Information collated by Dr Justus Apffelstaedt, specialist surgeon with an interest in breast, thyroid and parathyroid health as well as soft tissue surgical oncology.
Breast Cancer is the most common female cancer in the world, and is often spoken about at length. But how many women actually fully understand the jargon and terminology thrown around when it comes to understanding breast cancer? Professor Apffelstaedt has outlined and explained the various stages of breast cancer as well as the various treatment options. Knowledge is power, and the more women understand about breast cancer, the more likely they will be able to identify it early and minimise the risk of mortality.
Breast cancer is an uncontrolled growth of the cells in the breast gland which have the capability to spread to other parts of the body via the blood stream or lymph channel. The Staging of breast cancer is primarily clinical, which means by examination of the patient.
The stages can seem complex and detailed but they are vital as they essentially help your doctors to:
- Understand the prognosis (what the outcome is likely to be).
- Guide the treatment decisions (together with other parts of your pathology report).
- Provide a common way to describe the extent of breast cancer for doctors and nurses all over the world, so that results of your treatment can be compared and understood.
Stage 0: Here the breast cancer has no clinical signs and cannot be detected by examining the patient. Cancers at stage 0 are detected principally by mammographic screening for breast cancer. Their prognosis is excellent and most women diagnosed at this stage will survive with appropriate treatment as long as if they did not have cancer at all. If examined pathologically, many of these cancers are still non-invasive. This means, that they have not broken out of the milk duct where they originated and therefore have no access yet to lymph or blood vessels and therefore cannot spread. These cancers can be cured by surgical excision alone.
Stage I describes a tumour that measures up to 2 centimetres where lymph nodes are not enlarged.
Stage II is divided into subcategories IIA and IIB.
Stage IIA is breast cancer where either no tumour has been found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm) OR the tumour measures 2 centimeters or less and the axillary lymph nodes are enlarged OR the tumour is larger than 2 centimeters but not larger than 5 centimetres and the axillary lymph nodes are not enlarged.
Stage IIB. In this case the tumour is larger than 2 but no larger than 5 centimetres and the axillary lymph nodes are enlarged OR the tumour is larger than 5 centimetres but the axillary lymph nodes are not enlarged.
Stage III is divided into subcategories IIIA, IIIB, and IIIC.
In Stage IIIA no tumour is found in the breast but cancer is found in axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone. Or the tumour is 5 centimeters or smaller and axillary lymph nodes are clumped together or sticking to other structures. Or the tumour is larger than 5 centimeters and has spread to axillary lymph nodes that are clumped together or sticking to other structures
Stage IIIB is invasive breast cancer in which the tumour may be any size and has spread to the chest wall and/or skin of the breast AND may have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone. Inflammatory breast cancer is considered at least stage IIIB.
Stage IIIC invasive breast cancer has three elements to it – 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 AND the cancer has spread to lymph nodes above or below the collarbone AND the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone.
In the case of Stage IV the cancer has spread to other organs of the body — usually the lungs, liver, bone or brain.
Another important term to know is “Metastatic at presentation”. This means that the breast cancer has spread beyond the breast and nearby lymph nodes, even though this may be the first diagnosis of breast cancer. The reason for this is that the primary breast cancer was not found when it was only inside the breast. Metastatic cancer is considered stage IV.
Additional staging information
You may also hear terms such as “early” or “earlier” stage, “later,” or “advanced” stage breast cancer. Although these terms are not medically precise (they may be used differently by different doctors), here is a general idea of how they apply to the official staging system:
- Stage 0
- Stage I
- Stage II A
Later or advanced stage
- Stage IIB
- Stage III
- Stage IV
What type of treatments can you expect?
The differences among cancer cells is why your pathology report, blood tests, and other tests can be so complicated and why there are so many different treatments for breast cancer. Because the cancer cells can be so different, what kills one type of cell might not do anything to another.
Almost two hundred medications have been approved to treat cancer, and many more are being developed. Some treatments are very specialized, designed to target only a particular protein in the cancer cells. This targeted therapy might do its job well, but that’s only one part of the overall fight against the cancer. Other treatments are needed to fight other targets in the cancer cells. Each treatment does its part to get rid of the whole cancer. This is why some treatments work best in combination with other treatments or before or after other therapies.
The differences in cancer cells are why two people with breast cancer may have completely different treatment plans.
The best overall treatment involves getting the best out of each specialty. Surgery, radiation, chemotherapy, hormonal therapy, and targeted therapies all work in different ways on their own — plus they can be extra effective when given together. It is important that women speak to their doctors about any questions they may have regarding breast cancer – from the risk factors to what is considered a good breast health management plan. We need to protect the women of our country from this disease and the best way to ensure their protection, is through education and awareness.