The higher the stage, the more advanced the cancer is.
More advanced cancers have likely also spread to other tissues.
Breast cancer is one of the most common cancers in females.
Verywell / Jessica Olah
More than 280,000 females are diagnosed with breast cancer each year in the United States.
Thankfully, about 90% of females diagnosed with breast cancer are still alive five years later.
When first diagnosed with cancer, youll undergo testing and analysis.
Biopsied Tissue Grading
Biopsied tissue is analyzed by aspecialized doctor called a pathologist.
They then give the cells agradefrom 1 to 3.
This process, called immunohistochemistry, uses special dyes that attach to the receptors and highlight cells with them.
Cells use receptors like these to take in signals from other parts of the body.
If theyre negative for both, the cancer is considered hormone receptor negative (HR-).
If theyre positive for one or both, the cancer is called hormone receptor positive (HR+).
HER2 is detected in biopsied samples using special stains.
HER2-positive cancers have higher levels of the HER2 protein, which promotes the growth of cancer.
HER2+ cancers tend to grow faster, but this protein is also a target of treatment.
Which genes are turned on can help predict how likely the cancer is to come back after treatments.
Three examples of tests you might hear about include the Oncotype Dx, MammaPrint, and Prosigna.
These tests are more often used in early-stage cancers.
TNM System
Cancer staging typically follows the TNM system.
This system defines three features of cancer in a way that can be widely applied to other solid cancers.
An “X” means the characteristic cant be measured.
Doctors will measure thesize of the main tumorand determine how far within an organs layers it has spread.
A T measurement of 0 to 4 describes the size and extent of the main tumors growth.
A 0 would indicate that the main tumor cant be found or described.
An N number is given between 1 and 3, defining how many lymph nodes cancer has spread to.
An N0 means the cancer was found in no lymph nodes.
N0(i+) is used when these cells are detected using microscope techniques.
N0 (mol+) is used when the presence of cancer is detected using a molecular technique called RT-PCR.
“M” for Metastases
When cancer hasmetastasizedit has spread from its origin to other organs.
“M” in the TNM staging standards stands formetastasis.
Metastasis makes cancers harder to cure.
A 0 indicates theres no evidence that cancer has spread.
Stage Does Not Change
Cancers stage never changes from when it was first diagnosed.
Additional details may be added to cancers stage, including its recurrence.
Stages of Breast Cancer
Your cancer’s TNM numbers are used to determine your cancer’s stage.
These stages are grouped from 0 to 4 and can have many substages.
Generally, stage 0 cancer is defined as abnormal cells that have not started to spread.
Stages 1, 2, and 3 tumors are cancerous, have started to spread and grow larger.
Stage 4 cancers, generally, are the most advanced and have spread to distant parts of the body.
The AJCC released the eighth edition of cancer staging guidelines in 2018.
The latest edition incorporates specific markers found in the blood that can help indicate breast cancers prognosis.
It also includes cancers HER2, ER, and PR status.
Because it takes all these different factors into consideration, breast cancer staging is complex.
There are multiple ways a patient could end up with a given stage.
But these factors are what doctors must take into account when theyre treating breast cancer patients.
Stages include:
Treatment Options
Your healthcare team will recommend treatment based on breast cancer staging.
The specific treatments also depend on many individual factors, so always discuss your options with your healthcare professional.
Hormone therapies and chemotherapy can help reduce the risk that cancer will come back.
Lymph nodes will also be biopsied or dissected to detect cancer.
Targeted therapies may also be used for HER2-positive stage 1 cancers.
Lymph nodes will be removed and biopsied, and others may need to be treated with radiation.
You may also get hormone therapy, targeted therapy, or immunotherapy depending on the characteristics of your cancer.
Lymph nodes will also likely be removed during surgery.
Targeted therapies, includinghormone therapy, can also be used depending on your cancers specific characteristics.
This may include hormone therapy, targeted therapy, chemotherapy, immunotherapy, radiation, or surgery.
Triple-Negative Cancers
Immunotherapies may be an option for high-risk (stage 2 and 3) triple-negative cancers.
Summary
Breast cancer staging helps guide treatment options.
It requires a physical examination, biopsy, imaging, hormone receptor testing, and genetic testing.
The stage is determined by criteria in the AJCC staging system, from stage 0 to stage 4.
The stage of the cancer does not change once it is determined.
Theyll also order imaging tests and blood tests.
This tissue sample will be analyzed to determine how wild the cancer cells look.
The cancer sample will also be tested for receptors that give the cancer various characteristics.
They were most recently updated in 2018.
Theyre often called the TNM staging system or the AJCC staging system.
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American Joint Committee on Cancer.AJCC Cancer Staging Manual.
New York, NY: Springer; 2017: 715-725.
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American Cancer Society.Imaging tests to find out if breast cancer has spread.
American Cancer Society.Breast cancer grades | Grading breast cancer.
American Cancer Society.Breast cancer hormone receptor status | Estrogen receptor.
American Cancer Society.Breast cancer HER2 status | HER2 positive breast cancer.
American Cancer Society.Breast cancer gene expression tests.
BreastCancer.org.Breast cancer stages: 0 through IV.
BreastCancer.orgStage 0 treatment options.
BreastCancer.org.Stage IA & IB treatment options.
BreastCancer.org.Stage IIA & IIB treatment options.
BreastCancer.org.Stage IIIA, IIIB, & IIIC Treatment Options.
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National Cancer Institute.Definition of TNM staging system - NCI Dictionary of Cancer Terms
