Breast Cancer Basics — The Stages of Breast Cancer

How is breast cancer staged? If you are diagnosed with breast cancer, your doctors should immediately perform various tests to determine how widespread the cancer is in your body.  The degree to which the cancer has grown and/or spread in your body as of the time of diagnosis is called the “stage” of the cancer.  The tests and procedures that are used to assist your doctors in determining the stage of your breast cancer include:

• Chest x-ray:  This test is done to see whether the breast cancer has spread to your lungs.
• Bone scan:  A bone scan can help show whether a cancer has metastasized (spread) to your bones. It can be more useful than standard x-rays because it can show all of the bones of the body at the same time.  To perform this test, a low-level radioactive material is injected into one of your veins. Over the next several hours, this substance will settle in areas of changes in your bones. A picture is then made of your skeleton showing the areas where the low-level radioactive substance has settled.  These areas may suggest the presence of metastatic cancer.
• CT scan:  The CT scan is an x-ray test that produces detailed cross-sectional images of your body. Instead of taking one picture, like a regular x-ray, a CT scanner takes many pictures as it rotates around you while you lie on a table. A computer then combines these pictures into images of slices of the part of your body being studied. In women with breast cancer, this test is most often used to look at the chest and/or abdomen to see if the cancer has spread to other organs.
• CT-guided biopsy:  CT scans can also be used to precisely guide a biopsy needle into a suspected area of cancer spread. During CT-guided biopsy, you remain on the CT scanning table while a radiologist advances an instrument called a biopsy needle through the skin and toward the location of the mass. CT scans are repeated until the doctors are sure that the needle is within the mass or suspected area of cancer spread. A fine needle biopsy sample (tiny fragment of tissue) or a core needle biopsy sample (a thin cylinder of tissue about one half-inch long and less than 1/8-inch in diameter) is then removed and sent for microscopic evaluation.
• MRI:  MRI scans use radio waves and very strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into a very detailed image of parts of the body.  MRI scans are particularly helpful in looking for the spread of cancer in the brain and spinal cord.
• Ultrasound:  Ultrasound tests use sound waves and their echoes to produce a picture of your internal organs or any masses that may exist. During ultrasound, a gel is applied to the skin and a small instrument called a transducer is placed on the skin. The transducer emits sound waves and picks up the echoes as they bounce the tissue in your body. These echoes are converted into black and white images that are displayed on a computer screen.  Abdominal ultrasound can be used to look for tumors in your liver or other abdominal organs.
• PET scan:  PET stands for positron emission tomography.  PET scanning is useful when your doctor thinks your breast cancer may have spread but doesn’t know where.  During PET, glucose (a form of sugar) that contains a radioactive atom is injected into your bloodstream. Because cancer cells in the body are growing rapidly, they absorb large amounts of the radioactive sugar. After about an hour, a special camera is used to create a picture of areas of radioactivity in the body.
• Surgery:  Breast-conserving surgery is often used for earlier-stage invasive breast cancers so long as the cancer is small enough. If the cancer is too large, a mastectomy is used.  In either case, the lymph nodes are checked and removed if they contain cancer.

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What are the different stages of breast cancer?

The staging of your breast cancer depends on the interplay of three different variables:  (1) the size of the breast cancer tumor in your breast (“T”); (2) the degree of cancer spread to the lymph nodes near the breast (“N”); and (3) the degree of cancer spread to your other organs (“M”).  Let’s look a little closer at each of these variables.

• Tumor size:  The size of your breast cancer tumor is measured as follows:
• TX:  Primary tumor cannot be measured;
• T0:  No evidence of primary tumor;
• Tis:  Carcinoma in situ, a.k.a. “CIS” (either ductal CIS (DCIS), lobular CIS (LCIS), or Paget disease of the nipple with no associated tumor mass);
• T1:  Tumor is 2 cm (3/4 of an inch) or less across;
• T2:  Tumor is more than 2 cm but not more than 5 cm (2 inches) 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).
• Breast cancer spread to nearby lymph nodes:  The degree of breast cancer spread to the lymph nodes near your breast is measured as follows:

• NX:  Nearby lymph nodes cannot be assessed (because removed previously for example);
• N0:  Breast cancer has not spread to nearby lymph nodes;
• N1:  Breast cancer has spread to 1 to 3 axillary (underarm) lymph node(s), and/or tiny amounts of cancer are found in internal mammary lymph nodes (those near the breast bone) on sentinel lymph node biopsy;
• N2:  Cancer has spread to 4 to 9 axillary lymph nodes under the arm, or cancer has enlarged the internal mammary lymph nodes;
• N3:  One of the following applies:

  – Cancer has spread to 10 or more axillary lymph nodes.
  – Cancer has spread to the lymph nodes under the clavicle (collar bone).
  – Cancer has spread to the lymph nodes above the clavicle.
  – Cancer involves axillary lymph nodes and has enlarged the internal mammary lymph nodes.
  – Cancer involves 4 or more axillary lymph nodes, and tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy.

• Breast cancer spread to other organs (metastasis):  The degree of breast cancer spread to other organs is measured as follows:
• MX>:  Presence of distant spread (metastasis) cannot be assessed;
• M0:  No distant spread;
• M1:  Spread to distant organs is present (most common sites are bone, lung, brain, and liver).

Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping.  Breast cancers with similar stages tend to have a similar outlook and are often treated in a similar way. Stage is expressed in Roman numerals from stage I (the least advanced stage) to stage IV (the most advanced stage).  Non-invasive cancer is listed as stage 0.  Here are some important details about each breast cancer stage:

• Stage 0:  If you have Tis-N0-M0, you have a breast cancer stage 0.  This is the earliest form of breast cancer.  This can be ductal CIS, in which cancer cells are still within a duct and have not invaded deeper into the surrounding fatty breast tissue; lobular CIS, in which abnormal cells grow within the lobules or milk-producing glands, but they do not penetrate through the wall of these lobules; or Paget disease of the nipple without an underlying tumor mass.  In all stage 0 cases, the cancer has not spread to lymph nodes or distant sites.
• Stage I:  If you have T1-N0-M0, you have a breast cancer stage I.  This means that the primary breast tumor is 2 cm (about 3/4 of an inch) or less across and the cancer has not spread to lymph nodes or distant sites.
• Stage IIA:  If you have any of the following:  T0-N1->M0; or T1-N1-M0; or T2-N0-M0, your breast cancer is stage IIA.  In all stage IIA cases, the breast cancer has not spread to distant sites.
• Stage IIB:  If you have either of the following:  T2-N1-M0; or T3-N0-M0, your breast cancer is stage IIB.  In all stage IIB cases, the breast cancer has not spread to distant sites.
• Stage IIIA:  If you have any of the following:  T0-2, N2, M0, or T3, N1-2, MO, your breast cancer is stage IIIA.  In all stage IIIA cases, the breast cancer has not spread to distant sites.
• Stage IIIB:  If you have any of the following:  T4, N0-2, MO, your breast cancer is stage IIIB.  Inflammatory breast cancer is also classified as stage IIIB unless it has spread to distant lymph nodes or organs, in which case it becomes a stage IV.  In all stage IIIB cases, the breast cancer has not spread to distant sites.
• Stage IIIC:  If you have any of the following:  T0-4, N3, M0, your breast cancer is stage IIIC.  In all stage IIIC cases, the breast cancer has not spread to distant sites.
• Stage IV<:  If you have any of the following:  T0-4, N0-3, M1, your breast cancer is a stage IV.  With stage IV breast cancer, the primary tumor can be any size and the cancer may or may not have spread to nearby lymph nodes, but it has spread to one or more distant organs, or to lymph nodes far from the breast.

What are the survival rates for the various stages of breast cancer?

Based on women who were diagnosed with breast cancer between 1988 and 2001, the five-year relative survival rate for breast cancer stage 0 is 100%; stage I is 100%; stage II is 86%; stage III is 57%; stage IV is 20%.

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A cancer misdiagnosis can change your entire life in an instant. Even a top-tier Pittsburgh hospital can give an incorrect diagnosis, including facilities such as Forbes Hospital, St. Clair Hospital and Jefferson Hospital. If your breast cancer was missed or misdiagnosed, see the breast cancer malpractice lawyers of Pennsylvania. Berger Lagnese & Paul, LLC is a law firm that specializes in breast cancer medical malpractice cases. We work on cases in Pittsburgh and all over Western Pennsylvania, including Greensburg, Washington, Uniontown, Beaver, and Erie. Our office is located at 310 Grant St #720, Pittsburgh, PA 15219 and consultations can be scheduled either online or by calling (412) 471-4300.