Stages of Breast Cancer

Breast Cancer: Stages

The way in which a cancer spread or grow is called staging. Staging basically describes the location of cancer, the extent of growth of cancer, and area of spreading of cancer. The stage of cancer is confirmed by diagnostic tests. The confirmation of staging helps the doctor to decide the best kind of treatment and can predict prognosis of a patient, which are chances of recovery. Different types of cancer have different stage description.

Stages of ductal carcinoma of breast cancer

TNM staging system

The commonly used tool to describe the stages of cancer is the TNM system. Doctors take the results from diagnostic tests and employ them to find the answer of following questions:

·         Tumor (T): How large is the extent of primary tumor? Where is it’s location?

·         Node (N): Has the tumor grow to the lymph nodes? If yes, where and how many?

·         Metastasis (M): Has the cancer spread to certain other parts of the body? If yes, where and how much?

The stages of cancer for each person are determined from the combined results.

There are mainly five type of stages: A stage which is non-invasive ductile carcinoma in situ (DCIS) is called stage 0 (zero). The other stages from I through V are employed for invasive breast cancer.

Staging can be pathological or clinical. Pathological surgery is based on removing breast tissue and lymph nodes during surgery. The results are usually obtained after many days after surgery. Generally, pathological staging gives the complete information for determining prognosis of a patient. While clinical staging depends on results of tests before surgery which may include mammogram, MRI scans, physical examination and ultrasound.

The further detail of the TNM system for the breast cancer is given below:

Tumor (T)

Utilizing the TNM system, the “T” with a letter or number from 0 to 4 is used for describing the location and size of the tumor. The size of tumor is measured in centimeter (cm). A centimeter is nearly equal to the width of a standard pencil or pen.

Stages may also be divided into further smaller groups in order to explain the more detail of tumor. The information of specific stages of tumor are listed below:

TX: The primary tumor cannot be graded

T0 (T plus zero): This indicates no evidence of cancer in the breast.

Tis: This indicates to carcinoma in situ. The cancer is restricted within the ducts of breast tissue and has not proliferate into the surrounding tissue of the breast. Breast carcinoma in situ has 2 types.

·         Tis (DCIS): DCIS is noninvasive type of cancer, but it can develop into invasive breast cancer later if it is not removed. DCIS refers to the situation where cancer cells have been confined into ducts of breast and have not proliferate past the layer of tissue where they began.

·         Tis (Paget’s): Paget’s disease of the nipple is a rare and early noninvasive form of cancer that is present only in the skin cells of nipple. Paget’s disease sometimes become associated with invasive breast cancer. If another invasive breast cancer is present, it is classified depending on the stage of invasive tumor.

T1: The tumor in the breast at its widest area is 20 milli-meters or smaller in size. Its size is little less than an inch. This stage is further divided into four substages based on the size of the tumor:

·         T1mi is a tumor having size 1 mm or even smaller

·         T1a is a tumor having size larger than 1 mm but 5 mm or even smaller

·         T1b is a tumor having size larger than 5 mm but 10 mm or even smaller

·         T1c is a tumor having size larger than 10 mm but 20 mm or even smaller

T2: The tumor having size larger than 20 mm but not larger than 50 mm.

T3: The tumor having size larger than 50 mm.

T4: The tumor falls into 1 of the groups given below:

·         T4a refers to the tumor that has grown into the chest wall.

·         T4b refers to the tumor that has grown into the skin.

·         T4c refers to the tumor that has grown into the chest wall and the skin.

·         T4d is refers to inflammatory breast cancer.

Node (N)

The “N” in the TNM staging system refers for lymph nodes. Regional lymph nodes include:

·         Lymph nodes that are lacated under the arm are termed as axillary lymph nodes

·         Below and above the collarbone

·         Under the breastbone which is termed as internal mammary lymph nodes

Lymph nodes that are present in other parts of the body are termed as distant lymph nodes. If the doctor diagnosis lymph nodes without surgery using various tests and physical examination, the letter “N” is placed by “C” for clinical staging. If the doctor diagnosis lymph nodes after surgery which is a more authentic evaluation, the letter “N” is replaced by “P” for pathological staging. The pathological staging is described by the following information.

NX: Refers to the lymph nodes were not evaluated.

N0: Either of the following situations:

·         No cancer was diagnosed in the lymph nodes.

·         Lymph nodes contain areas of cancer that are smaller than 0.2 millimeter (mm).

N1: The cancer has proliferated to 1 to 3 internal mammary lymph nodes and axillary lymph nodes. If the size of tumor located in the lymph nodes is larger than 0.2 mm but equal to 2mm or smaller, it is termed as “micrometastatic” (N1mi).

N2: The cancer has proliferate to 4 to 9 axillary lymph nodes. Or it has proliferate to the internal mammary lymph nodes, but not found the axillary lymph nodes.

N3: The cancer has proliferate to 10 or more axillary lymph nodes. Or it has proliferate to the lymph nodes present under the collarbone or clavicle. It may have also proliferate to the internal mammary lymph nodes. Tumor that has proliferate to the lymph nodes above the clavicle is termed the supraclavicular lymph nodes, is also described as N3.

If the tumor is present in the lymph nodes, it is important to find the number of lymph nodes that are involved in cancer and also their location to help the doctors to plan treatment. The pathologists can evaluate the number of axillary lymph nodes that are involved in cancer after removing them during surgery. If the cancer is located in axillary lymph nodes, treatments other than surgery such as chemotherapy, radiation therapy and hormonal therapy are used during early stages of treatment.

Metastasis (M)

The “M” in the TNM system refers to whether has proliferated to various parts of the body which is termed as distant metastasis. This is no longer falls into the category of early-stage or locally advanced cancer.

MX: Refers to distant proliferation that cannot be evaluated.

M0: Refers to the disease that has not metastasized.

M0 (i+): It refers to the condition where no clinical or radiographic evidence of distant metastases are evaluated. Microscopic evidences of cancer cells is found in the bone marrow, blood or other lymph nodes that have size 0.2 mm or smaller.

M1: Evidences have reveal the metastasis to another part of the body which means that breast cancer cells are growing in other organs.

Cancer stage grouping

Doctors have assigned the stage of the cancer by combination of T, N, and M classifications and the grade of tumor and the results of PR/ER and HER2 testing. This information is used in determining the prognosis. T, N and M classification is the simple approach for explaining the stages of cancer. Different stages are described below on the basis of this approach.

The exact stage of cancer is finalized after surgery usually about 5 to 7 days after surgery. Doctor may termed stage I to stage IIA cancer as early stage cancer and stage IIB to III as locally advanced cancer.

Stage 0: When the disease is only in the ducts of breast tissue and has not proliferate to the surrounding tissue of the breast. It also termed as noninvasive cancer.

Stage IA: The tumor is invasive, small and has not proliferate to the lymph nodes.

Stage IB: Cancer has proliferate to the lymph nodes having size larger than 0.2 mm but smaller than 2 mm in size. There are no evidences of tumor in the breast having size 20 mm or smaller.

Stage IIA: Any 1 of these conditions:

·         The cancer has proliferate to 1 to 3 axillary lymph nodes but there are no evidences of tumor in the breast. It has not proliferate to the distant parts of the body.

·         The size of tumor is 20 mm or smaller and has proliferate the axillary lymph nodes.

·         The size of tumor is larger than 20 mm but smaller than 50 mm and has not proliferate to the axillary lymph nodes.

Stage IIB: Either of these conditions:

·         The size of tumor is larger than 20 mm but smaller than 50 mm and has proliferate to 1 to 3 axillary lymph nodes.

·         The size of tumor is larger than 50 mm but has not proliferate to the axillary lymph nodes.

Stage IIIA: The cancer of any size has proliferate to internal mammary lymph nodes or to 4 to 9 axillary lymph nodes. It has not proliferate to other body parts. Stage IIIA can also be a tumor larger than 50 mm that has proliferate to 1 to 3 axillary lymph nodes.

Stage IIIB: The tumor has proliferate to the chest wall or caused ulceration or swelling of the breast or may be diagnosed as inflammatory breast cancer. It may or may not have proliferate to up to internal or 9 axillary mammary lymph nodes. It has not proliferate to other parts of the body.

Stage IIIC: A tumor of any size that has proliferate to the internal mammary lymph nodes, 10 or more axillary lymph nodes and the lymph nodes under the collarbone. It has not proliferate to other parts of the body.

Stage IV (metastatic): .The tumor can be of any size and has proliferate to other organs such as the lungs, bones, liver, brain, chest wall and distant lymph nodes. When the tumor is first diadnosed occurs about 6% of the time, then it leads to metastatic breast cancer. Mostly, metastatic breast cancer is evaluated after previous diagnosis of early breast cancer.

Recurrent: The cancer that comes back after treatment is termed as recurrent cancer and can be described as regional, local and distant. If there is recurrence of cancer after treatment, another round of test will begin to learn about the extent of recurrence. These tests and scans are nearly similar to those at the time of the original diagmosis.