What Should A Person With Stage 0 Or Stage 1 Breast Cancer Expect Regarding Treatment
Even though Stage 0 breast cancer is considered non-invasive, it does require treatment, typically surgery or radiation, or a combination of the two. Chemotherapy is usually not part of the treatment regimen for earlier stages of cancer.
Stage 1 is highly treatable, however, it does require treatment, typically surgery and often radiation, or a combination of the two. Additionally, you may consider hormone therapy, depending on the type of cancer cells found and your additional risk factors. Like stage 0, Chemotherapy is often not necessary for earlier stages of cancer.
Material on this page courtesy of National Cancer Institute
Medically Reviewed on April 15, 2020
What Is Stage Ii Breast Cancer
Stage II describes cancer that is in a limited region of the breast but has grown larger. It reflects how many lymph nodes may contain cancer cells. This stage is divided into two subcategories.
Stage IIA is based on one of the following:
- Either there is no tumor in the breast or there is a breast tumor up to 20 millimeters , plus cancer has spread to the lymph nodes under the arm.
- A tumor of 20 to 50 millimeters is present in the breast, but cancer has not spread to the lymph nodes.
Stage IIB is based on one of these criteria:
- A tumor of 20 to 50 millimeters is present in the breast, along with cancer that has spread to between one and three nearby lymph nodes.
- A tumor in the breast is larger than 50 millimeters, but cancer has not spread to any lymph nodes.
How Do All These Factors Turn Into A I
Finally, when we have all these data, we put them all together and get a breast cancer stage . Also, we get an idea of how we need to treat it:
- Is it small? surgery may be enough. Are there metastases? you will need chemotherapy, probably
- Is it hormone receptor +? We can use anti-hormone treatments
- Is it HER2 +? We can use antiHER2
- Is it a high grade tumor? and so on.
There are huge complex tables that factor in all these factors and calculate the stage. However, thats your doctors job, so dont go too crazy looking at them because they really are knotty. They look like this:
For example, imagine you have a grade 2 breast tumor that is 5 cm long, with axillary lymph nodes affected. Hormone receptors are positive and HER2 is negative. According to this table its stage is
Its a IB stage.
Its crazy because when they added the new biomarkers in 2018, staging changed completely. Before 2018, based on TNM, you would be a IIIB stage. Today, however, because that tumor has positive hormone receptors, youll be a IB stage. From stage III to I! Because your tumor can be treated with anti-hormone drugs, its prognosis is much better than its anatomic features suggest.
This doesnt mean that they wouldnt use anti-hormone drugs for your case before 2018 . But the staging was not so accurate, it didnt reflect these nuances.
Now that staging is complete, its time to move on to how to treat breast cancer.
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No matter which stage your breast cancer falls under, the team of experts at Regional Cancer Care Associates wont let you fight alone. Once we determine the stage of your cancer, we will collaborate with our on-site oncologists, plastic surgeons and other specialists to devise an effective course of treatment. To learn more, contact us today.
The Stages Of Breast Cancer
Stage 0: The disease is only in the ducts and lobules of the breast. It has not spread to the surrounding tissue. It is also called noninvasive cancer .
Stage I: The disease is invasive. Cancer cells are now in normal breast tissue. There are 2 types:
- Stage IA: The tumor is up to 2 centimeters . It has not spread to the lymph nodes .
- Stage IB: The tumor is in the breast and is less than 2 cm. Or the tumor is in the lymph nodes of the breast and there is no tumor in the breast tissue.
Stage II describes invasive breast cancer. There are 2 types:
- Stage IIA: A tumor may not be found in the breast, but cancer cells have spread to at least 1 to 3 lymph nodes. Or Stage IIA may show a 2 to 5 cm tumor in the breast with or without spread to the axillary lymph nodes.
- Stage IIB: The tumor is 2 to 5 cm and the disease has spread to 1 to 3 axillary lymph nodes. Or the tumor is larger than 5 cm but has not spread to the axillary lymph nodes.
Stage III describes invasive breast cancer. There are 3 types:
Stage IV : The tumor can be any size and the disease has spread to other organs and tissues, such as the bones, lungs, brain, liver, distant lymph nodes, or chest wall .
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The Hormone Receptor Status Of The Tumor
Some types of breast cancer are fueled by certain hormones produced naturally by the body, such as estrogen and progesterone. These breast cancer cells have special proteins on their surface. After binding to the hormone receptors, the hormones can accelerate the growth of the tumor.
When performing a biopsy, a pathologist can test the tumor tissue to determine its hormone receptor status. The breast cancer will be classified as estrogen-receptor-positive if it has receptors for estrogen, which suggests that the cancerous cells, like healthy breast cells, may receive signals from estrogen that could promote their growth. Likewise, the breast cancer will be classified as progesterone-receptor-positive if it has receptors for progesterone.
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How Is Breast Cancer Treated
There are several breast cancer treatment options, including surgery, chemotherapy, radiation therapy, hormone therapy, immunotherapy and targeted drug therapy. Whats right for you depends on many factors, including the location and size of the tumor, the results of your lab tests and whether the cancer has spread to other parts of your body. Your healthcare provider will tailor your treatment plan according to your unique needs. Its not uncommon to receive a combination of different treatments, too.
Breast cancer surgery
Breast cancer surgery involves removing the cancerous portion of your breast and an area of normal tissue surrounding the tumor. There are different types of surgery depending on your situation, including:
Chemotherapy for breast cancer
Your healthcare provider may recommend chemotherapy for breast cancer before a lumpectomy in an effort to shrink the tumor. Sometimes, its given after surgery to kill any remaining cancer cells and reduce the risk of recurrence . If the cancer has spread beyond your breast to other parts of your body, then your healthcare provider may recommend chemotherapy as a primary treatment.
Radiation therapy for breast cancer
Radiation therapy for breast cancer is typically given after a lumpectomy or mastectomy to kill remaining cancer cells. It can also be used to treat individual metastatic tumors that are causing pain or other problems.
Hormone therapy for breast cancer
Immunotherapy for breast cancer
When And How Does My Doctor Determine The Stage Of My Breast Cancer
Your doctor will assign a stage to your cancer after your physical exam and the initial results from your mammogram or other diagnostic imaging test. The stage may be adjusted after lab reports from your breast biopsy or surgery. In determining the stage of your cancer, your doctor will take into account what is called the T-N-M scale: T meaning tumor size N relating to the involvement of nearby lymph nodes and M referring to whether the cancer has metastasized beyond the breast to other parts of your body.
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The Her2 Status Of The Tumor
Human epidermal growth factor receptor 2 is a protein found on the surface of some breast cancer cells. HER2 plays an integral role in the growth and survival of the cancer cells. During a biopsy, a pathologist can test the tumor sample for HER2 if this protein is detected, the cancer is classified asHER2-positive breast cancer.
Why Is Staging Important
During your initial diagnosis, you and your cancer team will work together to develop a treatment plan. Staging allows you to answer the following questions:
- How does this cancer typically progress?
- Which treatments may work?
Some of the staging may be even more in-depth, but in general, its designed to prepare a more tailored approach to your disease. Your care team will be able to explain any new terms and what they mean for you.
Expert cancer care
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Stage 2 Breast Cancer
Stage 2 breast cancer is divided into two groups:
Stage 2A can mean:
No cancer is seen in the breast but cancer is found in one to three lymph nodes under the arm or near the breastbone
The cancer in the breast is 2cm or smaller and cancer is found in one to three lymph nodes under the arm or near the breastbone.
The cancer in the breast is larger than 2cm but smaller than 5cm and no cancer is found in the lymph nodes under the arm.
Stage 2B can mean:
The cancer in the breast is larger than 2cm but smaller than 5cm. Cancer is found in one to three lymph nodes under the arm or near the breastbone
The cancer in the breast is larger than 5cm and no cancer is found in the lymph nodes under the arm.
How Is Stage 1a Breast Cancer Treated
Patients with stage 1 breast cancer typically undergo surgery upfront, Mouabbi said, which may be a breast-conserving surgery or a mastectomy.
Surgery essentially “puts the patient in a cancer-free state because the cancer is removed already,” Mouabbi said. “So I tell my patients, everything that comes after that step is prevention making sure the cancer does not come back.”
But the exact treatments involved depend on a few factors. For instance, if a patient opted for a lumpectomy, they will likely receive radiation after surgery, Zeidman said. And if the patient’s cancer did spread to nearby lymph nodes they may receive radiation to “the regional lymph nodes around the breast,” Mouabbi explained.
And, in a subset of patients with specific types of breast cancer, chemotherapy may be recommended, Mouabbi said.
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What Is Stage 0 Lcis
Lobular carcinoma in situ at Stage 0 generally is not considered cancer. Although it has carcinoma in the name, it really describes a growth of abnormal but non-invasive cells forming in the lobules. Some experts prefer the name lobular neoplasia for this reason because it accurately refers to the abnormal cells without naming them as cancer. LCIS, however, may indicate a woman has an increased risk of developing breast cancer.
If you have been diagnosed with LCIS, your doctor may recommend regular clinical breast exams and mammograms. He or she may also prescribe Tamoxifen, a hormone therapy medication that helps prevent cancer cells from growing.
Talk To Your Doctor To Find Out What Your Breast Cancer Stage Is And How It Is Used To Plan The Best Treatment For You
After surgery, your doctor will receive a pathology report that describes the size and location of the primary tumor, the spread of cancer to nearby lymph nodes, tumor grade, and whether certain biomarkers are present. The pathology report and other test results are used to determine your breast cancer stage.
You are likely to have many questions. Ask your doctor to explain how staging is used to decide the best options to treat your cancer and whether there are clinical trials that might be right for you.
The treatment of breast cancer depends partly on the stage of the disease.
For treatment options for stage IIIB, inoperable stage IIIC, and inflammatory breast cancer, see Treatment of Locally Advanced Inflammatory Breast Cancer.
For treatment options for stage IV breast cancer or breast cancer that has recurred in distant parts of the body, see Treatment of Metastatic Breast Cancer.
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How Can I Be Sure That My Cancer Will Be Detected Before It Has Spread
While you cant prevent breast cancer altogether, there are certain things you can do to reduce your risk of discovering it at an advanced stage. For example:
- Get routine mammograms. The American Cancer Society recommends having a baseline mammogram at age 35, and a screening mammogram every year after age 40.
- Examine your breasts every month after age 20. Youll become familiar with the contours and feel of your breasts and will be more alert to changes.
- Have your breasts examined by a healthcare provider at least once every three years after age 20, and every year after age 40. Clinical breast exams can detect lumps that mammograms may not find.
Treatment Of Locoregional Recurrent Breast Cancer
For information about the treatments listed below, see the Treatment Option Overview section.
For information about treatment options for breast cancer that has spread to parts of the body outside the breast, chest wall, or nearby lymph nodes, see the Treatment of Metastatic Breast Cancer section.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
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Treatment For Stage 4 Breast Cancer
Treatment for may include the following, either alone or in combination:
- targeted therapy, which targets the protein that allows cancer cells to grow
- immunotherapy, which boosts the bodys ability to fight cancer
In rare cases, a surgeon will operate to try and remove tumors. This is not usually the first option.
However, a doctor may recommend surgery to help relieve pain or other issues that may develop as a result of stage 4 breast cancer. These include spinal cord compression, removing single masses caused by metastasis, and fixing any broken bones.
A doctor may also prescribe medication to treat related symptoms, such as pain.
New treatments and therapies are emerging all the time, and anyone who has breast cancer at any stage can volunteer to try out these new treatments. People considering this should talk with their doctor to see whether any trials are available in their area.
As well as numbers, a zero or an X often follow the letters T, N, and M. According to the AJCC, the meanings are as follows:
The stages of breast cancer help doctors and individuals understand how far cancer affects the body and which treatment options may be effective. However, other factors can also play a role in making treatment decisions.
The outlook for breast cancer will depend on the stage at diagnosis, the type of cancer the person has, and other factors.
The average survival rates according to the stage at diagnosis, says SEER, were:
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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