What Does It Mean To Have Stage 2 Breast Cancer?

Stage 2 means the breast cancer is growing, but it is still contained in the breast or growth has only extended to the nearby lymph nodes.

This stage is divided into groups: Stage 2A and Stage 2B. The difference is determined by the size of the tumor and whether the breast cancer has spread to the lymph nodes.

For Stage 2 breast cancer, chemotherapy is usually done first, followed by surgery and radiation therapy.

Stage IIA Breast Cancer Means One Of The Following Descriptions Applies.

Either:

No actual tumor is associated with the cancerous cells and less than four auxillary lymph nodes have cancer cells present.

OR

The tumor is less than 2 centimeters and less than four auxillary lymph nodes have cancer cells present.

OR

The tumor is between 2 and 5 centimeters and has not yet spread to the lymph nodes.

Stage IIB Breast Cancer Means One Of The Following Descriptions Applies.

Either:

The tumor is between the 2 and 5 centimeters and has spread to less than four axillary lymph nodes.

OR

The tumor is larger than five centimeters, but has not spread to any axillary lymph nodes.

Medically reviewed June 2023

The post Stage 2 (II) And Stage 2A (IIA) Breast Cancer Overview appeared first on National Breast Cancer Foundation.

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.

Stage 3A Breast Cancer Means One Of The Following Descriptions Applies.

Either:

No actual tumor is associated with the cancerous cells or the tumor may be any size, AND the nearby lymph nodes (4 or more nodes with as many as 9 affected) contain cancer.

Or

The tumor is larger than the approximate size of a small lime (more than 5 centimeters), AND small clusters of breast cancer cells are found in the lymph nodes between the approximate size of a pinprick and the width of a grain of rice. (.2mm – 2.0mm.)

Or

The tumor is larger than the approximate size of a small lime (over 5 centimeters), AND the cancer has spread to 1, 2, or 3 lymph nodes under the arm or near the breastbone.

Stage 3B Breast Cancer Means The Following Descriptions Apply.

The tumor may be any size, AND cancer has invaded the chest wall or breast skin with evidence of swelling, inflammation, or ulcers (such as with cases like inflammatory breast cancer). The breast cancer may also have invaded up to 9 nearby lymph nodes.

Stage 3C Breast Cancer Means One Of The Following Descriptions Applies.

Either:

No actual tumor is found in the breast (such as with cases like inflammatory breast cancer) or the tumor may be any size, AND cancer may have invaded the chest wall or breast skin with evidence of swelling, inflammation, or ulcers and cancer has also invaded 10 or more lymph nodes under the arm

OR

No actual tumor is found in the breast or the tumor may be any size AND lymph nodes extending to the collarbone area are found to contain cancer. 

OR

No actual tumor is found in the breast or the tumor may be any size AND lymph nodes under the arm and near the breastbone are found to contain cancer.

“Inoperable” Breast Cancer Is Often Still Treatable.

Stage 3C breast cancer is divided into operable and inoperable stage 3C breast cancer. However, the term “inoperable” is not the same as “untreatable.”

If your physician uses the word “inoperable,” it may simply mean that a simple surgery at this time would not be enough to get rid of all the breast cancer that is within the breast and the tissue around the breast. There must be healthy tissue at all of the margins of the breast when it is removed. Keep in mind that the breast tissue goes beyond the breast mound – it goes up to the clavicle and down to a few inches below the breast mound. There must also be tissue to close the chest wound after the surgery is performed.

Another treatment method may be used first to shrink the breast cancer as much as possible before surgery is considered.
 

What Should A Person With Stage 3 Breast Cancer Expect From Treatment?

Stage 3 treatment options vary widely and may consist of mastectomy and radiation for local treatment and hormone therapy or chemotherapy for systemic treatment. Nearly every person with a Stage 3 diagnosis will do best with a combination of two or more treatments. 

Chemotherapy is always given first with the goal to shrink the breast cancer to be smaller within the breast and within the lymph nodes that are affected. This is known as neoadjuvant chemotherapy.

Other possible treatments include biologic targeted therapy and immunotherapy. There may be various clinical trial options for interested patients with Stage 3 breast cancer.

Medically reviewed June 2023

The post Stage 3 (III) A, B, And C Breast Cancer Overview appeared first on National Breast Cancer Foundation.

Stage 4 breast cancer means that the cancer has spread to other areas of the body, such as the brain, bones, lung and liver. Stage 4 breast cancer is also known as metastatic breast cancer.

Although Stage 4 breast cancer is not curable, it is usually treatable and current advances in research and medical technology mean that more and more women are living longer by managing the disease as a chronic illness with a focus on quality of life as a primary goal. With excellent care and support, as well as personal motivation, Stage 4 breast cancer may respond to a number of treatment options that can extend your life for several years.

What Should A Person With Stage 4 Breast Cancer Expect From Treatment?

Treatment options vary widely depending on where you live, your access to specialists and sub-specialists, and your willingness to try therapies that are still in the experimental phase.

Seek out oncology specialists who specialize in Stage 4 breast cancer. Discuss with your treatment team what clinical trials may be available for your clinical situation.

During this time, be sure to surround yourself with a support system of friends and family.  

Medically reviewed June 2023

The post Stage 4 (IV) Breast Cancer appeared first on National Breast Cancer Foundation.

What Types Of Cancer Are Diagnosed As Stage 0 And 1 Breast Cancer?

The stage of cancer indicates the size of the tumor of abnormal cells and whether or not those cells are contained to the place of origin. The most common type of breast cancer is ductal carcinoma in situ (DCIS), indicating the cancer cell growth starts in the milk ducts. 

What does the term, “in situ” mean?

Stage 0 cancers are called “carcinoma in situ.” Carcinoma means cancer and “in situ” means “in the original place.” Three possible types of “in situ carcinoma” of the breast tissue are:

• DCIS – Ductal carcinoma in situ
• LCIS – Lobular carcinoma in situ
• Paget disease of the nipple

What Is Stage 0 DCIS?

Stage 0 breast cancer, ductal carcinoma in situ (DCIS) is a non-invasive cancer where abnormal cells have been found in the lining of the breast milk duct. In Stage 0 breast cancer, the atypical cells have not spread outside of the ducts or lobules into the surrounding breast tissue. Ductal Carcinoma In Situ is very early cancer that is highly treatable, but if it’s left untreated or undetected, it can spread into the surrounding breast tissue.

What is Stage 0 LCIS?

Lobular carcinoma in situ at Stage 0 generally is not considered cancer. Although it has carcinoma in the name, it really describes a growth of abnormal but non-invasive cells forming in the lobules. Some experts prefer the name lobular neoplasia for this reason because it accurately refers to the abnormal cells without naming them as cancer. LCIS, however, may indicate a woman has an increased risk of developing breast cancer.

If you have been diagnosed with LCIS, your doctor may recommend regular clinical breast exams and mammograms. He or she may also prescribe Tamoxifen, a hormone therapy medication that helps prevent cancer cells from growing.

What Does It Mean To Have Stage 1 Breast Cancer?

In Stage 1 breast cancer, cancer is evident, but it is contained to only the area where the first abnormal cells began to develop. The breast cancer has been detected in the early stages and can be very effectively treated.

Stage 1 can be divided into Stage 1A and Stage 1B. The difference is determined by the size of the tumor and the lymph nodes with evidence of cancer.

Stage 1A breast cancer means the following description applies:

The tumor is smaller than the approximate size of a peanut (2 centimeters or smaller) AND has not spread to the lymph nodes. (2.5 centimeters=1 inch)

Stage 1B breast cancer means one of the following descriptions applies:

Lymph nodes have cancer evidence with small clusters of cells between the approximate size of a pinprick to the approximate width of a grain of rice (.2mm to 2.0 mm).

AND EITHER 
No actual tumor is found in the breast.

OR 
The tumor is smaller than the approximate size of a peanut (2 centimeters or smaller). (2.5 centimeters=1 inch)

Similar to stage 0, breast cancer at this stage is very treatable and survivable. When breast cancer is detected early, and is in the localized stage (there is no sign that the cancer has spread outside of the breast), the 5-year relative survival rate is 99%.

What Should A Person With Stage 0 Or Stage 1 Breast Cancer Expect Regarding Treatment?

Even though Stage 0 breast cancer is considered “non-invasive,” it does require treatment, typically surgery or radiation, or a combination of the two.  Chemotherapy is usually not part of the treatment regimen for earlier stages of cancer.

Stage 1 is highly treatable, however, it does require treatment, typically surgery and often radiation, or a combination of the two. Additionally, you may consider hormone therapy, depending on the type of cancer cells found and your additional risk factors. Like stage 0, Chemotherapy is often not necessary for earlier stages of cancer. 

Material on this page courtesy of National Cancer Institute

Medically Reviewed on April 15, 2020

The post Stages 0 & 1 Breast Cancer Overview appeared first on National Breast Cancer Foundation.

Breast Cancer Stage

Once a person is determined to have a malignant tumor or the diagnosis of breast cancer, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.

The process used to find out whether the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of some of the tests used to diagnose breast cancer are also used to stage the disease.

On January 1, 2018, the American Join Committee on Cancer (AJCC) launched new staging guidelines for breast cancer.

Determining Breast Cancer Stage

In breast cancer, stage is based on the size and location of the primary tumor, the spread of cancer to nearby lymph nodes or other parts of the body, tumor grade, and whether certain biomarkers are present.

The TNM system, the grading system, and the biomarker status are combined to find out the breast cancer stage.

TNM System

The TNM system is used to describe the size of the primary tumor and the spread of cancer to nearby lymph nodes or other parts of the body.

TNM stands for:

• T = Tumor. The size and location of the tumor.
• N = Lymph Node. The size and location of lymph nodes where cancer has spread.
• M = Metastasis. The spread of cancer to other parts of the body.

Grading System

The tumor grading system is used to describe how quickly a breast tumor is likely to grow and spread.

Biomarker Test

Biomarker testing is used to find out whether breast cancer cells have certain receptors.

Breast Cancer Tests

The following tests and procedures also may be used in the staging process:

• Sentinel lymph node biopsy: The removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node in a group of lymph nodes to receive lymphatic drainage from the primary tumor. It is the first lymph node the cancer is likely to spread to from the primary tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist examines this tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. Sometimes, a sentinel lymph node is found in more than one group of nodes.
• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• MRI (magnetic resonance imaging): During a breast MRI, a magnet connected to a computer transmits magnetic energy and radio waves (not radiation) through the breast tissue. It scans the tissue, making detailed pictures of areas within the breast. These images help the medical team distinguish between normal and diseased tissue.
• Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
• Blood tests: The doctor may choose to order some specific blood tests to look at the function of the liver, and other organs as well.

Metastasis

There are three ways that cancer spreads in the body. Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas. The report may say there are cancer cells that extend beyond the area where the cancer originally started to grow.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body. The report may say there are positive lymph nodes or that there is the presence of lymphatic invasion.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body. The report may say there is the presence of vascular invasion, or that blood vessels are seen running through the breast cancer tumor itself.

Cancer may spread from where it began to other parts of the body. When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bone, the cancer cells in the bone are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

Breast Cancer Stage Groups

In breast cancer, stage is based on the size and location of the primary tumor, the spread of cancer to nearby lymph nodes or other parts of the body, tumor grade, and whether certain biomarkers are present. To plan the best treatment and understand your prognosis, it is important to know the breast cancer stage.

There are 3 types of breast cancer stage groups:

• Clinical Prognostic Stage is used first to assign a stage for all patients based on health history, physical exam, imaging tests (if done), and biopsies. The Clinical Prognostic Stage is described by the TNM system, tumor grade, and biomarker status (ER, PR, HER2). In clinical staging, mammography or ultrasound is used to check the lymph nodes for signs of cancer.
• Pathological Prognostic Stage is then used for patients who have surgery as their first treatment. The Pathological Prognostic Stage is based on all clinical information, biomarker status, and laboratory test results from breast tissue and lymph nodes removed during surgery.
• Anatomic Stage is based on the size and the spread of cancer as described by the TNM system. The Anatomic Stage is used in parts of the world where biomarker testing is not available. It is not used in the United States.

TNM System

The TNM system is used to describe the size of the primary tumor and the spread of cancer to nearby lymph nodes or other parts of the body.

For breast cancer, the TNM system describes the tumor as follows:

Tumor (T). The size and location of the tumor.

TX: Primary tumor cannot be assessed.

• T0: No sign of a primary tumor in the breast.
• Tis: Carcinoma in situ. There are 2 types of breast carcinoma in situ:
  • Tis (DCIS): DCIS is a condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive breast cancer that is able to spread to other tissues. At this time, there is no way to know which lesions can become invasive.
  • Tis (Paget disease): Paget disease of the nipple is a condition in which abnormal cells are found in the skin cells of the nipple and may spread to the areola. It is not staged according to the TNM system. If Paget disease AND an invasive breast cancer are present, the TNM system is used to stage the invasive breast cancer.
• T1: The tumor is 20 millimeters or smaller. There are 4 subtypes of a T1 tumor depending on the size of the tumor:
  • T1mi: the tumor is 1 millimeter or smaller.
  • T1a: the tumor is larger than 1 millimeter but not larger than 5 millimeters.
  • T1b: the tumor is larger than 5 millimeters but not larger than 10 millimeters.
  • T1c: the tumor is larger than 10 millimeters but not larger than 20 millimeters.
• T2: The tumor is larger than 20 millimeters but not larger than 50 millimeters.
• T3: The tumor is larger than 50 millimeters.
• T4: The tumor is described as one of the following:
  • T4a: the tumor has grown into the chest wall.
  • T4b: the tumor has grown into the skin—an ulcer has formed on the surface of the skin on the breast, small tumor nodules have formed in the same breast as the primary tumor, and/or there is swelling of the skin on the breast.
  • T4c: the tumor has grown into the chest wall and the skin.
  • T4d: inflammatory breast cancer—one-third or more of the skin on the breast is red and swollen (called peau d’orange).

Lymph Node (N). The size and location of lymph nodes where cancer has spread.

When the lymph nodes are removed by surgery and studied under a microscope by a pathologist, pathologic staging is used to describe the lymph nodes. The pathologic staging of lymph nodes is described below.

• NX: The lymph nodes cannot be assessed.
• N0: No sign of cancer in the lymph nodes, or tiny clusters of cancer cells not larger than 0.2 millimeters in the lymph nodes.
• N1: Cancer is described as one of the following:
  • N1mi: cancer has spread to the axillary (armpit area) lymph nodes and is larger than 0.2 millimeters but not larger than 2 millimeters.
  • N1a: cancer has spread to 1 to 3 axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters.
  • N1b: cancer has spread to lymph nodes near the breastbone on the same side of the body as the primary tumor, and the cancer is larger than 0.2 millimeters and is found by sentinel lymph node biopsy. Cancer is not found in the axillary lymph nodes.
  • N1c: cancer has spread to 1 to 3 axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters. Cancer is also found by sentinel lymph node biopsy in the lymph nodes near the breastbone on the same side of the body as the primary tumor.
• N2: Cancer is described as one of the following:
  • N2a: cancer has spread to 4 to 9 axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters.
  • N2b: cancer has spread to lymph nodes near the breastbone and the cancer is found by imaging tests. Cancer is not found in the axillary lymph nodes by sentinel lymph node biopsy or lymph node dissection.
• N3: Cancer is described as one of the following:
  • N3a: cancer has spread to 10 or more axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters, or cancer has spread to lymph nodes below the collarbone.
  • N3b: cancer has spread to 1 to 9 axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters. Cancer has also spread to lymph nodes near the breastbone and the cancer is found by imaging tests; or
  • cancer has spread to 4 to 9 axillary lymph nodes and cancer in at least one of the lymph nodes is larger than 2 millimeters. Cancer has also spread to lymph nodes near the breastbone on the same side of the body as the primary tumor, and the cancer is larger than 0.2 millimeters and is found by sentinel lymph node biopsy.
  • N3c: cancer has spread to lymph nodes above the collarbone on the same side of the body as the primary tumor.

When the lymph nodes are checked using mammography or ultrasound, it is called clinical staging. The clinical staging of lymph nodes is not described here.

Metastasis (M). The spread of cancer to other parts of the body.

• M0: There is no sign that cancer has spread to other parts of the body.
• M1: Cancer has spread to other parts of the body, most often the bones, lungs, liver, or brain. If cancer has spread to distant lymph nodes, the cancer in the lymph nodes is larger than 0.2 millimeters. The cancer is called metastatic breast cancer.

Grading System

The grading system is used to describe how quickly a breast tumor is likely to grow and spread. The grading system describes a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Low-grade cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells.

To describe how abnormal the cancer cells and tissue are, the pathologist will assess the following three features:

• How much of the tumor tissue has normal breast ducts.
• The size and shape of the nuclei in the tumor cells.
• How many dividing cells are present, which is a measure of how fast the tumor cells are growing and dividing.

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 normal 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 are possible:

• Total score of 3 to 5: G1 (Low grade or well differentiated).
• Total score of 6 to 7: G2 (Intermediate grade or moderately differentiated).
• Total score of 8 to 9: G3 (High grade or poorly differentiated).

Biomarker Testing

Biomarker testing is used to find out whether breast cancer cells have certain receptors.

Healthy breast cells, and some breast cancer cells, have receptors (biomarkers) that attach to the hormones estrogen and progesterone. These hormones are needed for healthy cells, and some breast cancer cells, to grow and divide. To check for these biomarkers, samples of tissue containing breast cancer cells are removed during a biopsy or surgery. The samples are tested in a laboratory to see whether the breast cancer cells have estrogen or progesterone receptors.

Another type of receptor (biomarker) that is found on the surface of all breast cancer cells is called HER2. HER2 receptors are needed for the breast cancer cells to grow and divide.

For breast cancer, biomarker testing includes the following:

• Estrogen receptor (ER). If the breast cancer cells have estrogen receptors, the cancer cells are called ER positive (ER+). If the breast cancer cells do not have estrogen receptors, the cancer cells are called ER negative (ER-).
• Progesterone receptor (PR). If the breast cancer cells have progesterone receptors, the cancer cells are called PR positive (PR+). If the breast cancer cells do not have progesterone receptors, the cancer cells are called PR negative (PR-).
• Human epidermal growth factor type 2 receptor (HER2/neu or HER2). If the breast cancer cells have larger than normal amounts of HER2 receptors on their surface, the cancer cells are called HER2 positive (HER2+). If the breast cancer cells have a normal amount of HER2 on their surface, the cancer cells are called HER2 negative (HER2-). HER2+ and HER2/neu breast cancers are more likely to grow and divide faster than HER2- breast cancer.

Sometimes the breast cancer cells will be described as triple negative or triple positive.

• Triple negative. If the breast cancer cells do not have estrogen receptors, progesterone receptors, or a larger than normal amount of HER2 receptors, the cancer cells are called triple negative.
• Triple positive. If the breast cancer cells do have estrogen receptors, progesterone receptors, and a larger than normal amount of HER2 receptors, the cancer cells are called triple positive.

It is important to know the estrogen receptor, progesterone receptor, and HER2 receptor status to choose the best treatment. There are drugs that can stop the receptors from attaching to the hormones estrogen and progesterone and stop the cancer from growing. Other drugs may be used to block the HER2 receptors on the surface of the breast cancer cells and stop the cancer from growing.

Staging Examples

The TNM system, the grading system, and biomarker status are combined to find out the breast cancer stage.

Here are 3 examples that combine the TNM system, the grading system, and the biomarker status to find out the Pathological Prognostic breast cancer stage for a woman whose first treatment was surgery:

If the tumor size is 30 millimeters (T2), has not spread to nearby lymph nodes (N0), has not spread to distant parts of the body (M0), and is:

• Grade 1
• HER2+
• ER-
• PR-

The cancer is stage IIA.

If the tumor size is 53 millimeters (T3), has spread to 4 to 9 axillary lymph nodes (N2), has not spread to other parts of the body (M0), and is:

• Grade 2
• HER2+
• ER+
• PR-

The tumor is stage IIIA.

If the tumor size is 65 millimeters (T3), has spread to 3 axillary lymph nodes (N1a), has spread to the lungs (M1), and is:

• Grade 1
• HER2+
• ER-
• PR-

The cancer is stage IV (metastatic breast cancer).

Talk to your doctor to find out what your breast cancer stage is and how it is used to plan the best treatment for you.

After surgery, your doctor will receive a pathology report that describes the size and location of the primary tumor, the spread of cancer to nearby lymph nodes, tumor grade, and whether certain biomarkers are present. The pathology report and other test results are used to determine your breast cancer stage.

Ask your doctor to explain how staging is used to decide the best options to treat your cancer and whether there are clinical trials that might be right for you. Since this is likely to be a stressful time and you may have many questions, it may be a good idea for you to take a friend or loved one with you to your appointment to help take notes. You can also ask your doctor if you can record the consultation on your cell phone or a recording device to refer back to later.

Medically reviewed June 2023

Materials on this page courtesy of National Cancer Institute

The post Breast Cancer Stages appeared first on National Breast Cancer Foundation.