Breast Cancer Staging

Staging is the process of finding out if cancer is localized or widespread. It will show if the cancer has spread to other body structures and, if so, how far. The treatment and prognosis (outlook for survival) depends, to a large extent, on the cancer's stage.

Defining Staging

This important step is called staging. Knowing the exact stage of your disease will help your doctor plan your treatment. Your doctor will want to know:

Staging is the process of finding out how far the cancer has spread. This is very important because your treatment and the outlook for your recovery depend on the stage of your cancer. There is more than one system for staging cancer. The staging system of the American Joint Committee on Cancer (AJCC), also known as the TNM system, is the one used most often for breast cancer.

TNM Staging System

The TNM system for staging gives three key pieces of information:

To make this information somewhat clearer, the TNM descriptions can be grouped together into a simpler set of stages, labeled stage 0 through stage IV (0-4).

In general, the lower the number, the less the cancer has spread. A higher number, such as stage IV (4), means a more serious cancer.

After looking at your test results, the doctor will tell you the stage of your cancer. Be sure to ask your doctor to explain your stage in a way you understand. This will help you both decide on the best treatment for you.
 

Breast Cancer Staging

Stage O

Description
Very early breast cancer. This type of cancer has not spread within or outside the breast. It is sometimes called DCIS, LCIS, or breast cancer in situ or noninvasive cancer.

Treatment
The two types of stage 0 breast cancer, ductal carcinoma in situ (DCIS), and lobular carcinoma in situ (LCIS), are treated quite differently. Most women with LCIS do not need treatment because the condition is not a true cancer. Close follow-up is important, though, because the risk of developing cancer later on is higher. These women may also want to consider taking part in a clinical trial for breast cancer prevention with drugs such as tamoxifen or raloxifene, as well as looking at other methods of reducing risk such as exercise, changes in diet, or preventive surgery.Treatment choice for DCIS include lumpectomy, usually with radiation therapy, and mastectomy, depending on mammography and biopsy results. Recent studies suggest that tamoxifen can lower the risk of invasive cancer developing after treatment of DCIS with lumpectomy and radiation therapy.

>>Prognosis

Stage I

Description
The cancer is no larger than about 1 inch in size and has not spread outside the breast. (Also described as early breast cancer.)

Treatment
One option is lumpectomy with removal of lymph nodes under the arm followed by radiation therapy. Sentinel lymph node sampling may be used instead of standard lymph node dissection. Another option is modified radical mastectomy. Adjuvant therapy may follow the surgery depending on the size and other features of the tumor.

>>Prognosis

Stage II

Description
The doctor may find any of the following:

• The cancer is no larger than 1 inch, but has spread to the lymph nodes under the arm.The cancer is between 1 and 2 inches. It may or may not have spread to the lymph nodes under the arm.
• The cancer is larger than 2 inches, but has not spread to the lymph nodes under the arm.

Treatment
Surgery and radiation therapy options for stage I and stage II tumors are similar, except that in stage II, radiation therapy may be considered after mastectomy if the tumor is large or has spread to many lymph nodes. Adjuvant therapy may include chemotherapy, hormone therapy, or both. If ten or more positive lymph nodes are found, a woman in good health might want to consider taking part in a clinical trial of high-dose chemotherapy with stem cell or bone marrow transplant.

>>Prognosis

Stage III

Stage III is divided into stages IIIA and IIIB:

Stage IIIA

Description
The doctor may find either of the following:

• The cancer is smaller than 2 inches and has spread to the lymph nodes under the arm.
• The cancer also is spreading further to other lymph nodes.
• The cancer is larger than 2 inches and has spread to the lymph nodes under the arm.

Treatment
Some combination of surgery (lumpectomy or a modified radical mastectomy), chemotherapy, radiation, and hormone therapy is often used. Sometimes chemotherapy (with or without hormonal therapy) is given both before and after the surgery. In some cases, high-dose chemotherapy with stem cell or bone marrow transplantation (as part of a clinical trial) might be used.

>>Prognosis 

Stage IIIB

Description
The doctor may find either of the following:

• The cancer has spread to tissues near the breast (skin, chest wall, including the ribs and the muscles in the chest).
• The cancer has spread to lymph nodes inside the chest wall along the breast bone.

Treatment
Some combination of surgery (lumpectomy or a modified radical mastectomy), chemotherapy, radiation, and hormone therapy is often used. Sometimes chemotherapy (with or without hormonal therapy) is given both before and after the surgery. In some cases, high-dose chemotherapy with stem cell or bone marrow transplantation (as part of a clinical trial) might be used.

>>Prognosis

Stage IV

Description
The doctor may find either of the following:

• The cancer has spread to other parts of the body, most often the bones, lungs, liver, or brain.
• Or, the tumor has spread locally to the skin and lymph nodes inside the neck, near the collarbone.

Treatment
Systemic therapy is the primary treatment, using chemotherapy, hormonal therapy, or both. Immunotherapy, alone or combined with chemotherapy, is an option for women whose cancer cells have high levels of the HER2/neu protein. Radiation and/or surgery may also be used to provide relief of certain symptoms. Patients in otherwise good health are encouraged to take part in clinical trials of high-dose chemotherapy with stem cell transplantation, or other promising treatments being studied.

>>Prognosis

Prognosis by Stages

The 5-year relative survival rate is the percentage of patients who are alive 5 years after diagnosis. Of course, patients might live more than 5 years after diagnosis. And these 5-year survival rates are based on women with breast cancer first treated more than 5 years ago. Patients treated today may have a more favorable outlook.