Staging Breast Cancer

To plan a breast cancer treatment, the physician needs to know the extent (stage) of the disease. The stage is based on the size of the tumor and whether the cancer has spread. Staging may involve X-rays and lab tests to learn whether the cancer has spread and, if so, to what parts of the body. When breast cancer spreads, cancer cells are often found in lymph nodes under the arm (axillary lymph nodes). The extent of the cancer often is not known until after surgery to remove the tumor in the breast and the lymph nodes under the arm.

Breast cancer is described by the following stages:

Stage 0: carcinoma in situ

• Lobular carcinoma in situ (LCIS) refers to abnormal cells in the lining of a lobule. These abnormal cells are a marker of increased risk. This means LCIS increases the risk of developing invasive cancer in either breast, or both, sometime in the future.
• Ductal carcinoma in situ (DCIS), also called intraductal carcinoma, is a precancerous condition in the lining of a duct. This means abnormal cells have not spread outside the duct to invade the surrounding breast tissue. However, if not treated, DCIS sometimes becomes invasive cancer.

Stage I: Early stage invasive breast cancer

• Stage I means that the tumor is no more than 2 centimeters (less than three-quarters of an inch) across, and cancer cells have not spread beyond the breast.

Stage II:

• The tumor in the breast is no more than 2 centimeters (less than three-quarters of an inch) across, and the cancer has spread to the lymph nodes under the arm; or
• The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches), and the cancer may have spread to the lymph nodes under the arm; or
• The tumor is larger than 5 centimeters (2 inches) but has not spread to the lymph nodes under the arm.

Stage III

• Stage IIIA means the tumor in the breast is smaller than 5 centimeters, the cancer has spread to the underarm lymph nodes, and the lymph nodes are attached to each other or to other structures. Or the tumor is large (more than 5 centimeters across), and the cancer has spread to the underarm lymph nodes.
• Stage IIIB means the tumor may have grown into the chest wall or the skin of the breast; or the cancer has spread to lymph nodes under the breastbone. Inflammatory breast cancer is a type of Stage IIIB breast cancer. It is rare. The breast looks red and swollen (or inflamed) because cancer cells block the lymph vessels in the skin of the breast.
• Stage IIIC means the cancer has spread to the lymph nodes under the breastbone and under the arm, or to the lymph nodes under or above the collarbone. The primary breast tumor may be of any size.

Stage IV

• Stage IV is characterized by distant metastatic cancer where the cancer has spread to other parts of the body.

Recurrent Breast Cancer

Recurrent cancer is cancer that has come back (recurred) after treatment. It may recur locally (in the breast or chest wall) or in any other part of the body (such as bone, liver, or lungs). Treatment for the recurrent disease depends mainly on the location and extent of the cancer and on the type of treatment the woman had before. If breast cancer comes back in the breast (and not anywhere else) after breast-sparing surgery, the woman may have a mastectomy. Chances are good that the disease will not come back again elsewhere. If breast cancer recurs in other parts of the body, the treatment may involve chemotherapy, hormonal therapy, or biological therapy. Radiation therapy may help control cancer that recurs in the chest muscles or in certain other areas of the body.  As with Stage IV breast cancer, treatment can seldom cure cancer that recurs outside the breast. Palliative care is often an important part of the treatment plan. Many patients have palliative care to ease their symptoms while they have anticancer treatments to slow the progress of the disease. Some receive only palliative care to improve their quality of life by easing pain, nausea, and other symptoms.