Tests and procedures used to stage Breast Cancer may include:
- Blood tests, such as a complete blood count
- Mammogram of the other breast to look for signs of cancer
- Chest X-ray
- Breast MRI
- Bone scan
- Computerized tomography (CT) scan
- Positron emission tomography (PET) scan
Not all women will need all of these tests and procedures. Your doctor selects the appropriate tests.
Breast Cancer stages range from 0 to IV, with 0 indicating cancer that is very small and noninvasive. Stage IV Breast Cancer, also called metastatic Breast Cancer, indicates cancer that has spread to other areas of the body.
Staging is a method that has been developed to describe the extent of cancer growth. Breast Cancer is 'staged' by information that is obtained from surgical and other findings. Specifically, information is gathered from the pathology (disease) report that accompanies a lumpectomy (lump removal), mastectomy (breast removal), or other form of breast surgery. In addition, staging is based upon findings from imaging studies - such as chest x-ray, abdominal ultrasound (images produced by high-frequency sound waves) computed tomography (CT or CAT scan; computer-assisted technique that produces cross-sectional images of the body), and bone scans.
The physician uses all available findings to choose a stage that best describes the person's condition. Staging helps to predict how an individual will fare over time - that is, it helps the physician to estimate how long a person will live and the risk of cancer recurrence, or relapse. Correspondingly, staging allows the physician to customize cancer treatment. In general, the lower the stage, the better the person's prognosis (expected outcome).
The TNM System
Pathologists (disease specialists) use a specific system to stage Breast Cancer. This method- known as the TNM system - was devised by the American Joint Committee on Cancer (AJCC) in collaboration with the National Cancer Institute (NCI). Within the TNM system, "T" refers totumor size, "N" refers to lymph node involvement, and "M" refers to the extent ofmetastasis. The primary tumor (T) is ranked within one of the following categories:
The lower the stage number, the less the cancer has grown and spread. For example, a "stage I" Breast Cancer is relatively small and has not yet spread to the lymph nodes or other sites. By contrast, a "stage IV" cancer is much more serious, as it has already metastasized to the lymph nodes as well as another location(s).
Women with low-stage tumors have a better chance of surviving Breast Cancer than women with high-stage tumors. Recent findings from the National Cancer Institute (NCI) indicate that 5-year survival rates are 96% for limited, low-stage Breast Cancers (stage 0, stage I, and some stage II cancers), 75% for Breast Cancers that have invaded the surrounding tissue (stage II & III cancers), and only 20% for Breast Cancers that have metastasized (stage IV cancers). Unfortunately, survival rates are lower and Breast Cancer stages tend to be higher among women from low socioeconomic backgrounds.
Cancer stage is based on the size of the tumor, whether the cancer is invasive or non-invasive, whether lymph nodes are involved, and whether the cancer has spread beyond the breast.
The purpose of the staging system is to help organize the different factors and some of the personality features of the cancer into categories, in order to:
- best understand your prognosis (the most likely outcome of the disease)
- guide treatment decisions (together with other parts of your pathology report), since clinical studies of Breast Cancer treatments that you and your doctor will consider are partly organized by the staging system
- provide a common way to describe the extent of Breast Cancer for doctors and nurses all over the world, so that results of your treatment can be compared and understood
Stage 0
Stage 0 is used to describe non-invasive Breast Cancers, such as DCIS and LCIS. In stage 0, there is no evidence of cancer cells or non-cancerous abnormal cells breaking out of the part of the breast in which they started, or of getting through to or invading neighboring normal tissue.
Stage I
Stage I describes invasive Breast Cancer (cancer cells are breaking through to or invading neighboring normal tissue) in which:
- the tumor measures up to 2 centimeters, AND
- no lymph nodes are involved
Stage II
Stage II is divided into subcategories known as IIA and IIB.
Stage IIA describesinvasive Breast Cancer in which:
- no tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm), OR
- the tumor measures 2 centimeters or less and has spread to the axillary lymph nodes, OR
- the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes
Stage IIB describes invasive Breast Cancer in which:
- the tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodes, OR
- the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes
Stage III
Stage III is divided into subcategories known as IIIA, IIIB, and IIIC.
Stage IIIA describes invasive Breast Cancer in which either:
- no tumor is found in the breast. Cancer is found in axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone, OR
- the tumor is 5 centimeters or smaller and has spread to axillary lymph nodes that are clumped together or sticking to other structures, OR
- the tumor is larger than 5 centimeters and has spread to axillary lymph nodes that are clumped together or sticking to other structures
Stage IIIB describes invasive Breast Cancer in which:
- the tumor may be any size and has spread to the chest wall and/or skin of the breast AND
- may have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone
- Inflammatory Breast Cancer is considered at least stage IIIB.
Stage IIIC describes invasive Breast Cancer in which:
- there may be no sign of cancer in the breast or, if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast, AND
- the cancer has spread to lymph nodes above or below the collarbone, AND
- the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone
Stage IV
Stage IVdescribes invasive Breast Cancer in which:
- the cancer has spread to other organs of the body -- usually the lungs, liver, bone, or brain
"Metastatic at presentation" means that the Breast Cancer has spread beyond the breast and nearby lymph nodes, even though this is the first diagnosis of Breast Cancer. The reason for this is that the primary Breast Cancer was not found when it was only inside the breast. Metastatic cancer is considered stage IV.
Additional staging information
You may also hear terms such as "early" or "earlier" stage, "later," or "advanced" stage Breast Cancer. Although these terms are not medically precise (they may be used differently by different doctors), here is a general idea of how they apply to the official staging system:
Early stage
- Stage 0
- Stage I
- Stage II
- Some stage III
Later or advancedstage
- Other stage III
- StageIV
Doctors use a staging system to determine how far a cancer has spread. The most common system is the TNM staging system. You may hear the cancer described by three characteristics:
- size (T stands for tumor)
- lymph node involvement (N stands for node)
- whether it has metastasized (M stands for metastasis)
The T (size) category describes the original (primary) tumor:
- TX means the tumor can't be measured or found.
- T0 means there isn't any evidence of the primary tumor.
- Tis means the cancer is "in situ" (the tumor has not started growing into the breast tissue).
- The numbers T1-T4 describe the size and/or how much the cancer has grown into the breast tissue. The higher the T number, the larger the tumor and/or the more it may have grown into the breast tissue.
The N (node involvement) category describes whether or not the cancer has reached nearby lymph nodes:
- NX means the nearby lymph nodes can't be measured or found.
- N0 means nearby lymph nodes do not contain cancer.
- The numbers N1-N3 describe the size, location, and/or the number of lymph nodes involved. The higher the N number, the more the lymph nodes are involved.
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