Stage 0 Breast Cancer Explained

The earliest stage of breast cancer, Stage 0 is non-invasive, meaning it hasn’t spread outside of its original location in the breast tissue, and is highly treatable when detected early. If left undetected or untreated, however, it can spread into surrounding breast tissue.

No matter what the stage, it is important to know about the type of breast cancer, diagnosis, and potential treatments. Learn more about all breast cancer stages.

What is Stage 0 Breast Cancer?

Stage 0 breast cancer, or “carcinoma in situ,” is a non-invasive cancer where abnormal cells have been found in the lining of the breast milk duct but have not spread. It is called “non-invasive” because the cancer cells have not invaded, or spread, beyond the original site of the cancerous growth. Stage 0 breast cancer accounts for 20% of all newly diagnosed breast cancers. DCIS, ductal carcinoma in situ, is the earliest form of breast cancer that can be detected.

People with breast cancer that has not spread beyond the breast tissue, such as Stage 0, have a five-year relative survival rate of 99%, according to the American Cancer Society.

Even though Stage 0 is the earliest stage of breast cancer, it is important to talk with your healthcare team about treatment options and what to expect.

What does the term “in situ” mean?

Stage 0 cancers are called “carcinoma in situ.” The term carcinoma means cancer and in situ means “in the original place.” Therefore, Stage 0 breast cancer is cancer that is in its original location, which indicates that it has not spread.

Types of Stage 0 Breast Cancer

There are three possible types of “carcinoma in situ” of the breast tissue. They are:

• Ductal carcinoma in situ (DCIS)
• Lobular carcinoma in situ (LCIS)- It should be noted that LCIS is not breast cancer, despite being called “carcinoma in situ.” Instead, it is a risk factor for developing breast cancer.
• Paget disease of the nipple

What is DCIS Stage 0 Breast Cancer?

Stage 0 ductal carcinoma in situ (DCIS) is a non-invasive or pre-invasive cancer where abnormal cells have been found in the lining of the breast milk ducts but have not spread to the lymph nodes, bloodstream, or surrounding tissue.

DCIS is very early cancer that is highly treatable, but it can spread into surrounding breast tissue if left untreated or undetected.

Staging of DCIS

DCIS is considered Stage 0 breast cancer because it is localized and has not spread, or metastasized, to other areas of the body, such as lymph nodes or other organs. Learn more about breast cancer stages and how they are determined.

What is LCIS Stage 0?

Although it has carcinoma in the name, lobular carcinoma in situ (LCIS) is not breast cancer; it is a breast condition or breast change. LCIS is a collection of abnormal but non-invasive cells that form in the lobules (milk glands) of the breast. 

While LCIS is not cancer, it may indicate a woman has an increased risk of developing breast cancer in one or both breasts and may require additional breast screenings.

Often no treatment is required for LCIS. However, your doctor may recommend regular clinical breast exams and mammograms to stay vigilant. Sometimes, surgery to remove the abnormal cells may be recommended. Additionally, hormone therapy medications that help prevent cancer cells from growing may be prescribed.

Stage 0 Breast Cancer Symptoms

Stage 0 breast cancer often has no symptoms at all and is typically discovered during a routine screening mammogram or other imaging test.

If symptoms are present, they can include a lump or abnormal nipple discharge, including blood. To learn more about breast cancer signs and symptoms, download NBCF’s free Know the Symptoms Guide.

Stage 0 Breast Cancer Diagnosis

Mammogram & Ultrasound for Stage 0 Breast Cancer

Early-stage breast cancer is often found through a routine mammogram or testing following the discovery of a lump.

A mammogram, or low-dose breast x-ray, is often the best option for detecting breast cancer in its earliest stages. Mammograms can find breast cancer or other issues even before symptoms develop. Mammograms are performed with a machine that has two plates that flatten the breast and spread the tissue apart, providing a clearer picture of the breast.

Following the discovery of a lump, abnormal nipple discharge, or other abnormal symptom, doctors will advise further testing to get to the bottom of the issue. These tests may include a diagnostic mammogram and/or ultrasound to test for Stage 0 breast cancer. Learn more about mammograms and how to prepare for one with NBCF’s free Mammogram 101 eBook.

After an initial mammogram, doctors might also recommend a breast ultrasound, which uses sound waves to view the inside of the breasts. The ultrasound generates a picture called a sonogram, which can help measure the size and location of a lump and determine if it is a cyst, which is not typically cancerous, or breast cancer.

DCIS Grades

When abnormal cells are detected on a mammogram, your doctor will order a follow-up needle biopsy that removes cells from the area of concern for further testing in order to determine if the cells are cancerous or not. A pathologist examines the cells under a microscope to make a diagnosis and grade the cancer.

DCIS or Stage 0 breast cancer is classified into 3 grades, sometimes called nuclear grades, which can help inform treatment decisions. The lower the grade, the less aggressive the cancer.

Following an early-stage breast cancer diagnosis, some people opt for genetic testing to learn more about their cancer, their genetic risks, and the likelihood that the cancer will return. The information uncovered through genetic testing can help determine the best treatment plan for Stage 0 breast cancer.

Stage 0 Breast Cancer Treatment

Not all Stage 0 breast cancers require treatment. Sometimes active monitoring or a watch-and-wait approach is recommended to see if the cancer will remain stable or if it will progress. However, DCIS is often treated because the cancerous cells can undergo additional changes that later become invasive breast cancer. Research is underway to help determine which types of DCIS cells will progress into invasive breast cancer and which ones likely will not. That research will directly impact which cancers get treated, and how, in the future.

Treatments such as surgery, radiation, hormone therapy, or a combination of these treatments, may be recommended. Chemotherapy is not part of the treatment regimen for Stage 0 breast cancer.

The best treatment plan for Stage 0 breast cancer will vary from person to person based on:

• Age at diagnosis. Women who are diagnosed with Stage 0 breast cancer at a younger age are at greater risk of recurrence, which may encourage more immediate treatment, according to research. If diagnosed at an early age, women hoping to become pregnant may choose to freeze their eggs ahead of treatment.
• Estrogen receptors. Cancer cells with estrogen receptors (ER+) may progress more slowly, allowing more time for a treatment decision to be made.
• Genetic risk: Breast cancer is sometimes caused by inherited gene mutations, such as BRCA mutations. Based on family history and genetic risk, women may choose to proceed with treatment sooner than later.
• Health history. Based on other health factors, women may choose a particular course of treatment that makes sense for their entire health picture.
• Personal preference: Some women are comfortable with a “wait-and-watch” approach while others want to address Stage 0 immediately. The recommendations of your healthcare team can also play into this decision.

Treatment Options

Stage 0 breast cancer typically covers a small area of tissue and there are a variety of treatment options, with many patients opting for a combination of Stage 0 treatments. Chemotherapy is not used to treat Stage 0 breast cancer. Side effects vary by treatment.

Lumpectomy

Lumpectomy, also known as breast-conserving surgery, is the most common treatment for Stage 0 DCIS breast cancer. Rather than removing all of the breast tissue, a lumpectomy removes only the cancerous tissue and a small margin of normal tissue around it. Lymph node removal is not usually needed. Lumpectomy for Stage 0 breast cancer is often followed by radiation to reduce the chance of the cancer coming back.

Mastectomy

While mastectomy was once the gold-standard for Stage 0 DCIS breast cancer treatment, breast-conserving surgery (lumpectomy) is now more common. However, if the Stage 0 cancer is widespread, occurs in multiple areas of the breast, or a lumpectomy cannot remove the cancer completely, then a mastectomy will likely be recommended. If a mastectomy is performed, a sentinel node biopsy will also be performed to determine if any of the tissue that contains DCIS cells also contains areas of invasive cancer. 

A double mastectomy to treat Stage 0 breast cancer is rare, but may be discussed with your healthcare team and surgeon. Women who have a mastectomy for Stage 0 breast cancer typically do not require radiation after surgery.Read more about breast surgery options by downloading NBCF’s free Breast Cancer Surgery eBook.

Radiation

Radiation, which is used to destroy any remaining cancer cells post-surgery, may be used after a lumpectomy for Stage 0 DCIS. Radiation reduces the chance of cancer recurrence. Most radiation is administered at a radiation center and usually begins three to four weeks after surgery.

If the cancerous area is small or low-grade, then radiation may not be needed following a lumpectomy.

Wait-and-Watch Approach

Some women with Stage 0 breast cancer opt for a wait-and-watch approach, sometimes called active surveillance, in lieu of immediate treatment. They will undergo more frequent screening to ensure that the abnormal cells haven’t spread, but won’t have a lumpectomy, mastectomy, radiation, or other treatments in the meantime.

Hormone Therapy

Hormone therapy may be given to women with hormone receptor-positive (HR+) breast cancer after radiation or surgery to decrease the risk of recurrence. Drugs, including tamoxifen or aromatase inhibitor (for post-menopausal women), can be taken as a pill for up to five years post-surgery.

Targeted Cancer Therapy

In addition to other treatments for Stage 0 breast cancer, newer targeted therapies can attack specific breast cancer cells without harming normal cells and with fewer side effects. Targeted cancer therapy, which uses drugs to block the growth of cancer cells, may be used in conjunction with other treatment options for DCIS.

Bone Strengthening Treatment

Bone-density medications are sometimes given to help prevent bone loss during breast cancer treatment. Known as bisphosphonates, bone-strengthening treatments may also reduce the risk of recurrence or invasive breast cancer for those with DCIS. Risks, however, can include heart disease and kidney issues.

Breast cancer survivors have a significantly higher risk of osteoporosis and osteopenia, according to research, and hormonal therapy can also increase the risk of fractures. It is important to talk with your doctor about overall bone health.

Stage 0 Breast Cancer Survival Rate

People with breast cancer that has not spread beyond the breast tissue, such as Stage 0, have a five-year survival rate of 99%, according to the American Cancer Society. When caught and treated early, the prognosis for recovery from Stage 0 breast cancer is excellent.

Life After Stage 0 Breast Cancer

Stage 0 breast cancer is very treatable and very survivable. With a variety of treatment options and an excellent survival rate, Stage 0 may still create stress and anxiety, but there is far more reason for hope as patients with DCIS have normal life expectancy.

You can enjoy a full, healthy life after stage 0 breast cancer. You will likely receive additional screenings and diagnostic mammograms, and it is important to maintain contact with your healthcare provider. Many Stage 0 cancer survivors also decide to devote greater time to their mental and emotional health and well-being. To learn how to live fully present in the moment, download NBCF’s free 10 Prompts to Mindfulness eBook.

If you would like additional support no matter where you are in your breast cancer journey, NBCF is here to help. We can provide encouragement and comfort in the form of a patient navigator to help you manage the journey, a support group, a HOPE Kit, and more—all reminders that you are never alone.

Sources: National Cancer Institute

The post Stage 0 Breast Cancer Overview appeared first on National Breast Cancer Foundation.

Stage 1 breast cancer is the earliest stage of what is considered invasive breast cancer. But what exactly does “invasive” mean? Invasive breast cancer indicates that the cancer is no longer contained in its original location because it has spread to, or invaded, other areas of the body.

In Stage 1 breast cancer, cancerous cells have spread beyond the original location they began in the breast to the surrounding normal tissue or lymph nodes. The spread is generally contained to a small area.

Stage 1 breast cancer is considered early-stage, localized cancer and is highly treatable and survivable. The five-year relative survival rate for breast cancer found and treated in the localized stage is 99%, according to the American Cancer Society.

Learn more about breast cancer stages.

What is Stage 1 Breast Cancer?

Whereas Stage 0 is non-invasive breast cancer, Stage 1 breast cancer is invasive breast cancer. Stage 1 invasive breast cancer is early-stage breast cancer, where tumors are generally small and found to be in the early stages when it can be most effectively treated.

Stage 1 invasive breast cancer is classified into two categories—Stage 1A or Stage 1B—based on the size of the tumor and whether it is only in the breast tissue or has spread to the lymph nodes.

Stage 1A Breast Cancer

In Stage 1A breast cancer, the tumor is smaller than 2 centimeters (smaller than the size of a peanut) and has not spread to the lymph nodes.

Stage 1B Breast Cancer

When breast cancer spreads, it typically spreads to the lymph nodes close to the breast first. Therefore, Stage 1B breast cancer implies that there is lymph node involvement. This means that at least one lymph node has evidence of cancer due to the presence of small clusters of abnormal (cancerous) cells between the size of a pinprick to the width of a grain of rice (0.2mm to 2.0mm).

Most times in Stage 1B, a small cancerous tumor (2 centimeters or smaller) is found in the breast, in addition to cancerous cells in the lymph nodes.

Other times, there is no actual tumor found in the breast of a person with Stage 1B breast cancer; instead, cancerous cells are found only within the lymph nodes close to the breast.

Stage 1 Breast Cancer Signs & Symptoms

Stage 1 breast cancer may present with symptoms or not. If symptoms are present, Stage 1 signs of breast cancer may include:

• A lump in the breast (this is the most common Stage 1 symptom)
• Nipple discharge, including bloody or clear fluid
• Inversion (turning inward) or flattening of the nipple
• Dimpling of the skin
• Changes to breast skin texture
• Changes in the size or shape of breast
• Redness or swelling

Stage 1 Breast Cancer Diagnosis

Stage 1 breast cancer is typically discovered in one of two ways. The first way is through a routine screening mammogram when no symptoms were present. The second way is through a diagnostic mammogram and ultrasound following the appearance of symptoms or an abnormal finding in a breast self-exam or clinical breast exam. Based on these test results, a Stage 1 breast cancer diagnosis can be made.

Mammogram for Stage 1 Breast Cancer

A mammogram is often the best option for detecting breast cancer in its earliest stages. This low-dose x-ray is performed with a machine that has two plates that flatten the breast and spread the tissue apart, providing a clearer picture of the breast.

There are two types of mammograms. A screening mammogram is administered at a routine mammogram appointment in women who have no apparent signs or symptoms of breast cancer present.

A diagnostic mammogram is administered if the screening mammogram showed an abnormal result or if there are signs of breast cancer present. A diagnostic mammogram can look for breast cancer and help doctors determine both diagnosis and staging.

NBCF offers a free Mammogram 101 resource that helps you learn more about and prepare for a mammogram.

Breast Ultrasound for Stage 1 Breast Cancer

To determine a Stage 1 breast cancer diagnosis, doctors may also recommend a breast ultrasound, which uses sound waves to view the inside of the breasts. The ultrasound generates a picture called a sonogram, which can help measure the size and location of a breast lump and determine if it is a cyst, which is not typically cancerous, or breast cancer.

If you are experiencing any potential Stage 1 breast cancer symptoms, schedule an appointment with your healthcare provider to discuss symptoms and signs, testing, and potential diagnosis.

Stage 1 Breast Cancer Treatment

Unlike Stage 0, Stage 1 breast cancer typically does require treatment. Stage 1 breast cancer treatment typically includes surgery, radiation, or a combination of treatments.

Stage 1 breast cancer treatment guidelines are based on several factors, including age at diagnosis, personal health history, genetic risk, and more. Treatment options continue to evolve and improve, with many patients opting for a combination of Stage 1 breast cancer treatments.

Surgery

There are three common types of Stage 1 breast cancer surgery: lumpectomy, mastectomy, and sentinel lymph node removal.

Lumpectomy, or breast-conserving surgery, is the most common surgical treatment for Stage 1 breast cancer since the tumor is small. A lumpectomy removes the cancerous tissue, a small margin of healthy tissue around it, and affected lymph nodes, if needed. Lumpectomy is often followed by radiation to reduce the chance of the cancer coming back.

For Stage 1 breast cancer that has spread further or if a lumpectomy can’t remove all of the cancerous cells, a mastectomy to remove the entirety of the breast tissue may be recommended.

Finally, doctors may also consider lymph node removal if the Stage 1 breast cancer has spread to nearby lymph nodes. However, many early stage breast cancer patients are now given radiation instead of lymph node removal surgery.

Read more about surgical options with NBCF’s free Breast Cancer Surgery eBook.

Radiation

Radiation may be used after a lumpectomy or mastectomy to reduce the chance of cancer recurrence. For this treatment option, the breast tissue and lymph nodes are treated with cancer-killing radiation therapy for several weeks at a hospital, radiation center, or other outpatient facility.

Common radiation side effects include fatigue, skin irritation (redness, peeling, or itchiness), and swelling of the breast or arm.

Hormone Therapy

Depending on the type of cancer cells found and additional risk factors, a hormonal therapy regimen is sometimes used to treat Stage 1 breast cancer. Tamoxifen, a daily pill, is the most common hormonal therapy for those with hormone receptor-positive breast cancer after radiation or surgery. Women who are post-menopausal may take an aromatase inhibitor instead. Hormone therapy can be used for up to five years after a lumpectomy or mastectomy to decrease the risk of recurrence.

Targeted Cancer Therapy

More recent biologic targeted therapies for Stage 1 breast cancer attack breast cancer cells without harming healthy cells; they also come with fewer side effects. Targeted cancer therapy, which uses drugs to block the growth of cancer cells, can be used in conjunction with other Stage 1 breast cancer treatments.

Chemotherapy

Chemotherapy is rarely used to treat Stage 1 or other early stages of cancer. But in some cases, it is used post-surgery to reduce the chances of the cancer coming back.

Bone Strengthening Treatment

Bone-density medications, called bisphosphonates, are not a treatment for cancer, but they can help prevent bone loss during breast cancer treatment. These treatments may also reduce the risk of recurrence for those with Stage 1 breast cancer. Risks can include heart disease and kidney issues.

Breast cancer survivors have a significantly higher risk of osteoporosis and osteopenia, and some treatments increase the risk of fractures. Talk with your doctor about bone health and recommendations for bone strengthening.

Stage 1 Breast Cancer Survival Rate

Early stage breast cancer is very treatable, and the Stage 1 breast cancer survival rate is high. The 5-year relative survival rate for women in the United States with localized or Stage 1 breast cancer is 99%, according to the American Cancer Society.

Breast cancer survival rates can vary based on type of cancer, stage and grade, age at diagnosis, overall health, and more. You can further discuss Stage 1 breast cancer prognosis with your healthcare provider.

Life After Stage 1 Breast Cancer

Earlier stage breast cancers, such as Stage 1 breast cancer, are treatable and survivable. Life after Stage 1 breast cancer can be full and long.

Your healthcare provider may encourage additional screenings and it is always important to pay attention to your physical and mental health by staying active, eating a healthy diet, eliminating or limiting alcohol consumption, meditating, and maintaining relationships.NBCF offers support at every step of your breast cancer journey, including a wealth of resources such as patient navigators, support groups, HOPE Kits, and access to free educational guides.

Stage 1 Breast Cancer FAQs

Is Stage 1 breast cancer curable?

While you are not likely to hear a doctor use the word “curable,” they may use the term “cancer free.” Stage 1 breast cancer has many options for treatment and an excellent prognosis for recovery and becoming “cancer free.”

Can Stage 1 breast cancer spread to the bones?

Stage 1 breast cancer will not be found in the bones as any spread beyond the breast tissue and/or lymph nodes is no longer considered Stage 1 cancer. If breast cancer has spread to the bones or other sites, it is considered Stage 4 metastatic breast cancer.

What are the types of breast cancer recurrence?

While it is rare for Stage 1 breast cancer to recur, it is important to be aware of the different levels of breast cancer recurrence. There are three levels of breast cancer recurrence:

Learn more with NBCF’s free Breast Cancer Recurrence eBook.

Where can I turn to for breast cancer education?

NBCF’s mission is to provide help and inspire hope to those impacted by breast cancer. Please visit our Breast Cancer Resources page to download free educational guides, get information on the NBCF National Mammography Program and Patient Navigator Program, information on financial support, and more.

Sources: National Cancer Institute

The post Stage 1 Breast Cancer Overview appeared first on National Breast Cancer Foundation.

What Does It Mean To Have Stage 2 Breast Cancer?

Stage 2 means the breast cancer is growing, but it is still contained in the breast or growth has only extended to the nearby lymph nodes.

This stage is divided into groups: Stage 2A and Stage 2B. The difference is determined by the size of the tumor and whether the breast cancer has spread to the lymph nodes.

For Stage 2 breast cancer, chemotherapy is usually done first, followed by surgery and radiation therapy.

Stage IIA Breast Cancer Means One Of The Following Descriptions Applies.

Either:

No actual tumor is associated with the cancerous cells and less than four axillary lymph nodes have cancer cells present.

OR

The tumor is less than 2 centimeters and less than four axillary lymph nodes have cancer cells present.

OR

The tumor is between 2 and 5 centimeters and has not yet spread to the lymph nodes.

Stage IIB Breast Cancer Means One Of The Following Descriptions Applies.

Either:

The tumor is between the 2 and 5 centimeters and has spread to less than four axillary lymph nodes.

OR

The tumor is larger than five centimeters, but has not spread to any axillary lymph nodes.

The post Stage 2 (II) And Stage 2A (IIA) Breast Cancer Overview appeared first on National Breast Cancer Foundation.

Stage 3 cancer means the breast cancer has extended to beyond the immediate region of the tumor and may have invaded nearby lymph nodes and muscles, but has not spread to distant organs. Although this stage is considered to be advanced, there are a growing number of effective treatment options.

This stage is divided into three groups: Stage 3A, Stage 3B, and Stage 3C. The difference is determined by the size of the tumor and whether cancer has spread to the lymph nodes and surrounding tissue.

Stage 3A Breast Cancer Means One Of The Following Descriptions Applies.

Either:

No actual tumor is associated with the cancerous cells or the tumor may be any size, AND the nearby lymph nodes (4 or more nodes with as many as 9 affected) contain cancer.

Or

The tumor is larger than the approximate size of a small lime (more than 5 centimeters), AND small clusters of breast cancer cells are found in the lymph nodes between the approximate size of a pinprick and the width of a grain of rice. (.2mm – 2.0mm.)

Or

The tumor is larger than the approximate size of a small lime (over 5 centimeters), AND the cancer has spread to 1, 2, or 3 lymph nodes under the arm or near the breastbone.

Stage 3B Breast Cancer Means The Following Descriptions Apply.

The tumor may be any size, AND cancer has invaded the chest wall or breast skin with evidence of swelling, inflammation, or ulcers (such as with cases like inflammatory breast cancer). The breast cancer may also have invaded up to 9 nearby lymph nodes.

Stage 3C Breast Cancer Means One Of The Following Descriptions Applies.

Either:

No actual tumor is found in the breast (such as with cases like inflammatory breast cancer) or the tumor may be any size, AND cancer may have invaded the chest wall or breast skin with evidence of swelling, inflammation, or ulcers and cancer has also invaded 10 or more lymph nodes under the arm

OR

No actual tumor is found in the breast or the tumor may be any size AND lymph nodes extending to the collarbone area are found to contain cancer. 

OR

No actual tumor is found in the breast or the tumor may be any size AND lymph nodes under the arm and near the breastbone are found to contain cancer.

“Inoperable” Breast Cancer Is Often Still Treatable.

Stage 3C breast cancer is divided into operable and inoperable stage 3C breast cancer. However, the term “inoperable” is not the same as “untreatable.”

If your physician uses the word “inoperable,” it may simply mean that a simple surgery at this time would not be enough to get rid of all the breast cancer that is within the breast and the tissue around the breast. There must be healthy tissue at all of the margins of the breast when it is removed. Keep in mind that the breast tissue goes beyond the breast mound – it goes up to the clavicle and down to a few inches below the breast mound. There must also be tissue to close the chest wound after the surgery is performed.

Another treatment method may be used first to shrink the breast cancer as much as possible before surgery is considered.
 

What Should A Person With Stage 3 Breast Cancer Expect From Treatment?

Stage 3 treatment options vary widely and may consist of mastectomy and radiation for local treatment and hormone therapy or chemotherapy for systemic treatment. Nearly every person with a Stage 3 diagnosis will do best with a combination of two or more treatments. 

Chemotherapy is always given first with the goal to shrink the breast cancer to be smaller within the breast and within the lymph nodes that are affected. This is known as neoadjuvant chemotherapy.

Other possible treatments include biologic targeted therapy and immunotherapy. There may be various clinical trial options for interested patients with Stage 3 breast cancer.

The post Stage 3 (III) A, B, And C Breast Cancer Overview appeared first on National Breast Cancer Foundation.

Stage 4 breast cancer means that the cancer has spread to other areas of the body, such as the brain, bones, lung and liver. Stage 4 breast cancer is also known as metastatic breast cancer.

Although Stage 4 breast cancer is not curable, it is usually treatable and current advances in research and medical technology mean that more and more women are living longer by managing the disease as a chronic illness with a focus on quality of life as a primary goal. With excellent care and support, as well as personal motivation, Stage 4 breast cancer may respond to a number of treatment options that can extend your life for several years.

What Should A Person With Stage 4 Breast Cancer Expect From Treatment?

Treatment options vary widely depending on where you live, your access to specialists and sub-specialists, and your willingness to try therapies that are still in the experimental phase.

Seek out oncology specialists who specialize in Stage 4 breast cancer. Discuss with your treatment team what clinical trials may be available for your clinical situation.

During this time, be sure to surround yourself with a support system of friends and family.  

The post Stage 4 (IV) Breast Cancer appeared first on National Breast Cancer Foundation.

Once a person is determined to have a malignant tumor or the diagnosis of breast cancer, 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 results of some of the tests used to diagnose breast cancer are also used to stage the disease.

On January 1, 2018, the American Join Committee on Cancer (AJCC) launched new staging guidelines for breast cancer.

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.

TNM System

The TNM system is used to describe the size of the primary tumor and the spread of cancer to nearby lymph nodes or other parts of the body.

TNM stands for:

• T = Tumor. The size and location of the tumor.
• N = Lymph Node. The size and location of lymph nodes where cancer has spread.
• M = Metastasis. The spread of cancer to other parts of the body.

Grading System

The tumor grading system is used to describe how quickly a breast tumor is likely to grow and spread.

Biomarker Test

Biomarker testing is used to find out whether breast cancer cells have certain receptors.

Breast Cancer Tests

The following tests and procedures also 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 in a group of lymph nodes to receive lymphatic drainage from the primary tumor. It is the first lymph node the cancer is likely to spread to from the primary 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 examines this 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. Sometimes, a sentinel lymph node is found in more than one group of 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.
• MRI (magnetic resonance imaging): During a breast MRI, a magnet connected to a computer transmits magnetic energy and radio waves (not radiation) through the breast tissue. It scans the tissue, making detailed pictures of areas within the breast. These images help the medical team distinguish between normal and diseased tissue.
• 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 with cancer 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.
• Blood tests: The doctor may choose to order some specific blood tests to look at the function of the liver, and other organs as well.

Metastasis

There are three ways that cancer spreads in the body. Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas. The report may say there are cancer cells that extend beyond the area where the cancer originally started to grow.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body. The report may say there are positive lymph nodes or that there is the presence of lymphatic invasion.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body. The report may say there is the presence of vascular invasion, or that blood vessels are seen running through the breast cancer tumor itself.

Cancer may spread from where it began to other parts of the body. When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bone, the cancer cells in the bone are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

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 (if done), and biopsies. The Clinical Prognostic Stage is described by the TNM system, tumor grade, and biomarker status (ER, PR, HER2). 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.

TNM System

The TNM system is used to describe the size of the primary tumor and the spread of cancer to nearby lymph nodes or other parts of the body.

For breast cancer, the TNM system describes the tumor as follows:

Tumor (T). The size and location of the tumor.

TX: Primary tumor cannot be assessed.

• T0: No sign of a primary tumor in the breast.
• Tis: Carcinoma in situ. There are 2 types of breast carcinoma in situ:
  • Tis (DCIS): DCIS is a 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 breast cancer that is able to spread to other tissues. At this time, there is no way to know which lesions can become invasive.
  • Tis (Paget disease): Paget disease of the nipple is a condition in which abnormal cells are found in the skin cells of the nipple and may spread to the areola. It is not staged according to the TNM system. If Paget disease AND an invasive breast cancer are present, the TNM system is used to stage the invasive breast cancer.
• T1: The tumor is 20 millimeters or smaller. There are 4 subtypes of a T1 tumor depending on the size of the tumor:
  • T1mi: the tumor is 1 millimeter or smaller.
  • T1a: the tumor is larger than 1 millimeter but not larger than 5 millimeters.
  • T1b: the tumor is larger than 5 millimeters but not larger than 10 millimeters.
  • T1c: the tumor is larger than 10 millimeters but not larger than 20 millimeters.
• T2: The tumor is larger than 20 millimeters but not larger than 50 millimeters.
• T3: The tumor is larger than 50 millimeters.
• T4: The tumor is described as one of the following:
  • T4a: the tumor has grown into the chest wall.
  • T4b: the tumor has grown into the skin—an ulcer has formed on the surface of the skin on the breast, small tumor nodules have formed in the same breast as the primary tumor, and/or there is swelling of the skin on the breast.
  • T4c: the tumor has grown into the chest wall and the skin.
  • T4d: inflammatory breast cancer—one-third or more of the skin on the breast is red and swollen (called peau d’orange).

Lymph Node (N). The size and location of lymph nodes where cancer has spread.

When the lymph nodes are removed by surgery and studied under a microscope by a pathologist, pathologic staging is used to describe the lymph nodes. The pathologic staging of lymph nodes is described below.

• NX: The lymph nodes cannot be assessed.
• N0: No sign of cancer in the lymph nodes, or tiny clusters of cancer cells not larger than 0.2 millimeters in the lymph nodes.
• N1: Cancer is described as one of the following:
  • N1mi: cancer has spread to the axillary (armpit area) lymph nodes and is larger than 0.2 millimeters but not larger than 2 millimeters.
  • N1a: cancer has spread to 1 to 3 axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters.
  • N1b: cancer has spread to lymph nodes near the breastbone on the same side of the body as the primary tumor, and the cancer is larger than 0.2 millimeters and is found by sentinel lymph node biopsy. Cancer is not found in the axillary lymph nodes.
  • N1c: cancer has spread to 1 to 3 axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters. Cancer is also found by sentinel lymph node biopsy in the lymph nodes near the breastbone on the same side of the body as the primary tumor.
• N2: Cancer is described as one of the following:
  • N2a: cancer has spread to 4 to 9 axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters.
  • N2b: cancer has spread to lymph nodes near the breastbone and the cancer is found by imaging tests. Cancer is not found in the axillary lymph nodes by sentinel lymph node biopsy or lymph node dissection.
• N3: Cancer is described as one of the following:
  • N3a: cancer has spread to 10 or more axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters, or cancer has spread to lymph nodes below the collarbone.
  • N3b: cancer has spread to 1 to 9 axillary lymph nodes and the cancer in at least one of the lymph nodes is larger than 2 millimeters. Cancer has also spread to lymph nodes near the breastbone and the cancer is found by imaging tests; or
  • cancer has spread to 4 to 9 axillary lymph nodes and cancer in at least one of the lymph nodes is larger than 2 millimeters. Cancer has also spread to lymph nodes near the breastbone on the same side of the body as the primary tumor, and the cancer is larger than 0.2 millimeters and is found by sentinel lymph node biopsy.
  • N3c: cancer has spread to lymph nodes above the collarbone on the same side of the body as the primary tumor.

When the lymph nodes are checked using mammography or ultrasound, it is called clinical staging. The clinical staging of lymph nodes is not described here.

Metastasis (M). The spread of cancer to other parts of the body.

• M0: There is no sign that cancer has spread to other parts of the body.
• M1: Cancer has spread to other parts of the body, most often the bones, lungs, liver, or brain. If cancer has spread to distant lymph nodes, the cancer in the lymph nodes is larger than 0.2 millimeters. The cancer is called metastatic breast cancer.

Grading System

The grading system is used to describe how quickly a breast tumor is likely to grow and spread. The grading system describes a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Low-grade cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells.

To describe how abnormal the cancer cells and tissue are, the pathologist will assess the following three features:

• How much of the tumor tissue has normal breast ducts.
• The size and shape of the nuclei in the tumor cells.
• How many dividing cells are present, which is a measure of how fast the tumor cells are growing and dividing.

For each feature, the pathologist assigns a score of 1 to 3; a score of “1” means the cells and tumor tissue look the most like normal cells and tissue, and a score of “3” means the cells and tissue look the most abnormal. The scores for each feature are added together to get a total score between 3 and 9.

Three grades are possible:

• Total score of 3 to 5: G1 (Low grade or well differentiated).
• Total score of 6 to 7: G2 (Intermediate grade or moderately differentiated).
• Total score of 8 to 9: G3 (High grade or poorly differentiated).

Biomarker Testing

Biomarker testing is used to find out whether breast cancer cells have certain receptors.

Healthy breast cells, and some breast cancer cells, have receptors (biomarkers) that attach to the hormones estrogen and progesterone. These hormones are needed for healthy cells, and some breast cancer cells, to grow and divide. To check for these biomarkers, samples of tissue containing breast cancer cells are removed during a biopsy or surgery. The samples are tested in a laboratory to see whether the breast cancer cells have estrogen or progesterone receptors.

Another type of receptor (biomarker) that is found on the surface of all breast cancer cells is called HER2. HER2 receptors are needed for the breast cancer cells to grow and divide.

For breast cancer, biomarker testing includes the following:

• Estrogen receptor (ER). If the breast cancer cells have estrogen receptors, the cancer cells are called ER positive (ER+). If the breast cancer cells do not have estrogen receptors, the cancer cells are called ER negative (ER-).
• Progesterone receptor (PR). If the breast cancer cells have progesterone receptors, the cancer cells are called PR positive (PR+). If the breast cancer cells do not have progesterone receptors, the cancer cells are called PR negative (PR-).
• Human epidermal growth factor type 2 receptor (HER2/neu or HER2). If the breast cancer cells have larger than normal amounts of HER2 receptors on their surface, the cancer cells are called HER2 positive (HER2+). If the breast cancer cells have a normal amount of HER2 on their surface, the cancer cells are called HER2 negative (HER2-). HER2+ and HER2/neu breast cancers are more likely to grow and divide faster than HER2- breast cancer.

Sometimes the breast cancer cells will be described as triple negative or triple positive.

• Triple negative. If the breast cancer cells do not have estrogen receptors, progesterone receptors, or a larger than normal amount of HER2 receptors, the cancer cells are called triple negative.
• Triple positive. If the breast cancer cells do have estrogen receptors, progesterone receptors, and a larger than normal amount of HER2 receptors, the cancer cells are called triple positive.

It is important to know the estrogen receptor, progesterone receptor, and HER2 receptor status to choose the best treatment. There are drugs that can stop the receptors from attaching to the hormones estrogen and progesterone and stop the cancer from growing. Other drugs may be used to block the HER2 receptors on the surface of the breast cancer cells and stop the cancer from growing.

Staging Examples

The TNM system, the grading system, and biomarker status are combined to find out the breast cancer stage.

Here are 3 examples that combine the TNM system, the grading system, and the biomarker status to find out the Pathological Prognostic breast cancer stage for a woman whose first treatment was surgery:

If the tumor size is 30 millimeters (T2), has not spread to nearby lymph nodes (N0), has not spread to distant parts of the body (M0), and is:

• Grade 1
• HER2+
• ER-
• PR-

The cancer is stage IIA.

If the tumor size is 53 millimeters (T3), has spread to 4 to 9 axillary lymph nodes (N2), has not spread to other parts of the body (M0), and is:

• Grade 2
• HER2+
• ER+
• PR-

The tumor is stage IIIA.

If the tumor size is 65 millimeters (T3), has spread to 3 axillary lymph nodes (N1a), has spread to the lungs (M1), and is:

• Grade 1
• HER2+
• ER-
• PR-

The cancer is stage IV (metastatic breast cancer).

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.

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. Since this is likely to be a stressful time and you may have many questions, it may be a good idea for you to take a friend or loved one with you to your appointment to help take notes. You can also ask your doctor if you can record the consultation on your cell phone or a recording device to refer back to later.

Materials on this page courtesy of National Cancer Institute

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