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Breast cancer staging
Breast cancer stages
Once the surgery is completed, your doctor can determine the stage of your cancer. Breast cancer stages range from 0 to IV, with many subcategories. Lower numbers indicate earlier stages of cancer, while higher numbers reflect a late-stage cancer.
Stage 0
This stage describes noninvasive (in situ) breast cancer. It hasn't spread within the breast or to other parts of the body. Ductal carcinoma in situ (DCIS) is an example of stage 0 cancer.
Stage I
This stage is an early stage of invasive breast cancer in which:
- The tumor measures no more than 2 centimeters (cm) in diameter (3/4 inch)
- No lymph nodes are involved — the cancer hasn't spread outside the breast
Stage II
This stage, subdivided into IIA and IIB, describes invasive breast cancers in which one of the following is true:
- The tumor measures less than 2 cm but has spread to lymph nodes under the arm
- No tumor is found in the breast but cancer is found in the axillary lymph nodes
- The tumor is between 2 cm and 5 cm (about 1 to 2 inches) and may have spread to lymph nodes under the arm
- The tumor is larger than 5 cm but hasn't spread to any lymph nodes
Stage III
Stage III breast cancers are subdivided into three categories — IIIA, IIIB and IIIC — based on a number of different criteria. By definition, stage III cancers haven't spread (metastasized) to distant sites.
For example, a stage IIIA tumor is larger than 5 cm and has spread to one to three lymph nodes under the arm. Other stage IIIA tumors may be any size and have spread into multiple lymph nodes. The lymph nodes clump together and attach to one another or to the surrounding tissue.
In stage IIIB breast cancer, a tumor of any size has spread to tissues near the breast — the skin and chest muscles — and may have spread to lymph nodes within the breast or under the arm. Stage IIIB also includes inflammatory breast cancer, an uncommon but aggressive type of breast cancer.
Stage IIIC cancer is a tumor of any size that has spread:
- To 10 or more lymph nodes under the arm
- To lymph nodes above or beneath the collarbone and near the neck
- To lymph nodes within the breast itself and to lymph nodes under the arm
Stage IV
Stage IV breast cancer has spread to other, distant parts of the body, such as the lungs, liver, bones or brain.
Estimating your outlook
Identifying the stage of your cancer helps your doctor decide on an appropriate treatment strategy. The stage also helps predict how well you might do — whether the cancer will come back (recurrence), for instance. Based on statistics collected from other women's experiences, scientists can estimate the five-year disease-free survival rate — the percentage of women who remain free of disease five years after their cancers were diagnosed.
Another way to express the outlook for your disease is the five-year overall survival rate — the percentage of women who are still alive five years after the breast cancer diagnosis. Five-year survival is lower among women with a more advanced stage of cancer at diagnosis. In general, the larger the tumor and the more lymph nodes involved, the more likely the cancer is to recur or spread to other parts of the body. Among all people with breast cancer, five-year survival is 98 percent for early-stage, localized cancer, 84 percent for regional cancer, and 27 percent for stage IV, distant-spread cancer.
The breast cancer stage isn't the only factor doctors consider when deciding on treatment. Other key information includes:
- The tumor grade and size
- The presence or absence of receptors for the hormones estrogen and progesterone
- The amount of a protein called HER-2 produced by the cancer cells
- Your menopausal status
- Your general health
Newer methods of estimating survival and the possibility of recurrence look at many of these variables. This detailed information about specific tumors paves the way for more individualized breast cancer treatment. Doctors can use online calculators that take into account all the variables above and estimate the added benefits of chemotherapy, hormonal therapy or no treatment.
A new test (Oncotype DX) done directly on cancer cells can also help determine if added treatments will help you. This test is used only for women with small, estrogen receptor positive, node-negative breast cancers. It can help you and your doctor know if you need chemotherapy or can safely avoid it.
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