Breast Cancer Staging
Stages and Grades

Breast Cancer Stages

Contents

• Breast Cancer Staging: Explained
• How Is Breast Cancer Staged?
• What Are The Stages and Survival Rates?

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Breast Cancer Guide

Breast Cancer Staging: Explained

Breast cancers vary according to location and other characteristics. For this reason, what may happen to one woman with breast cancer will not necessarily happen to another. To help distinguish between breast cancers, doctors frequently refer to a system known as the international TNM staging system. The T stands for tumor size, the N for number of lymph nodes affected and M for the presence of metastases (cancer) in other parts of the body. In other words, staging describes the extent of the cancer in the body. The stage of cancer will determine which type of breast cancer treatment is used. It also helps determine the woman's prognosis - her chance of cure and life expectancy. Each stage will have a specific breast cancer survival rate.

How Is Breast Cancer Staged?

In order to stage a cancer, clinicians need to verify the presence of a tumor (if there is one), what size it is, have cancerous cells spread beyond the breast ducts or lobules to the breasts themselves or to nearby lymph nodes or beyond. To do this, various procedures may be carried out, including:

Mammograms
More extensive mammograms may be carried out, including a diagnostic mammogram to examine the breasts more thoroughly.

Chest X-Ray
An X-ray to test if cancer has spread (metastasized) to the lungs.

Bone Scan
This can check if cancer has metastasized to the bones. For this test a low-level radioactive material is injected into the veins which make it easier to check for bone changes. Hot spots appear where bone changes have occurred as they attract radioactivity. As arthritis and other bone diseases cause similar patterns other imaging tests such as MRI scan or CT scan will be needed.

Computed Tomography (CT or CAT Scan)
A CT scan produces a detailed cross section image of the body. Instead of taking one image like an X-ray, a CT scan takes many pictures as it rotates over the person while they lie on a table. In women with breast cancer it is more often used to check if cancer has spread to the chest, stomach and other vital organs.

CT Guided Needle Biopsy
The CT scan can be used to guide a needle into a suspected area of cancer for a biopsy of the breast.

Magnetic Resonance Imaging (MRI)
A MRI can be used to examine the breast for cancer. It may also be used to examine the opposite breast for any signs of the disease. It is not yet clear how useful this is for someone planning cancer surgery. MRI scans, like CT scans can also be used to check for cancer in other parts of the body. They are however more uncomfortable than CT Scans, they take longer, and you have to lie inside a confined narrow tube which is difficult for those with even mild claustrophobia. The machine makes a buzzing and clicking noise which some people find frightening. New 'open' MRI machines can sometimes help in these cases.

Ultrasound Scan
Ultrasounds can be used to look for tumors in internal organs or tissue masses. The test is painless and does not expose the patient to radiation.

Positron Emission Tomography (PET) Scan
This type of scan is used when a doctor thinks cancer has spread, but he does not know where to. The picture is not as detailed as a CT or MRI scan but it does provide useful information about the whole body. Some new machines can now do CT and PET scans together.

What Are The Stages and Survival Rates?

Stage 0 Breast Cancer

Cancer at stage 0 is confined to the duct or lobules of the breast and is called either ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS). The TNM status for this is T0 N0 M0. Stage 0 is considered by some scientists as 'pre-cancer', as women with DCIS or LCIS may never develop breast cancer. They view it as an advanced form of hyperplasia or abnormal cell overgrowth. That said women with DICS or LCIS have a 25 percent increased risk of developing further invasive breast cancer in their lifetime. For this reason, how to treat women with Stage 0 breast cancer is one of the most controversial in breast cancer therapy.

Stage 1 Breast Cancer

Stage 1 cancer consists of a small lump less than 2 cm across and has invaded the breast beyond the ducts or lobules. It has not however spread to the lymph nodes or other parts of the body. Stage 1 and 2 are most likely to be treated with lumpectomy operation.

Stage 1 is subdivided into group A and B:

Stage 1A (T1, N0, M0): The tumor is 2 cm or less across (T1), has not spread to lymph nodes (N0) or distant parts of the body (M0).
Stage 1B (T0/T1, N1mi, M0): The tumor is 2 cm or less across, or is not found (T0 or T1) with micrometastases in 1-3 axillary lymph nodes. The cancer has not spread to other parts of the body (M0).

The 5 year survival rate for women with Stage 1 breast cancer is 95 percent.

Read our tips for breast cancer prevention and genetic testing for breast cancer.

Stage 2 Breast Cancer

There is no concrete sign that cancer has spread (metastases) beyond the breast but a slightly larger lump (tumor) or enlarged lymph nodes (see lymphatic system) suggests that more trouble may be imminent.

The five year survival rate for a woman with stage 2 cancer is 80 percent.

Stage 2 is subdivided into group A and B:

Group 2A can be either:
T1 N1 MO: Either a tumor is smaller than 2cm with 1 or more axillary lymph nodes affected (N1) and no known distant metastasis (cancer has not spread beyond the breast). OR
T2 N0 M0: A tumor is 2cm-5cm has been detected, but no nodes have been affected and no known distant metastasis.

Group 2B can be either:
T2 N1 M0: Either a tumor 2cm-5cm has been detected, with positive detection in nodes but no known distant metastasis. OR
T3 N0 M0: A tumor larger than 5cm (T3) has been detected with no positive node infection or known distant metastasis.

Stage 3 Breast Cancer

At this stage a tumor may be larger than 5cm or has invaded the chest wall or surrounding skin. Lymph nodes are enlarged but scans and tests of bones, liver, lungs and other organs show no concrete signs of cancer. The 5 year survival rate for women with stage 3 breast cancer drops to 50 percent, which suggests in many cases that cancer is lurking in distant organs, it may just not reveal itself yet. This will require a mastectomy. Most women also opt for breast reconstruction surgery.

Stage 3 is subdivided into group A and B:

Group 3A can be either:
T1/2 N2 MO: A tumor of 5cm or under with fixed (stuck to other tissues) axillary lymph nodes on the same side (N2) but no known distant metastasis. OR
T3 N1/2 M0: A tumor larger than 5cm (T3) with either fixed or free axillary lymph nodes and no known distant metastasis.

Group 3B can be either:
T(any) N3 M0: Either any size tumor with lymph nodes of the chest involved (N3) but no known distant metastasis. OR
T4 N(any) M0: A tumor that involves the chest wall or breaks through the skin (T4) with any number of axillary lymph nodes affected. Still no known metastasis.

Stage 4 Breast Cancer

At this stage the breast cancer is highly invasive and detectable in other organs of the body and is considered incurable. That said, 10 percent of women with stage 4 cancer will be alive 5 years later. See also breast cancer recurrence.

According to the TNM staging system this is known as T(any) N(any) M1.

Comparing Other Gynecologic Cancer Stages

Cervical Cancer Stages
Fallopian Tube Cancer Stages
Ovarian Cancer Stages
Vagina Cancer Stages
Vulva Cancer Staging
Endometrial Cancer Staging

Related Articles on Breast Cancer

For more on female cancers, see the following:

• Inflammatory breast cancer: Why its always stage 3 or 4.
• Breast self-examination: How to perform a self test.
• Hormone therapy for breast cancer: Newer forms of drugs.

Back To Homepage: Womens Health Advice