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Staging is the process of finding out if cancer is localized or widespread. It will show if the cancer has spread to other
body structures and, if so, how far. The treatment and prognosis (outlook for survival) depends, to a large extent, on the cancer's stage.
Defining Staging
This important step is called staging. Knowing the exact stage of your disease will help your doctor plan
your treatment. Your doctor will want to know:
- The size of the tumor and exactly where it is in your breast.
- If the cancer has spread within your breast.
- If cancer is present in your lymph nodes under your arm.
- If cancer is present in other parts of your body.
Staging is the process of finding out how far the cancer has spread. This is very
important because your treatment and the outlook for your recovery depend on the stage of your cancer. There is more than one system for staging cancer.
The staging system of the American Joint Committee on Cancer (AJCC), also known as the TNM system, is the one used most often for breast cancer.
TNM Staging System
The TNM system for staging gives three key pieces of information:
- The letter T, followed by a number from 0 to 4, describes the tumor's size and
spread to the skin or chest wall under the breast. A higher number means a larger tumor and/or more spread to tissues near the breast.
- The letter N, followed by a number from 0 to 3, indicates whether the cancer has
spread to lymph nodes near the breast and, if so, whether the affected nodes are fixed (stuck) to other structures under the arm.
- The letter M, followed by a 0 or 1, shows whether the cancer has spread
(metastasized) to other organs of the body or to lymph nodes that are not next to the breast
To make this information somewhat clearer, the TNM descriptions can be grouped together into a simpler set of stages,
labeled stage 0 through stage IV (0-4).
In general, the lower the number, the less the cancer has spread. A higher number, such as stage IV (4), means a
more serious cancer.
After looking at your test results, the doctor will tell you the stage of your cancer. Be sure to ask your doctor to
explain your stage in a way you understand. This will help you both decide on the best treatment for you.
Breast
Cancer Staging
Stage O
Description
Very early breast cancer. This type of cancer has not spread within or outside the breast. It is sometimes called DCIS, LCIS, or breast cancer in situ or noninvasive cancer.
Treatment
The two types of stage 0 breast cancer, ductal carcinoma in situ (DCIS), and lobular carcinoma in situ (LCIS), are treated quite differently. Most women
with LCIS do not need treatment because the condition is not a true cancer. Close follow-up is important, though, because the risk of developing cancer
later on is higher. These women may also want to consider taking part in a clinical trial for breast cancer prevention with drugs such as tamoxifen or
raloxifene, as well as looking at other methods of reducing risk such as exercise, changes in diet, or preventive surgery.Treatment choice for DCIS include lumpectomy, usually with radiation therapy, and mastectomy, depending on mammography
and biopsy results. Recent studies suggest that tamoxifen can lower the risk of invasive cancer developing after treatment of DCIS with lumpectomy and
radiation therapy.
>>Prognosis
Stage I
Description
The cancer is no larger than about 1 inch in size and has not spread outside the breast. (Also described as early breast cancer.)
Treatment
One option is lumpectomy with removal of lymph nodes under the arm followed by radiation therapy. Sentinel lymph node sampling may be used instead of
standard lymph node dissection. Another option is modified radical mastectomy. Adjuvant therapy may follow the surgery depending on the size and other
features of the tumor.
>>Prognosis
Stage II
Description
The doctor may find any of the following:
- The cancer is no larger than 1 inch, but has spread to the lymph nodes under the arm.The cancer is between 1 and 2 inches. It may or may not have spread to the lymph nodes under the arm.
- The cancer is larger than 2 inches, but has not spread to the lymph nodes under the arm.
Treatment
Surgery and radiation therapy options for stage I and stage II tumors are similar, except that in stage II, radiation therapy may be considered after
mastectomy if the tumor is large or has spread to many lymph nodes. Adjuvant therapy may include chemotherapy, hormone therapy, or both. If ten or more
positive lymph nodes are found, a woman in good health might want to consider taking part in a clinical trial of high-dose chemotherapy with stem cell
or bone marrow transplant.
>>Prognosis
Stage III
Stage III is divided into stages IIIA and IIIB:
Stage IIIA
Description
The doctor may find either of the following:
- The cancer is smaller than 2 inches and has spread to the lymph nodes under the arm.
- The cancer also is spreading further to other lymph nodes.
- The cancer is larger than 2 inches and has spread to the lymph nodes under the arm.
Treatment
Some combination of surgery (lumpectomy or a modified radical mastectomy), chemotherapy, radiation, and hormone therapy is often used. Sometimes
chemotherapy (with or without hormonal therapy) is given both before and after the surgery. In some cases, high-dose chemotherapy with stem cell or bone
marrow transplantation (as part of a clinical trial) might be used.
>>Prognosis
Stage IIIB
Description
The doctor may find either of the following:
- The cancer has spread to tissues near the breast (skin, chest wall, including the ribs and the muscles in the chest).
- The cancer has spread to lymph nodes inside the chest wall along the breast bone.
Treatment
Some combination of surgery (lumpectomy or a modified radical mastectomy), chemotherapy, radiation, and hormone therapy is often used. Sometimes
chemotherapy (with or without hormonal therapy) is given both before and after the surgery. In some cases, high-dose chemotherapy with stem cell or bone
marrow transplantation (as part of a clinical trial) might be used.
>>Prognosis
Stage IV
Description
The doctor may find either of the following:
- The cancer has spread to other parts of the body, most often the bones, lungs, liver, or brain.
- Or, the tumor has spread locally to the skin and lymph nodes inside the neck, near the collarbone.
Treatment
Systemic therapy is the primary treatment, using chemotherapy, hormonal therapy, or both. Immunotherapy, alone or combined with chemotherapy, is an option
for women whose cancer cells have high levels of the HER2/neu protein. Radiation and/or surgery may also be used to provide relief of certain symptoms.
Patients in otherwise good health are encouraged to take part in clinical trials of high-dose chemotherapy with stem cell transplantation, or other
promising treatments being studied.
>>Prognosis
Prognosis
by Stages
The 5-year relative survival rate is the percentage of patients who are alive 5 years after diagnosis. Of course, patients
might live more than 5 years after diagnosis. And these 5-year survival rates are based on women with breast cancer first treated more than 5 years ago.
Patients treated today may have a more favorable outlook.
Stage |
5-year relative survival rate |
0 |
100% |
I |
98% |
IIA |
88% |
IIB |
76% |
IIIA |
56% |
IIIB |
49% |
IV |
16% |
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