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Howisbreastcancerstaged?
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DownloadPrintableVersion[PDF] EARLYDETECTION,DIAGNOSIS,ANDSTAGINGTOPICS

Howisbreastcancerstaged?

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Breastcancersurvivalrates,by
stage

Howisbreastcancerstaged?
Thestagedescribestheextentofthecancerinthebody.Itisbasedonwhetherthecancerisinvasiveornon
invasive,thesizeofthetumor,howmanylymphnodesareinvolved,andifithasspreadtootherpartsofthebody.
Thecancersstageisoneofthemostimportantfactorsindeterminingprognosisandtreatmentoptions.
Stagingistheprocessoffindingouthowwidespreadacanceriswhenitisdiagnosed.Dependingontheresultsof
yourphysicalexamandbiopsy,yourdoctormaywantyoutohavecertainimagingtestssuchasachestxray,
mammogramsofbothbreasts,bonescans,computedtomography(CT)scans,magneticresonanceimaging(MRI),
and/orpositronemissiontomography(PET)scans.Bloodtestsmayalsobedonetoevaluateyouroverallhealthand
sometimescanindicateifthecancerhasspreadtocertainorgans.

TheAmericanJointCommitteeonCancer(AJCC)TNMsystem
Astagingsystemisastandardizedwayforthecancercareteamtosummarizeinformationabouthowfaracancer
hasspread.ThemostcommonsystemusedtodescribethestagesofbreastcanceristheAmericanJoint
CommitteeonCancer(AJCC)TNMsystem.
Thestageofabreastcancercanbebasedeitherontheresultsofphysicalexam,biopsy,andimagingtests(called
theclinicalstage),orontheresultsofthesetestsplustheresultsofsurgery(calledthepathologicstage).The
stagingdescribedhereisthepathologicstage,whichincludesthefindingsaftersurgery,whenthepathologisthas
lookedatthebreastmassandnearbylymphnodes.Pathologicstagingislikelytobemoreaccuratethanclinical
staging,asitallowsthedoctortogetafirsthandimpressionoftheextentofthecancer.
TheTNMstagingsystemclassifiescancersbasedontheirT,N,andMstages:

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TheletterTfollowedbyanumberfrom0to4describesthetumor'ssizeandspreadtotheskinortothechestwall
underthebreast.HigherTnumbersmeanalargertumorand/orwiderspreadtotissuesnearthebreast.
TheletterNfollowedbyanumberfrom0to3indicateswhetherthecancerhasspreadtolymphnodesnearthe
breastand,ifso,howmanylymphnodesareaffected.
TheletterMfollowedbya0or1indicateswhetherthecancerhasspreadtodistantorgansforexample,the
lungsorbones.

Primarytumor(T)categories:
TX:Primarytumorcannotbeassessed.
T0:Noevidenceofprimarytumor.
Tis:Carcinomainsitu(DCIS,LCIS,orPagetdiseaseofthenipplewithnoassociatedtumormass)
T1(includesT1a,T1b,andT1c):Tumoris2cm(3/4ofaninch)orlessacross.
T2:Tumorismorethan2cmbutnotmorethan5cm(2inches)across.
T3:Tumorismorethan5cmacross.
T4(includesT4a,T4b,T4c,andT4d):Tumorofanysizegrowingintothechestwallorskin.Thisincludes
inflammatorybreastcancer.

Nearbylymphnodes(Nbasedonlookingatthemunderamicroscope):
Lymphnodestagingforbreastcancerhaschangedastechnologyhasevolved.Earliermethodswereusefulinfinding
largedepositsofcancercellsinthelymphnodes,butcouldmissmicroscopicareasofcancerspread.Newer
methodshavemadeitpossibletofindsmallerandsmallerdepositsofcancercells,butexpertshaven'tbeensure
whattodowiththenewinformation.Dotinydepositsofcancercellsaffectoutlookthesamewaythatlargerdeposits
do?Howmuchcancerinthelymphnodeisneededtoseeachangeinoutlookortreatment?
Thesequestionsarestillbeingstudied,butfornow,adepositofcancercellsmustcontainatleast200cellsorbeat
least0.2mmacross(lessthan1/100ofaninch)forittochangetheNstage.Anareaofcancerspreadthatis
smallerthan0.2mm(orlessthan200cells)doesn'tchangethestage,butisrecordedwithabbreviationsthatreflect
thewaythecancerspreadwasdetected.Theabbreviation"i+"meansthatasmallnumberofcancercells(called
isolatedtumorcells)wereseeninroutinestainsorwhenaspecialtypeofstainingtechnique,called
immunohistochemistry,wasused.
Theabbreviation"mol+"isusedifthecancercouldonlybefoundusingatechniquecalledRTPCR.RTPCRisa
moleculartestthatcanfindverysmallnumbersofcellsthatcannotbeseenevenusingspecialstains.However,this
testisnotoftenusedforfindingbreastcancercellsinlymphnodesbecausetheresultsdonotinfluencetreatment
decisions.
Iftheareaofcancerspreadisatleast0.2mm(or200cells),butstillnotlargerthan2mm,itiscalleda
micrometastasis(onemmisaboutthesizeofthewidthofagrainofrice).Micrometastasesarecountedonlyifthere
aren'tanylargerareasofcancerspread.Areasofcancerspreadlargerthan2mmareknowntoaffectoutlookanddo
changetheNstage.Theselargerareasaresometimescalledmacrometastases,butaremoreoftenjustcalled
metastases.
NX:Nearbylymphnodescannotbeassessed(forexample,iftheywereremovedpreviously).
N0:Cancerhasnotspreadtonearbylymphnodes.
N0(i+):Tinyamountsofcancerarefoundinunderarmlymphnodesbyusingeitherroutineorspecialstains.The
areaofcancerspreadcontainslessthan200cellsandissmallerthan0.2mm.
N0(mol+):Cancercellscannotbeseeninunderarmlymphnodes(evenusingspecialstains),buttracesofcancer
cellsweredetectedusingRTPCR.
N1:Cancerhasspreadto1to3axillary(underarm)lymphnode(s),and/ortinyamountsofcancerarefoundininternal
mammarylymphnodes(thosenearthebreastbone)onsentinellymphnodebiopsy.

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N1mi:Micrometastases(tinyareasofcancerspread)in1to3lymphnodesunderthearm.Theareasofcancer
spreadinthelymphnodesare2mmorlessacross(butatleast200cancercellsor0.2mmacross).
N1a:Cancerhasspreadto1to3lymphnodesunderthearmwithatleastoneareaofcancerspreadgreaterthan2
mmacross.
N1b:Cancerhasspreadtointernalmammarylymphnodes,butthisspreadcouldonlybefoundonsentinellymph
nodebiopsy(itdidnotcausethelymphnodestobecomeenlarged).
N1c:BothN1aandN1bapply.
N2:Cancerhasspreadto4to9lymphnodesunderthearm,orcancerhasenlargedtheinternalmammarylymph
nodes(eitherN2aorN2b,butnotboth).
N2a:Cancerhasspreadto4to9lymphnodesunderthearm,withatleastoneareaofcancerspreadlargerthan2
mm.
N2b:Cancerhasspreadtooneormoreinternalmammarylymphnodes,causingthemtobecomeenlarged.
N3:Anyofthefollowing:
N3a:either
Cancerhasspreadto10ormoreaxillarylymphnodes,withatleastoneareaofcancerspreadgreaterthan2mm,
OR
Cancerhasspreadtothelymphnodesundertheclavicle(collarbone),withatleastoneareaofcancerspread
greaterthan2mm.
N3b:either:
Cancerisfoundinatleastoneaxillarylymphnode(withatleastoneareaofcancerspreadgreaterthan2mm)
andhasenlargedtheinternalmammarylymphnodes,OR
Cancerhasspreadto4ormoreaxillarylymphnodes(withatleastoneareaofcancerspreadgreaterthan2mm),
andtinyamountsofcancerarefoundininternalmammarylymphnodesonsentinellymphnodebiopsy.
N3c:Cancerhasspreadtothelymphnodesabovetheclaviclewithatleastoneareaofcancerspreadgreaterthan
2mm.

Metastasis(M):
MX:Distantspread(metastasis)cannotbeassessed.
M0:Nodistantspreadisfoundonxrays(orotherimagingprocedures)orbyphysicalexam.
cM0(i+):Smallnumbersofcancercellsarefoundinbloodorbonemarrow(foundonlybyspecialtests),ortiny
areasofcancerspread(nolargerthan0.2mm)arefoundinlymphnodesawayfromthebreast.
M1:Cancerhasspreadtodistantorgans.(Themostcommonsitesarebone,lung,brain,andliver.)

Breastcancerstagegrouping
OncetheT,N,andMcategorieshavebeendetermined,thisinformationiscombinedinaprocesscalledstage
grouping.Cancerswithsimilarstagestendtohaveasimilaroutlookandareoftentreatedinasimilarway.Stageis
expressedinRomannumeralsfromstageI(theleastadvancedstage)tostageIV(themostadvancedstage).Non
invasivecancerislistedasstage0.
Stage0:Tis,N0,M0:Thisisductalcarcinomainsitu(DCIS),aprecancerofthebreast.ManyconsiderDCISthe
earliestformofbreastcancer.InDCIS,cancercellsarestillwithinaductandhavenotinvadeddeeperintothe
surroundingfattybreasttissue.Lobularcarcinomainsitu(LCIS)sometimesalsoisclassifiedasstage0breast
cancer,butmostoncologistsbelieveitisnotatruecancerorprecancer.Pagetdiseaseofthenipple(withoutan
underlyingtumormass)isalsostage0.Inallcasesthecancerhasnotspreadtolymphnodesordistantsites.
StageIA:T1,N0,M0:Thetumoris2cm(about3/4ofaninch)orlessacross(T1)andhasnotspreadtolymph
nodes(N0)ordistantsites(M0).
StageIB:T0orT1,N1mi,M0:Thetumoris2cmorlessacross(orisnotfound)(T0orT1)withmicrometastasesin

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1to3axillarylymphnodes(thecancerinthelymphnodesisgreaterthan0.2mmacrossand/ormorethan200cells
butisnotlargerthan2mm)(N1mi).Thecancerhasnotspreadtodistantsites(M0).
StageIIA:Oneofthefollowingapplies:
T0orT1,N1(butnotN1mi),M0:Thetumoris2cmorlessacross(orisnotfound)(T1orT0)andeither:
Ithasspreadto1to3axillarylymphnodes,withthecancerinthelymphnodeslargerthan2mmacross(N1a),
OR
Tinyamountsofcancerarefoundininternalmammarylymphnodesonsentinellymphnodebiopsy(N1b),OR
Ithasspreadto1to3lymphnodesunderthearmandtointernalmammarylymphnodes(foundonsentinellymph
nodebiopsy)(N1c).
OR
T2,N0,M0:Thetumorislargerthan2cmbutlessthan5cmacross(T2)buthasn'tspreadtothelymphnodes(N0).
Thecancerhasn'tspreadtodistantsites(M0).
StageIIB:Oneofthefollowingapplies:
T2,N1,M0:Thetumorislargerthan2cmbutlessthan5cmacross(T2).Ithasspreadto1to3axillarylymph
nodesand/ortinyamountsofcancerarefoundininternalmammarylymphnodesonsentinellymphnodebiopsy(N1).
Thecancerhasn'tspreadtodistantsites(M0).
OR
T3,N0,M0:Thetumorislargerthan5cmacrossbutdoesnotgrowintothechestwallorskinandhasnotspreadto
lymphnodes(T3,N0).Thecancerhasn'tspreadtodistantsites(M0).
StageIIIA:Oneofthefollowingapplies:
T0toT2,N2,M0:Thetumorisnotmorethan5cmacross(orcannotbefound)(T0toT2).Ithasspreadto4to9
axillarylymphnodes,orithasenlargedtheinternalmammarylymphnodes(N2).Thecancerhasn'tspreadtodistant
sites(M0).
OR
T3,N1orN2,M0:Thetumorislargerthan5cmacrossbutdoesnotgrowintothechestwallorskin(T3).Ithas
spreadto1to9axillarynodes,ortointernalmammarynodes(N1orN2).Thecancerhasn'tspreadtodistantsites
(M0).
StageIIIB:T4,N0toN2,M0:Thetumorhasgrownintothechestwallorskin(T4),andoneofthefollowingapplies:
Ithasnotspreadtothelymphnodes(N0).
Ithasspreadto1to3axillarylymphnodesand/ortinyamountsofcancerarefoundininternalmammarylymph
nodesonsentinellymphnodebiopsy(N1).
Ithasspreadto4to9axillarylymphnodes,orithasenlargedtheinternalmammarylymphnodes(N2).
Thecancerhasn'tspreadtodistantsites(M0).
InflammatorybreastcancerisclassifiedasT4dandisatleaststageIIIB.Ifithasspreadtomanynearbylymph
nodes(N3)itcouldbestageIIIC,andifithasspreadtodistantlymphnodesororgans(M1)itwouldbestageIV.
StageIIIC:anyT,N3,M0:Thetumorisanysize(orcan'tbefound),andoneofthefollowingapplies:
Cancerhasspreadto10ormoreaxillarylymphnodes(N3).
Cancerhasspreadtothelymphnodesundertheclavicle(collarbone)(N3).
Cancerhasspreadtothelymphnodesabovetheclavicle(N3).

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Howisbreastcancerstaged?

Cancerinvolvesaxillarylymphnodesandhasenlargedtheinternalmammarylymphnodes(N3).
Cancerhasspreadto4ormoreaxillarylymphnodes,andtinyamountsofcancerarefoundininternalmammary
lymphnodesonsentinellymphnodebiopsy(N3).
Thecancerhasn'tspreadtodistantsites(M0).
StageIV:anyT,anyN,M1:Thecancercanbeanysize(anyT)andmayormaynothavespreadtonearbylymph
nodes(anyN).Ithasspreadtodistantorgansortolymphnodesfarfromthebreast(M1).Themostcommonsitesof
spreadarethebone,liver,brain,orlung,
Ifyouhaveanyquestionsaboutthestageofyourcancerandwhatitmightmeaninyourcase,besuretoaskyour
doctor.

LastMedicalReview:09/25/2014
LastRevised:06/10/2015
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GuideTopics

WhatIsBreastCancer?
Causes,RiskFactors,and
Prevention
EarlyDetection,Diagnosis,and
Staging
TreatingBreastCancer
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AfterTreatment
What`sNewinBreastCancer
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