Breast Cancer Stages
NOTE: In January 2018 The American Joint Committee on Cancer (AJCC) made updates to the 8th Edition staging classifications, including the TNM categories.
We will be updating ALL our articles on staging on this website at some point in the very near future. In the meantime, please click HERE for a summary of the recent changes.
Breast cancer screening is the process by which mammogram may detect any potentially malignant breast abnormality. If something abnormal appears on the mammogram, depending on how suspicious it looks, women will usually receive a ‘call 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. The pathologist will then rule out or confirm a diagnosis of breast cancer.
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
- extent of the breast cancer
- Size of the tumor
- Invasive status
- 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 a newer verion of this page with more up-to-date information Breast Cancer Staging.
Additional ‘diagnostic screening’ studies may be Necessary
When the initial screening process detects something abnormal there is a kind of ‘in between‘ state whereby more investigations may be necessary. Properly speaking, this 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 breast cancer, even after biopsy.
So, just because the doctors need to take additional images or request a biopsy, this does not mean that they are staging for breast cancer.
It simply means something abnormal and potentially harmful has been detected at initial screening, and medics need to figure out exactly what it is. In the majority of cases, follow-up imaging studies and biopsies turn out to be benign breast lesions.
Staging only happens after a diagnosis of Breast Cancer
‘Staging’ begins the moment that there is a confirmation of a breast cancer diagnosis by a pathologist. So, the purpose of staging is to assess the cancer and plan the treatment.
In some cases doctors will use the same imaging methods in staging as in screening. Additional breast X-rays might be necessary, possibly an MRI or ultrasound, and also either a PET scan or Scinti scan to check for metastasis.
Breast cancer stages require Input from all members of the Team
Breast cancer staging will certainly involve a TNM classification for the tumor. Indeed. the TNM stages of breast cancer describe the mass in terms of :-
- the size (diameter) of the breast mass
- 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 it’s 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.
Hormone Receptor Status and Breast Cancer
Some breast cancer growth can be ‘fuelled’ by hormones. So, 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. Also, this information can help medics decide how to get the most benefit from chemotherapy.
Relatively new staging techniques such as the sentinel lymph node biopsy are now in widespread use, which can often confirm the 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 focus on finding the ‘genetic fingerprint’ of an individual breast cancer tumor.
This is important in order to improve and specifically ‘target‘ treatment therapies and to arrive at a more accurate prognosis.
Some of the new ‘genetic‘ techniques 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 stages?
Your doctor determines breast cancer stages 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 necessay, but most women with a new diagnosis of breast cancer do not need all the diagnostic tests available.
Your doctor will select the necessary tests according to your individual situation. Particularly if your cancer is small and has not spread to nearby lymph nodes. So, 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
- 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 has not spread outside the breast.
What is stage II?
This stage describes invasive breast cancers in which one of the following is true;-
- Tumor measures less than 2 cm in diameter, but has spread to the lymph nodes underneath the arm.
- No tumor is found in the breast, but breast cancer cells are found in the lymph nodes under the arm.
- The tumor is between 2 cm and 5 cm in diameter and may or may not have spread to the lymph nodes under the arm.
- And lastly, the tumor is larger than 5 cm in diameter but has not spread to any lymph nodes.
What is stage III?
Stage III breast cancers are subdivided into three categories.
based on a number of criteria. By definition, stage III breast cancer has not 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.
- Stage IIIB breast cancer is a tumor of any size that 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.
- In stage IIIC cancers the tumor can be of any size but 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:-
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