M Categories For Breast Cancer
M followed by a 0 or 1 indicates whether the cancer has spread to distant organs — for example, the lungs, liver, or bones.
M0: No distant spread is found on x-rays or by physical exam.
cM0: Small numbers of cancer cells are found in blood or bone marrow , or tiny areas of cancer spread are found in lymph nodes away from the underarm, collarbone, or internal mammary areas.
M1: Cancer has spread to distant organs as seen on imaging tests or by physical exam, and/or a biopsy of one of these areas proves cancer has spread and is larger than 0.2mm.
Treatment Of Breast Cancer By Stage
This information is based on AJCC Staging systems prior to 2018 which were primarily based on tumor size and lymph node status. Since the updated staging system for breast cancer now also includes estrogen receptor , progesterone receptor , and HER2 status, the stages may be higher or lower than previous staging systems. Whether or not treatment strategies will change with this new staging system are yet to be determined. You should discuss your stage and treatment options with your doctor.
The stage of your breast cancer is an important factor in making decisions about your treatment options. In general, the more the breast cancer has spread, the more treatment you will likely need. But other factors can also be important, such as:
- If the cancer cells have hormone receptors
- If the cancer cells have large amounts of the HER2 protein
- If the cancer cells have a certain gene mutation
- Your overall health and personal preferences
- If you have gone through menopause or not
- How fast the cancer is growing and if it is affecting major organs like the lungs or liver
Talk with your doctor about how these factors can affect your treatment options.
Stage 0 cancers are limited to the inside of the milk duct and are non-invasive .
Ductal carcinoma in situ is a stage 0 breast tumor.
Tumor Size And Breast Cancer Staging
Doctors determine the stage of cancer as part of their diagnosis. To confirm the breast cancer stage, they assess several different factors, including tumor size.
Doctors use multiple tests and examinations to evaluate the specific characteristics of a persons breast cancer. They use this information to assign values to the TNM staging system, where:
- T refers to the size of the main, or primary, tumor.
- N refers to whether cancer has spread to nearby lymph nodes.
- M refers to whether the cancer is metastatic, which means if it has spread to distant parts of the body.
The overall stages of cancer range from 0 to 4. Stage 0 means the breast cancer is at a very early stage and has not yet spread. Stage 4 refers to late stage breast cancer, which means it has spread to other parts of the body.
While every persons breast cancer is different, its stage generally indicates an individuals treatment options and outlook.
People with early stage breast cancer are likely to have smaller tumors that doctors can easily treat. Larger tumors tend to indicate later stage breast cancer, which may be more difficult to treat.
Doctors measure the size of the primary breast cancer tumor at its widest point. They usually give the size in millimeters or centimeters .
According to the , doctors use the following system to grade tumor size:
Tumor size is just one of several factors that doctors consider when determining the stage of a persons breast cancer. Other factors include the following:
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Examples Using The Full Staging System
Because there are so many factors that go into stage grouping for breast cancer, it’s not possible to describe here every combination that might be included in each stage. The many different possible combinations mean that two women who have the same stage of breast cancer might have different factors that make up their stage.
Here are 3 examples of how all of the factors listed above are used to determine the pathologic breast cancer stage:
What Is Stage Iii Breast Cancer
In stage III breast cancer, the cancer has spread further into the breast or the tumor is a larger size than earlier stages. It is divided into three subcategories.
Stage IIIA is based on one of the following:
- With or without a tumor in the breast, cancer is found in four to nine nearby lymph nodes.
- A breast tumor is larger than 50 millimeters, and the cancer has spread to between one and three nearby lymph nodes.
In stage IIIB, a tumor has spread to the chest wall behind the breast. In addition, these factors contribute to assigning this stage:
- Cancer may also have spread to the skin, causing swelling or inflammation.
- It may have broken through the skin, causing an ulcerated area or wound.
- It may have spread to as many as nine underarm lymph nodes or to nodes near the breastbone.
In stage IIIC, there may be a tumor of any size in the breast, or no tumor present at all. But either way, the cancer has spread to one of the following places:
- ten or more underarm lymph nodes
- lymph nodes near the collarbone
- some underarm lymph nodes and lymph nodes near the breastbone
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T Categories For Breast Cancer
T followed by a number from 0 to 4 describes the main tumor’s size and if it has spread to the skin or to the chest wall under the breast. Higher T numbers mean a larger tumor and/or wider spread to tissues near the breast.
TX: Primary tumor cannot be assessed.
T0: No evidence of primary tumor.
Tis: Carcinoma in situ
T1 : Tumor is 2 cm or less across.
T2: Tumor is more than 2 cm but not more than 5 cm across.
T3: Tumor is more than 5 cm across.
T4 : Tumor of any size growing into the chest wall or skin. This includes inflammatory breast cancer.
M Refers To Metastasis
Metastasis is the spread of cancer to other areas of the body, otherwise known as distant spread. Some breast cancer cells have the ability to invade lymphatic and/or blood vessels where they can circulate to distant organs and tissues e.g. bones, liver, lungs and brain. Imaging such as CT scans and bone scans can be performed if the tumour is high risk and/or metastases are suspected.
Until recently breast cancer staging used only these measures to classify the stage of the cancer but in January 2018 the system was updated to take into account additional tumour biology factors that can affect outcomes.
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Diagnostic Tests That Inform The Clinical Stage
Many methods are used to detect and stage cancer. Some of the common tests include:
Biopsy: The doctor uses a needle to extract breast tissue or fluid, which is then sent to a lab. There, various techniques are used to examine different attributes, such as hormone receptor or HER2 status.
Tumor markers: Rapidly dividing cancerous cells interrupt some of the normal mechanisms of cell growth. This causes the cell to overproduce certain molecules. Lab tests detect these compounds, known as tumor markers, in blood or tissue samples.
Imaging techniques: Several different scans are used to examine characteristics of your cancer. Below are some of the noninvasive imaging techniques you might encounter:
- MRI scans use magnets and radio waves to generate detailed pictures of your tissues.
- CT scans use X-rays to look at your organs. Nuclear scans trace the flow of an injected safe radioactive dye in your body.
- PET scans are similar to nuclear scans but specifically examine glucose consumption in the bodysince cancer cells use more glucose than normal cells.
- Ultrasound imaging uses sound waves to see inside your body.
Breast Cancer Survival Rates
While it is not possible to predict the exact course of disease for any individual, survival rates for breast cancer have improved remarkably over time due to earlier detection and improved treatment methods. The five-year survival rate is currently 91% on average for Australians diagnosed with breast cancer.
Whilst every case is different, breast cancer survival rates can also vary significantly depending on the stage of the cancer. According to data from the Australian Institute of Health and Welfare , generally the earlier the stage when the breast cancer is first diagnosed, the higher the chance for better outcome.
Most patients with early or locally advanced breast cancer can be treated successfully. The poorest prognosis is for metastatic breast cancer . However, there are different treatment options available, and there are people who continue to live full and meaningful lives, despite having metastatic breast cancer.
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Determining Breast Cancer Stage
In breast cancer, stage is based on the size and location of the primary tumor, the spread of cancer to nearby lymph nodes or other parts of the body, tumor grade, and whether certain biomarkers are present.
The TNM system, the grading system, and the biomarker status are combined to find out the breast cancer stage.
Research Related To Breast Cancer Classification And Implications For Clinical Practice
Researcher: Dr. Sunil Lakhani, University of Queensland
Dr Lakhani recently published practice-changing findings that contributed to a new classification of a rare breast cancer, called metaplastic breast tumours, by the World Health Organisation. Learn more about his research here.
Breast cancer staging is based on tumour size, the extent that cancer has spread to other parts of the body and other clinical factors. Your doctor will use diagnostic information such as medical imaging including mammogram and/or ultrasound, and other diagnostic tests, such as a biopsy of the breast tissue and draining lymph nodes to determine the stage of the cancer.
Once the stage of the cancer has been determined, it is expressed on a scale of 0 to IV. Stage 0 refers to pre-invasive breast cancers, including ductal carcinoma in situ . Stage I and II are referred to as early breast cancer. Stage III is referred to as locally advanced breast cancer. Stage IV is called advanced or metastatic breast cancer. See above for more information.
Stage 0 refers to pre-invasive breast cancers, including ductal carcinoma in situ . This means that there are abnormal cells present, but they are contained inside the milk duct in the case of DCIS, or lobule , in the case of lobular carcinoma in situ .
Invasive breast cancer occurs when cancer cells within the milk duct or lobules break or invade through normal breast tissue. It can be Stage I, II, III or IV.
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What Is The Survival Outlook For Breast Cancer
According to the National Cancer Institute , the percentage of patients surviving five years after diagnosis is:
- 99 percent for breast cancer that is still local to the breast
- 86 percent for breast cancer that has spread just outside the breast
- 29 percent for breast cancer that has spread to more distant parts of the body
The NCI also lists the five-year survival rate for breast cancer overall as 90.6 percent for women and 83 percent for men.
Tnm Classification For Breast Cancer
The American Joint Committee on Cancer provides two principal groups for breast cancer staging: anatomic, which is based on extent of cancer as defined by tumor size , lymph node status , and distant metastasis and prognostic, which includes anatomic TNM plus tumor grade and the status of the biomarkers human epidermal growth factor receptor 2 , estrogen receptor , and progesterone receptor . The prognostic stage group is preferred for patient care and is to be used for reporting of all cancer patients in the United States.
In turn, prognostic stages are divided into clinical and pathological groups. Pathological stage applies to patients who have undergone surgery as the initial treatment for breast cancer. It includes all information used for clinical staging plus findings at surgery and pathological findings from surgical resection. Pathological prognostic stage does not apply to patients who received neoadjuvant therapy . See the tables below.
Table. TNM Classification for Breast Cancer
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How Is The Stage Determined
The staging system most often used for breast cancer is the American Joint Committee on Cancer TNM system. The most recent AJCC system, effective January 2018, has both clinical and pathologic staging systems for breast cancer:
- The pathologic stage is determined by examining tissue removed during an operation.
- Sometimes, if surgery is not possible right away or at all, the cancer will be given a clinical stage instead. This is based on the results of a physical exam, biopsy, and imaging tests. The clinical stage is used to help plan treatment. Sometimes, though, the cancer has spread further than the clinical stage estimates, and may not predict the patients outlook as accurately as a pathologic stage.
In both staging systems, 7 key pieces of information are used:
- The extent of the tumor : How large is the cancer? Has it grown into nearby areas?
- The spread to nearby lymph nodes : Has the cancer spread to nearby lymph nodes? If so, how many?
- The spread to distant sites : Has the cancer spread to distant organs such as the lungs or liver?
- Estrogen Receptor status: Does the cancer have the protein called an estrogen receptor?
- Progesterone Receptor status: Does the cancer have the protein called a progesterone receptor?
- HER2 status: Does the cancer make too much of a protein called HER2?
- Grade of the cancer : How much do the cancer cells look like normal cells?
In addition, Oncotype Dx® Recurrence Score results may also be considered in the stage in certain situations.
Stages Of Breast Cancer: How Theyve Changed Over Time
In the past, only the size of a tumor and the status of nearby lymph nodes were used to determine the stage of someones breast cancer. It was a fairly simple system based purely on anatomy, and was therefore easy for people to memorize.
- If a tumor was two centimeters wide or smaller, it was considered stage I.
- If a tumor was larger than that or the cancer was detectable in nearby lymph nodes, it was considered stage II.
- If a tumor had spread to the skin of the breast or not far beyond the adjacent lymph nodes, it was considered stage III.
- And if a tumor had spread anywhere else in the body, it was automatically considered stage IV.
But all of that changed in 2017. Advancements in tumor biology and prognostic biological markers such as estrogen receptor , progesterone receptor , and HER2/neu allowed clinicians to understand why similarly staged patients had significantly different outcomes. This led the American Joint Commission on Cancer to revise its staging manual for breast cancer.
Today, we know that what truly determines a breast cancers stage is not only its size and the amount of lymph node involvement, but also what type of breast cancer it is and how aggressive it looks under a microscope.
How hormones influence breast cancer stages
So, a patient with only three cancerous lymph nodes who has a hormone-sensitive tumor thats two centimeters wide could still be considered stage I despite the lymph node involvement.
How grades influence breast cancer stages
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The Appearance Of Cancer Cells
The appearance, or differentiation, of cancer cells is another factor in cancer staging. Doctors grade cancer cells according to how similar they appear to noncancerous cells under a microscope.
Healthcare professionals classify cancer cells that are close to resembling healthy cells as being low grade or well-differentiated. These cancers typically grow more slowly.
High grade, or poorly differentiated, cancer cells appear very different from normal cells and tend to grow faster.
After assessing the different characteristics of the breast cancer, doctors use the information to determine its overall stage from 04.
Here is an overview of each breast cancer stage :
- Stage 0: This cancer is noninvasive and is only present inside the milk ducts. This stage includes ductal carcinoma in situ.
- Stage 1: These are small tumors that either have not spread to the lymph nodes or have only affected a small area of the sentinel lymph node.
- Stage 2: These are larger tumors that have spread to some nearby lymph nodes.
- Stage 3: These tumors are large or growing into surrounding tissues, such as breast skin, muscle, and lymph nodes.
- Stage 4: These are tumors that started in the breast but have spread to other parts of the body.
When recommending treatment options for breast cancer, a doctor will take into account:
Treatment options can include:
- surgery, which may involve a mastectomy, removal of one or both breasts, or the removal of any affected lymph nodes
- lymph node involvement
Breast Cancer Stage Groups
In breast cancer, stage is based on the size and location of the primary tumor, the spread of cancer to nearby lymph nodes or other parts of the body, tumor grade, and whether certain biomarkers are present. To plan the best treatment and understand your prognosis, it is important to know the breast cancer stage.
There are 3 types of breast cancer stage groups:
- Clinical Prognostic Stage is used first to assign a stage for all patients based on health history, physical exam, imaging tests , and biopsies. The Clinical Prognostic Stage is described by the TNM system, tumor grade, and biomarker status . In clinical staging, mammography or ultrasound is used to check the lymph nodes for signs of cancer.
- Pathological Prognostic Stage is then used for patients who have surgery as their first treatment. The Pathological Prognostic Stage is based on all clinical information, biomarker status, and laboratory test results from breast tissue and lymph nodes removed during surgery.
- Anatomic Stage is based on the size and the spread of cancer as described by the TNM system. The Anatomic Stage is used in parts of the world where biomarker testing is not available. It is not used in the United States.
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