on imaging tests or by physical exam, and/or a biopsy of one of these areas proves cancer has spread and is larger than 0.2mm.
N Categories For Breast Cancer
N followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are involved.
Lymph node staging for breast cancer is based on how the nodes look under the microscope, and has changed as technology has gotten better. Newer methods have made it possible to find smaller and smaller groups of cancer cells, but experts haven’t been sure how much these tiny deposits of cancer cells influence outlook.
Its not yet clear how much cancer in the lymph node is needed to see a change in outlook or treatment. This is still being studied, but for now, a deposit of cancer cells must contain at least 200 cells or be at least 0.2 mm across for it to change the N stage. An area of cancer spread that is smaller than 0.2 mm doesn’t change the stage, but is recorded with abbreviations that indicate the type of special test used to find the spread.
If the area of cancer spread is at least 0.2 mm , but still not larger than 2 mm, it is called a micrometastasis . Micrometastases are counted only if there aren’t any larger areas of cancer spread. Areas of cancer spread larger than 2 mm are known to influence outlook and do change the N stage. These larger areas are sometimes called macrometastases, but are more often just called metastases.
NX: Nearby lymph nodes cannot be assessed .
N0: Cancer has not spread to nearby lymph nodes.
N1c: Both N1a and N1b apply.
N3: Any of the following:
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Learning You Have Breast Cancer
You wake one morning and find a lump in your breast or you go for a screening mammogram and get recalled for additional views.
Welcome to the roller coaster of breast disease. However, this process need not be frightening, as you are in control and you determine where you are going. What you need now is information.
Where do you begin this daunting task?
The most important thing to do is to get the answers to all of your questions. A mass in your breast or an abnormality on your mammogram will require further evaluation. An ultrasound is often required to further characterize a mass as solid or cystic .
There are also microscopic findings on mammograms called calcifications that may require spot magnification views. Depending upon the findings of your radiologic studies, you may be referred to a surgeon or radiologist for a biopsy.
Most procedures to biopsy the breast can be performed in an outpatient setting, which will allow you to have the procedure performed more quickly. Oftentimes, an ultrasound or mammogram is used to guide your surgeon to the abnormal area of your breast. If the lump in your breast is not apparent on any studies, it still needs to be evaluated and likely require a biopsy to determine whether or not it is cancerous. Remember, 20 percent of all cancers are not seen on mammograms or ultrasounds therefore, palpable masses with negative X-ray studies need to be thoroughly evaluated.
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.
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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. Were here if you need someone to talk to. You can:
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Sentinel Lymph Node Biopsy
Axillary lymph node evaluation has been the standard of care in breast cancer treatment. This procedure involves the removal of two levels of lymph nodes from the axilla to determine if the cancer has spread locally. This is considered part of the staging of the breast cancer and is routinely done at the time of the definitive breast cancer surgery.
One of the debilitating side effects of axillary dissection has been lymphedema . This occurs in approximately 8 to 12 percent of patients. The arm may also become numb above the elbow at the level of the triceps muscle. You must protect your arm from cuts and scrapes for the rest of your life to prevent lymphangitis .
In an attempt to better diagnose lymph node metastasis and decrease complications associated with axillary dissection, a method of lymph node mapping adopted from melanoma treatment has been used to identify the sentinel lymph node. This lymph node can be evaluated for microscopic metastasis through various procedures from a frozen section done in the operating room to high tech evaluation called cytokeratin staining. It generally takes 7 days to receive the results and is far more sensitive than the naked eye of the pathologist. .
We know that women previously thought to be node negative and therefore, have local disease, have died of distant metastasis. This may be related to our previous inability to find these microscopic metastatic deposits and treat them aggressively with chemotherapy.
What Does It Mean If My Carcinoma Has Tubular Mucinous Cribriform Or Micropapillary Features
These are different types of invasive ductal carcinoma that can be identified under the microscope.
- Tubular, mucinous, and cribriform carcinomas are special types of well-differentiated cancers that often have a better prognosis than the more common type of invasive ductal carcinoma .
- Micropapillary carcinoma is a type of invasive breast carcinoma that often has a worse prognosis.
If your doctor knows that your tumor is made up of one of these special types of breast cancer, he or she may recommend different treatment.
Since some tumors are made up of more than one type, the entire tumor must be removed in order to know what types your tumor contains. A needle biopsy doesnt give enough information to guide treatment.
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Examples Using The Full Staging System
Because there are so many factors that go into stage grouping for breast cancer, its not possible to describe here every combination that might be included in each stage. The many different possible combinations mean that two women who have the same stage of breast cancer might have different factors that make up their stage.
Here are 3 examples of how all of the factors listed above are used to determine the pathologic breast cancer stage:
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What Does It Mean If My Doctor Asks For A Special Molecular Test To Be Performed On My Specimen
Molecular tests such as Oncotype DX® and MammaPrint® may help predict the prognosis of certain breast cancers, but not all cases need these tests. If one of these tests is done, the results should be discussed with your treating doctor. The results will not affect your diagnosis, but they might affect your treatment.
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What Is Stage Iv Breast Cancer
Stage IV is the most advanced stage of breast cancer. It has spread to nearby lymph nodes and to distant parts of the body beyond the breast. This means it possibly involves your organs such as the lungs, liver, or brain or your bones.
Breast cancer may be stage IV when it is first diagnosed, or it can be a recurrence of a previous breast cancer that has spread.
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Physical Emotional And Social Effects Of Cancer
In general, cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Supportive care treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies.
Music therapy, meditation, stress management, and yoga for reducing anxiety and stress.
Meditation, relaxation, yoga, massage, and music therapy for depression and to improve other mood problems.
Meditation and yoga to improve general quality of life.
Acupressure and acupuncture to help with nausea and vomiting from chemotherapy.