Breast Cancer Staging
Breast cancer ‘screening‘ is the process by which any potentially malignant breast abnormality may be discovered through mammography. If something abnormal appears on the mammogram, depending on how suspicious it appears, the women will usually be ‘called back‘ for a second-look mammogram, or maybe an ultrasound or MRI. If that is insufficient to rule out breast cancer, then a tissue sample may be taken (a biopsy) and sent for pathological evaluation, where a diagnosis of breast cancer can either be confirmed, or ruled out. The ‘staging‘ process begins when a pathologist makes a definitive diagnosis of breast cancer, and a number of more specific diagnostic investigations are undertaken in order to determine the specific type of breast cancer, the ‘extent‘ (meaning the size of the tumor, invasive status, and any metastases), and also to try and determine the best or more advantageous ways to treat the breast cancer.
I just want to let you know that this page is getting kind of somewhat “older”… Don’t get me wrong though, it is still very useful for research. However, I have created a newer verion of this page with more up-to-date information Breast Cancer Stages.
Additional ‘diagnostic screening’ studies may be required
There is a kind of ‘in between‘ state when something abnormal is detected on the initial screening, but more investigations are required to figure out what it is. Properly speaking, that is still part of the screening process, even though much of that information will be useful for staging purposes. And, indeed, in quite a few ‘proliferative‘ breast lesions it remains unclear whether or not the neoplasm is actually benign or a potential threat of breast cancer, even after biopsy. So, just because the doctors need to take additional images or request a biopsy, this does not mean that a patient is being ‘staged‘ for breast cancer. It means something abnormal and potentially harmful has been detected at initial screening, and they need to figure out exactly what it is. In a majority of cases, follow-up imaging studies and biopsies turn out to be benign breast lesions.
Staging means breast cancer is confirmed and treatment must commence
‘Staging‘ begins the moment that a diagnosis of breast cancer is confirmed by a pathologist, and the purpose of staging is to assess the cancer and plan the treatment. In the some cases the same imaging modalities may be used again in staging as were used in screening. Additional breast X-rays might be taken, possibly and MRI or ultrasound, and quite possibly either a PET scan or Scinti scan to check for metastasis.
Breast cancer staging requires a tumor classification, nuclear grading, and input from all treatment team members
Breast cancer staging will certainly involve a TNM classification for the tumor, which will describe the breast mass in terms of its size (diameter), whether or not the cancer has spread (metastasized) to the lymph nodes (N), and whether or not there is metastasis to other distant areas of the body. (M). The multidisciplinary treatment team will try to determine as much information about the breast cancer as possible in order to predict its behavior and maximize treatment benefit. A full ‘histological‘ evaluation of the tumor will determine the nuclear grade of the cancer cells, and also the presence or absence of various hormones and hormone receptors. As breast cancer growth is ‘fueled‘ by hormones, determining the hormone receptor status of the tumor and also hormonal and chemical/molecular aspects of the blood gives valuable information as to the predictable aggressiveness of the tumor, and how to get the most benefit from chemotherapy, if indicated. Relatively new staging techniques such as the sentinel lymph node biopsy are now in widespread use, which can often confirm lack of lymph node metastasis and negate the necessity of lymph node excision.
Sentinel node biopsy, genetic fingerprinting
Much current research into breast cancer identification and staging seems to be centered around finding the ‘genetic fingerprint‘ of an individual breast cancer tumor, in order to improve and specifically ‘target‘ treatment therapies, and to arrive at a more accurate prognosis. Some of the new ‘genetic‘ techniques that are now used in breast cancer staging include determining molecular assays, and reverse transriptase-polymerase chain reaction testing.
For further reading, I suggest you visit this page with information about the progression of breast cancer stages.
Below are some common Q&A regarding this topic:
- What is some information that helps determine breast cancer stage? Your doctor determines your breast cancer stage by considering the size of your tumor, whether cancer cells have spread to the lymph nodes under your arm (known as axillary lymph nodes), and whether cancer cells of spread to other parts of your body (metastasizes).
- What are some tests and procedures that are used to stage breast cancer?
Some additional tests may be needed, but most women with a new diagnosis of breast cancer don’t need all the diagnostic tests available. Your doctor will select the necessary tests based on your situation. Particularly if your cancer is small and hasn’t spread to nearby lymph nodes, additional tests may offer little benefit, but lead to additional costs and carry a risk of complications. Staging tests include blood tests, breast imaging tests, and additional imaging tests.
- Why are there breast cancer stages? Breast cancer stages range from 0 to IV, with many subcategories Lower numbers indicate earlier stages of cancer, whereas higher numbers reflect late-stage cancers.
- What is breast cancer stage 0? This stage describes noninvasive (in situ) breast cancer. Ductal carcinoma in situ (DCIS) is an example of stage 0 breast cancer.
- What is stage I? This stage is an early stage of invasive breast cancer in which the tumor measures no more than 2 cm or about 3/4 inch in diameter, and no lymph nodes are involved – the cancer hasn’t spread outside the breast.
- What is stage II? This stage describes invasive breast cancers in which one f the following is true. 1) Tumor measures less than 2 cm in diameter, but has spread to the lymph nodes underneath the arm. 2) No tumor is found in the breast, but breast cancer cells are found in the lymph nodes under the arm. 3) The tumor is between 2 and 5 cm in diameter and may or may not have spread to the lymph nodes under the arm. 4) And lastly, the tumor is larger than 5 cm in diameter but hasn’t spread to any lymph nodes.
- What is stage III? Stage III breast cancers are subdivided into three categories. IIIA IIIB and IIIC, based on a number of criteria. By definition, stage III breast cancer haven’t spread to distant sites.
Stage IIIA tumor is larger than 5 cm and has spread to one to three lymph nodes under the arm. Other stage IIIA may be any size and have spread into multiple lymph nodes. The lymph nodes clump and attach to one another or to the surrounding tissue.
In stage IIIB breast cancer, a tumor of any size has spread to tissues near the breast, the skin and chest muscles, and my have spread to lymph nodes within the breast or under the arm. Stage IIIB also includes inflammatory breast cancer, an uncommon but aggressive type of breast cancer.
Stage IIIC cancer is a tumor of any size that has spread to 10 or more lymph nodes under the arm, to lymph nodes above or beneath the collarbone and near the neck, and/or to the lymph nodes within the breast itself and to lymph nodes under the arm as well.
- What is stage IV? Stage IV breast cancer has spread to distant parts of the entire body, such as the lungs, liver, bones or the brain.
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