It is always a shock to find out that a loved one or friend has breast cancer. When the news suddenly hits us personally, we are devastated and have millions of questions and uncertainties.
Breast cancer is the most common cancer after skin cancer and can occur in both men and women, but is far more common in women. Knowing more about breast cancer, the stages and the treatments, could give us more clarity on how to deal with a subject matter that we are all aware of, but choose not to think about until it affects us.
When we think of characteristics, we think of what someone looks like, how tall they are and how they behave. Breast cancer characteristics are very much the same and the stage of breast cancer is determined by characteristics, such as how large the growth is and whether or not it has hormone receptors.
Knowing the stage of the cancer will help with:
- figuring out your prognosis and the likely outcome of the disease
- deciding on the best treatment options for you
- determining if certain clinical trials may be a good option for you
There are five stages of breast cancer; stage 0 describes non-invasive cancers that remain within their original location and stage IV describes aggressive cancers that have spread outside the breast to other parts of the body.
How are the stages of breast cancer determined?
The most common tool that doctors use to determine the stage is the TNM system. Doctors use the results from diagnostic tests and scans to get answers to these questions:
- Tumour (T): How large is the primary tumour in the breast? What are its biomarkers?
- Node (N): Has the tumour spread to the lymph nodes? If so, to where, what size, and how many?
- Metastasis (M): Has the cancer spread to other parts of the body?
Using the TNM system and adding a number (0 to 4) helps to describe the size and location of the tumour. Tumour size is measured in centimetres.
These results are combined to determine the stage of cancer for each person and this system is used to ensure that all doctors and treatment facilities are describing cancer in a uniform way, so that the treatment results of all people can be compared, understood and monitored.
Stage 0
Stage 0 is used to describe non-invasive breast cancers and that there is no evidence of cancer cells breaking out of the part of the breast in which they started and thus getting through to, or invading neighbouring normal tissue.
Read more about the treatments you can generally expect for stage 0.
Stage I
Stage I describes invasive breast cancer (cancer cells are breaking through to, or invading normal surrounding breast tissue). Stage I is divided into subcategories known as IA and IB.
Stage IA describes invasive breast cancer where:
- the tumour measures up to 2 cm; and
- the cancer has not spread outside the breast; no lymph nodes are involved
Stage IB describes invasive breast cancer where:
- there is no tumour in the breast; but small groups of cancer cells are found in the lymph nodes; or
- there is a tumour in the breast that is no larger than 2 cm, and there are small groups of cancer cells in the lymph nodes
(If the cancer is estrogen-receptor-positive or progesterone-receptor-positive, it is likely to be classified as stage IA).
Microscopic invasion is possible in stage I breast cancer, which means the cancer cells have just started to invade the tissue outside the lining of the duct or lobule, but the invading cancer cells can't measure more than 1 mm.
Read more about the treatments you can generally expect for stage IA and IB.
Stage II
Stage II is divided into subcategories known as IIA and IIB.
Stage IIA describes invasive breast cancer where:
- no tumour can be found in the breast, but cancer (larger than 2 mm) is found in one or more lymph nodes under the arm, or in the lymph nodes near the breast bone;
- the tumour measures 2 cm or smaller and has spread to the lymph nodes under the arm; or
- the tumour is larger than 2 cm but not larger than 5 cm and has not spread to the lymph nodes under the arm
However:
If the cancer tumour measures between 2 and 5 cm and:
- has not spread to the lymph nodes or parts of the body away from the breast
- is HER2-negative
It will likely be classified as stage I.
Similarly, if the cancer tumour measures between 2 and 5 cm and:
- has not spread to the lymph nodes
- is HER2-negative
- is estrogen-receptor-positive
- is progesterone-receptor-negative
- has an Oncotype DX Recurrence Score of 9
It will likely be classified as stage IA.
Stage IIB describes invasive breast cancer where:
- the tumour is larger than 2 cm, but no larger than 5 cm; small groups of breast cancer cells are found in the lymph nodes;
- the tumour is larger than 2 cm but no larger than 5 cm; cancer has spread to one or more lymph nodes under the arm, or to lymph nodes near the breastbone (found during a sentinel node biopsy); or
- the tumour is larger than 5 cm but has not spread to the lymph nodes under the arm
However:
If the cancer tumour measures between 2 and 5 cm and:
- cancer is found in one to three axillary lymph nodes
- is HER2-positive
- is estrogen-receptor-positive
- is progesterone-receptor-positive
It will likely be classified as stage I.
Read more about the treatments you can generally expect for stage IIA and IIB.
Stage III
Stage III is divided into subcategories known as IIIA, IIIB, and IIIC.
Stage IIIA describes invasive breast cancer where either:
- no tumour is found in the breast, or the tumour may be any size; cancer is found in four to nine lymph nodes under the arm, or in the lymph nodes near the breastbone (found during imaging tests or a physical exam);
- the tumour is larger than 5 cm; small groups of breast cancer are found in the lymph nodes; or
- the tumour is larger than 5 cm; cancer has spread to one to three lymph nodes under the arm, or to the lymph nodes near the breastbone (found during a sentinel lymph node biopsy)
However:
If the cancer tumour measures more than 5 cm across and:
- is grade 2
- cancer is found in four to nine axillary lymph nodes
- is estrogen-receptor-positive
- is progesterone-receptor-positive
- is HER2-positive
It will likely be classified as stage IB.
Stage IIIB describes invasive breast cancer where:
- the tumour may be any size and has spread to the chest wall and/or skin of the breast and caused swelling or an ulcer;
- may have spread to up to nine lymph nodes under the arm; or
- may have spread to lymph nodes near the breastbone
However:
If the cancer tumour measures more than 5 cm across and:
- is grade 3
- cancer is found in four to nine axillary lymph nodes
- is estrogen-receptor-positive
- is progesterone-receptor-positive
- is HER2-positive
It will likely be classified as stage IIA.
Inflammatory breast cancer is considered at least stage IIIB. Typical features of inflammatory breast cancer include:
- reddening of a large portion of the breast skin
- the breast feels warm and may be swollen
- cancer cells have spread to the lymph nodes and may be found in the skin
Stage IIIC describes invasive breast cancer where:
- there may be no sign of cancer in the breast or, if there is a tumour, it may be any size and may have spread to the chest wall and/or the skin of the breast;
- the cancer has spread to 10 or more lymph nodes under the arm;
- the cancer has spread to lymph nodes above or below the collarbone; or
- the cancer has spread to lymph nodes under the arm or to lymph nodes near the breastbone
However:
If the above-mentioned cancer tumour measures any size and:
- is grade 2
- is estrogen-receptor-positive
- is progesterone-receptor-positive
- is HER2-positive or negative
It will likely be classified as stage IIIA.
Read more about the treatments you can generally expect for stage IIIA, IIIB, and IIIC.
Stage IV
Stage IV describes invasive breast cancer that has spread beyond the breast and nearby lymph nodes to other organs of the body, such as the lungs, distant lymph nodes, skin, bones, liver or brain.
You may hear the words “advanced” and “metastatic” used to describe stage IV breast cancer. Cancer may be stage IV at first diagnosis, called “de novo” by doctors, or it can be a recurrence of a previous breast cancer that has spread to other parts of the body.
Read more about the treatments you can generally expect for stage IV.
Men and breast cancer
Breast cancer in men accounts for 1% of all breast cancers and is thus rare. It is a hundred times more common in women than in men, but it does happen and men too should be made aware of possible symptoms.
Symptoms may include:
- a painless lump under the nipple or areola
- an inverted nipple (turned inward)
- swelling of the breast tissue
- a rash around the nipple
- discharge or bleeding from the nipple
- a swelling or lump in the armpit
Some resources on men and breast cancer:
Support and more information
Source:
BREASTCANCER.ORG
CANSA
Accessed October 2020
DISCLAIMER
Although this communication has been prepared with due care and in good faith, it provides information and opinions of a general nature. The interpretations and opinions are those of the authors and are subject to change without notice. Simeka Health accepts no liability or responsibility if any information is incorrect or for any loss or damage, including but not limited to, direct, indirect or consequential loss, that may arise from reliance on information contained herein. It does not constitute advice and should not be accepted as such and no part thereof should be relied upon without seeking appropriate professional advice. Simeka Health (Pty) Ltd is an authorised Financial Services Provider.