The Stages of Breast Cancer

Stage 0: This stage is used to describe non-invasive breast cancer. There is no evidence of cancer cells breaking out of the part of the breast in which it started, or of getting through to or invading neighboring normal tissue. Lobular carcinoma in situ (LCIS) and Ductal carcinoma in situ (DCIS) are examples of Stage 0.

Stage I: This stage describes invasive breast cancer (cancer cells are breaking through to or invading neighboring normal tissue) in which:

  • The tumor measures up to two centimeters
  • No lymph nodes are involved

Stage II: This stage describes invasive breast cancer in which:

  • The tumor measures at least two centimeters, but not more than five centimeters
  • OR cancer has spread to the lymph nodes under the arm on the same side as the breast cancer. Affected lymph nodes have not yet stuck to one another or to the surrounding tissues, a sign that the cancer has not yet advanced to stage III. (The tumor in the breast can be any size.)

Stage III: Stage III is divided into subcategories known as III A and III B.

Stage III A: Describes invasive breast cancer in which:

  • The tumor measures larger than five centimeters
  • OR there is significant involvement of lymph nodes. The nodes clump together or stick to one another or surrounding tissue.

Stage III B: This stage describes invasive breast cancer in which:

  • A tumor of any size has spread to the breast skin, chest wall, or internal mammary lymph nodes (located beneath the breast right under the ribs, inside the middle of the chest).

Stage III B includes inflammatory breast cancer, a very uncommon but very serious, aggressive type of breast cancer. The most distinguishing feature of inflammatory breast cancer is redness involving part or all of the breast. The redness feels warm. You may see puffiness of the breast’s skin that looks like the peel of a navel orange (“peau d’orange”), or even ridges, welts or hives. And part or all of the breast may be enlarged and hard. A lump is present only half of the time. Inflammatory breast cancer is sometimes misdiagnosed as a simple infection.

Stage IV: This stage includes invasive breast cancer in which:

  • A tumor has spread beyond the breast, underarm, and internal mammary lymph nodes
  • AND a tumor may have spread to the supraclavicular lymph nodes (nodes located at the base of the neck, above the collarbone), lungs, liver, bone, or brain.

Metastatic at presentation means that the breast cancer has spread beyond the breast and nearby lymph nodes, even though this is the first diagnosis of breast cancer. The reason for this is that the primary breast cancer was not found when it was only inside the breast. Metastatic cancer is considered stage IV.

ADDITIONAL STAGING INFORMATION
You may also hear terms such as “early” or “earlier” stage, “later” or “advanced” stage breast cancer. Although these terms are not medically precise (they may be used differently by different doctors), here is a general idea of how they apply to the official staging system:

  • Early stage
  • Stage 0
  • Stage I
  • Stage II
  • Later stage
  • (Stage II if there are many lymph nodes involved)
  • Stage III (IIIA, IIIB)
  • Advanced stage: Stage IV

You may also hear the cancer described by three characteristics:

  • Size (T stands for tumor). The T category describes the original (primary) tumor. TX means the tumor can’t be measured or found. T0 means there isn’t any evidence of the primary tumor. Tis means the cancer is “in situ” (the tumor has not started growing into the breast tissue). The numbers T1-T4 describe the size and/or how much the cancer has grown into the breast tissue. The higher the T number, the larger the tumor and/or the more it may have grown into the breast tissue.
  • Node involvement (N stands for node). The N category describes whether or not the cancer has reached nearby lymph nodes. NX means the nearby lymph nodes can’t be measured or found. N0 means nearby lymph nodes do not contain cancer. The numbers N1-N3 describe the size, location, and/or the number of lymph nodes involved. The higher the N number, the more the lymph nodes are involved.
  • Whether it has metastasized (M stands for metastasis). The M category tells whether there are distant metastases (whether the cancer has spread to other parts of body). MX means metastasis can’t be measured or found. M0 means there are no distant metastases. M1 means that distant metastases were found.

Once the pathologist knows your T, N, and M characteristics, they are combined, and an overall “stage” of 0, I, II, III, III A, III B, or IV is assigned. For example, a T1, N0, M0 breast cancer would mean that the primary breast tumor:

  • is less than two centimeters across (T1),
  • does not have lymph node involvement (N0)
  • AND has not spread to distant parts of the body (M0).

This cancer would be grouped as a stage I cancer.

For more information, please contact us at the Rucker MD Plastic Surgery Clinic at 800.456.8222. We are happy to assist you!

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