Breast Cancer Staging And Treatment

breast cancer staging and treatment

We have already discussed about breast cancer (here). After confirming the diagnosis of breast cancer, the next step is determining the breast cancer staging. The importance of breast cancer staging is:

• Describing the breast cancer: how severe, etc.
• Predicting the prognosis (prognosis is most likely outcome of disease)
• Determining treatment options 

Breast cancer staging is closely related with treatment options. Breast cancer staging is based on four basic informations:

1. The size of the cancer
2. Whether the breast cancer cells have spread to lymph nodes (especially under arm lymph nodes or axillary lymph nodes)
3. Whether the breast cancer cells have spread to other body parts such as liver, lungs, brain, etc.

There are many kinds of staging system. One of them is TNM system. It is based on:

• T: size of the cancer
• N: lymph node involvement
• M: whether the cancer cells have spread to other parts of the body

Here is the general breast cancer staging, as quoted from New York State Department of Health:

Stage 1

• Cancer cells are invading normal surrounding breast tissue where the tumor size is up to 2 cm
• There is no lymph nodes involvement
• There may be a microscopic invasion that can only be seen by microscope. The size of invading cancer cells can not measure more than 1 mm

Stage 2A

• The tumor size is up to 2 cm, OR 
• The tumor size is more than 2 cm but not more than 5 cm but not spread to the axillary lymph nodes, OR
• Cancer cells are found in the axillary lymph nodes (no tumor can be found in the breast tissue)

Stage 2B

• Tumor size is more than 2 cm but not larger than 5 cm AND has spread to the axillary lymph nodes, OR
• Tumor size is more than 5 cm and there is NO involvement in axillary lymph nodes.

Stage 3A

• Cancer is not found in the breast tissue but in axillary lymph nodes, which are sticking or clumped together to other structures, or cancer may have spread to lymph nodes around the breast bone, OR
• There is a cancer in any size and it has spread to axillary lymph nodes which are sticking to other structures.

Stage 3B

• There is a cancer in any size and it has spread to chest wall and/or the breast skin, AND
• Cancer may have spread to axillary lymph nodes which are sticking to other structures or it may have spread to lymph nodes near the breast bone.

Stage 4

• Cancer has spread elsewhere in the body such as liver, lung, bones, etc.
• Very life threatening.

Breast cancer staging and treatment

Stage 1

• Breast conserving surgery such as lumpectomy, partial mastectomy, or
• Mastectomy
• Axillary lymph node dissection 
• Lymph node biopsy to evaluate it
• Breast reconstruction (can be done at the same time as surgery or later)
• Radiotherapy (radiation therapy) may be given after breast-conserving surgery, but radiotherapy is contraindicated if:
• Age 70 or older
• The tumor contains hormon receptors (while hormonal therapy is given)
• Size of tumor is 2 cm or less an it has been completely removed.
• None of the lymph nodes that has been removed contains cancer
• Hormone therapy as adjuvant. The drug is Tamoxifen 

Stage 2

• Surgery
• Radiation therapy
• Chemotherapy before or after the surgery

Stage 3

• Mastectomy with or without breast reconstruction
• Adjuvant chemotherapy
• Adjuvant hormone therapy
• Inflammatory breast cancer: neoadjuvant chemotherapy with radiation, then mastectomy with axillary lymph nodes dissection.

Stage 4

• Chemotherapy
• Hormone therapy
• Surgery and radiation. They do not cure the cancer but help treat the pain and other symptoms where body parts involved.
• Symptomatic drugs to treat nausea, secondary infection, and fatigue.

Source:
Cancer Services Program, New York State Department of Health (click here)