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Breast Cancer Treatment (Patient) (cont.)

Stages of Breast Cancer

After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.

The process used to find out whether the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

  • Sentinel lymph node biopsy: The removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes.
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

  • Through tissue. Cancer invades the surrounding normal tissue.
  • Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
  • Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for breast cancer:

This section describes the stages of breast cancer. The breast cancer stage is based on the results of testing that is done on the tumor and lymph nodes removed during surgery and other tests.

Stage 0 (carcinoma in situ)

There are 3 types of breast carcinoma in situ:

  • Ductal carcinoma in situ (DCIS) is a noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues. At this time, there is no way to know which lesions could become invasive.
    Ductal carcinoma in situ (DCIS); drawing shows a lobe, ducts, and fatty tissue in a cross section of the breast. The inset shows a normal duct and a duct with abnormal cells.
    Ductal carcinoma in situ (DCIS). Abnormal cells are found in the lining of a breast duct.
  • Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are found in the lobules of the breast. This condition seldom becomes invasive cancer. However, having LCIS in one breast increases the risk of developing breast cancer in either breast.
    Lobular carcinoma in situ (LCIS); drawing shows a lobe, ducts, lobules, and fatty tissue in a cross section of the breast. Three separate pullouts show a normal lobe, a normal lobule, and a lobule with abnormal cells.
    Lobular carcinoma in situ (LCIS). Abnormal cells are found in the lobules of the breast.
  • Paget disease of the nipple is a condition in which abnormal cells are found in the nipple only.

Stage I

Stage I breast cancer. Drawing shows stage IA on the left; the tumor is 2 cm or smaller and has not spread outside the breast. Drawings in the middle and on the right show stage IB. In the middle, no tumor is found in the breast, but small clusters of cancer cells are found in the lymph nodes. In the drawing on the right, the tumor is 2 cm or smaller and small clusters of cancer cells are found in the lymph nodes.
Stage I breast cancer. In stage IA, the tumor is 2 centimeters or smaller and has not spread outside the breast. In stage IB, no tumor is found in the breast or the tumor is 2 centimeters or smaller. Small clusters of cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes.

In stage I, cancer has formed. Stage I is divided into stages IA and IB.

  • In stage IA, the tumor is 2 centimeters or smaller. Cancer has not spread outside the breast.
  • In stage IB, small clusters of breast cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes and either:
    • no tumor is found in the breast; or
    • the tumor is 2 centimeters or smaller.

Stage II

Stage II is divided into stages IIA and IIB.

  • In stage IIA:
    • no tumor is found in the breast or the tumor is 2 centimeters or smaller. Cancer (larger than 2 millimeters) is found in 1 to 3 axillary lymph nodes or in the lymph nodes near the breastbone (found during a sentinel lymph node biopsy); or
    • the tumor is larger than 2 centimeters but not larger than 5 centimeters. Cancer has not spread to the lymph nodes.

    Stage IIA breast cancer. Drawing on the left shows no tumor in the breast, but cancer is found in 3 axillary lymph nodes. Drawing in the middle shows the tumor size is 2 cm or smaller and cancer is found in 3 axillary lymph nodes. Drawing on the right shows the tumor is larger than 2 cm but not larger than 5 cm and has not spread to the lymph nodes.
    Stage IIA breast cancer. No tumor is found in the breast and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone (left panel); OR the tumor is 2 centimeters or smaller and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone (middle panel); OR the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the lymph nodes (right panel).
  • In stage IIB, the tumor is:
    • larger than 2 centimeters but not larger than 5 centimeters. Small clusters of breast cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes; or
    • larger than 2 centimeters but not larger than 5 centimeters. Cancer has spread to 1 to 3 axillary lymph nodes or to the lymph nodes near the breastbone (found during a sentinel lymph node biopsy); or
    • larger than 5 centimeters. Cancer has not spread to the lymph nodes.

    Stage IIB breast cancer. The drawing on the left shows the tumor is larger than 2 cm but not larger than 5 cm and small clusters of cancer cells are in the lymph nodes. The drawing in the middle shows the tumor is larger than 2 centimeters but not larger than 5 centimeters and cancer is in 3 axillary lymph nodes. The drawing on the right shows the tumor is larger than 5 cm but has not spread to the lymph nodes.
    Stage IIB breast cancer. The tumor is larger than 2 centimeters but not larger than 5 centimeters and small clusters of cancer cells are found in the lymph nodes (left panel); OR the tumor is larger than 2 centimeters but not larger than 5 centimeters and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone (middle panel); OR the tumor is larger than 5 centimeters and has not spread to the lymph nodes (right panel).

Stage IIIA

Stage IIIA breast cancer. The drawing on the left shows no tumor in the breast; cancer is found in 8 axillary lymph nodes. In the drawing in the middle, the tumor is larger than 5 centimeters and small clusters of cancer cells are in the lymph nodes. The drawing on the right shows the tumor is larger than 5 cm and cancer is in 3 axillary lymph nodes.
Stage IIIA breast cancer. No tumor is found in the breast or the tumor may be any size and cancer is found in 4 to 9 axillary lymph nodes or lymph nodes near the breastbone (left panel); OR the tumor is larger than 5 centimeters and small clusters of cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes (middle panel); OR the tumor is larger than 5 centimeters and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone (right panel).

In stage IIIA:

  • no tumor is found in the breast or the tumor may be any size. Cancer is found in 4 to 9 axillary lymph nodes or in the lymph nodes near the breastbone (found during imaging tests or a physical exam); or
  • the tumor is larger than 5 centimeters. Small clusters of breast cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes; or
  • the tumor is larger than 5 centimeters. Cancer has spread to 1 to 3 axillary lymph nodes or to the lymph nodes near the breastbone (found during a sentinel lymph node biopsy).

Stage IIIB

Stage IIIB breast cancer. The drawing on the left is a cross section of the breast showing that cancer has spread to the chest wall. The ribs, muscle, and fatty tissue are also shown. The drawing on the right shows the tumor has spread to the skin of the breast. An inset shows inflammatory breast cancer.
Stage IIIB breast cancer. The tumor may be any size and cancer has spread to the chest wall and/or to the skin of the breast and caused swelling or an ulcer. Cancer may have spread to axillary lymph nodes or lymph nodes near the breastbone. Cancer that has spread to the skin of the breast may be inflammatory breast cancer.

In stage IIIB, the tumor may be any size and cancer has spread to the chest wall and/or to the skin of the breast and caused swelling or an ulcer. Also, cancer may have spread to:

  • up to 9 axillary lymph nodes; or
  • the lymph nodes near the breastbone.

Cancer that has spread to the skin of the breast may also be inflammatory breast cancer. See the section on Inflammatory Breast Cancer for more information.

Stage IIIC

Stage IIIC breast cancer. Drawing on the left shows cancer in lymph nodes in the axilla. Drawing in the middle shows cancer is in lymph nodes above the collarbone. Drawing on the right shows cancer in the axillary lymph nodes and in lymph nodes near the breastbone.
Stage IIIC breast cancer. No tumor is found in the breast or the tumor may be any size and may have spread to the chest wall and/or the skin of the breast. Also, cancer has spread to 10 or more axillary lymph nodes (left panel); OR to lymph nodes above or below the collarbone (middle panel); OR to axillary lymph nodes and lymph nodes near the breastbone (right panel).

In stage IIIC, no tumor is found in the breast or the tumor may be any size. Cancer may have spread to the skin of the breast and caused swelling or an ulcer and/or has spread to the chest wall. Also, cancer has spread to:

  • 10 or more axillary lymph nodes; or
  • lymph nodes above or below the collarbone; or
  • axillary lymph nodes and lymph nodes near the breastbone.

Cancer that has spread to the skin of the breast may also be inflammatory breast cancer. See the section on Inflammatory Breast Cancer for more information.

For treatment, stage IIIC breast cancer is divided into operable and inoperable stage IIIC.

Stage IV

Stage IV breast cancer. Drawing shows cancer has spread from lymph nodes through the blood to other parts of the body, such as the brain, lungs, liver, and bone.
Stage IV breast cancer. The cancer has spread to other parts of the body, most often the bones, lungs, liver, or brain.

In stage IV, cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.

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