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Breast cancer stages

and treatment options

    Breast cancer

     

     

    Recent years have seen an explosion of life-saving treatments to combat breast cancer, bringing new hope and excitement. Instead of a few options, today there is an overwhelming menu of treatments to fight breast cancer.


    When your breast cancer diagnosis is completed, you and your doctor will put together a treatment plan specific to your situation. This plan is usually a combination of one or more specific treatments intended to target the cancer cells in different ways. This is to reduce the risk of future breast cancer recurrence. You and your doctor will base your treatment decisions on your unique situation.


    Treating breast cancer successfully means destroying the cancer or bringing it under control for an extended period of time. But because a breast cancer is made up of many different kinds of cancer cells, eliminating all those cells can require different types of treatments.

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    Types of breast cancer

     

    Most breast cancers are ductal cancers, meaning that they form in the cells that line the ducts. Some of these form in the cells that line the lobules and a small number start in other tissues.


    The most common breast cancers are:

     

    Ductal Carcinoma In Situ (DCIS)

    Occurs in the cells that line the breast ducts, below the nipple and areola. It is well contained and can be very successfully treated.

     

    Lobular Carcinoma In Situ (LCIS)

    Originates in the lobes, the glands that produce breast milk . The lobes are located deep inside the breast, under the ducts. This accounts for about 8% of breast cancers.

     

    Invasive Ductal Carcinoma (IDC)

    The second-most common group of breast cancers that invade nearby tissue. This type of cancer started in the milk ducts or lobes and spreads to healthy tissue. Invasive breast cancer can spread to other parts of the body through the bloodstream and lymph system.

     

    Other types of cancer

    Less Common Subtypes of Invasive Ductal Carcinoma ILC – Invasive Lobular Carcinoma, Inflammatory Breast Cancer Male Breast Cancer Recurrent and Metastatic Breast Cancer


    Inflammatory Breast Cancer is the least common, but most aggressive of breast cancers. Instead of lumps, it takes the form of sheets or nests. This type may originate in the soft tissues of the breast or may appear in the skin. Unlike ductal and lobular cancers, it is treated first with chemotherapy, and then with surgery. When caught early, inflammatory breast cancer can be managed and survival rates increase.


    Paget’s disease, named for Sir James Paget, is the least common and is a cancer of the nipple. Paget was first to recognize the connection between changes in the nipple and the underlying breast cancer. Cancer of the nipple resembles eczema, and can be itchy. The itching and scabs indicate that cancer may be under the surface of the skin and is breaking through. The usual treatment is mastectomy because the cancer has invaded the nipple, areola, and the milk ducts.

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    Stages of breast cancer

     

    Over time, cancer cells can attack nearby healthy breast tissue and travel into the underarm lymph nodes, small organs that filter out foreign substances in the body. If cancer cells enter the lymph nodes, this gives them a route to other parts of the body. The stage of breast cancer refers to how far the cancer cells have spread beyond the original tumor.


    Cancer stage is based on the size of the tumor, whether the cancer is invasive or non-invasive, whether lymph nodes are involved, and whether the cancer has spread beyond the breast.

     

    The stages of cancer are termed as Stage 0 and Stage IV.

     

    The terms ”early” or ”earlier” stage, ”later” or ”advanced” stage breast cancer is also used.

    Stage 0

    Describes non-invasive breast cancers. At stage 0, no evidence exists of cancer cells or non-cancerous abnormal cells breaking out of the part of the breast where they began, or breaking through to or invading adjacent normal tissue.

     

    Stage I

    Describes invasive breast cancer (cancer cells are breaking through to or affecting adjacent normal tissue) in which:

     

    the tumor measures up to two centimeters, AND

     no lymph nodes are involved.

     

    Stage II

    Divided into subcategories known as IIA and IIB.

     

    Stage IIA describes invasive breast cancer in which:

     

    • no tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm), OR
    • the tumor measures two centimeters or less and has spread to the axillary lymph nodes, OR
    • the tumor is larger than two centimeters, but not larger than five centimeters and has not spread to the axillary lymph nodes.

     

    Stage IIB describes invasive breast cancer in which:

     

    • no tumor is found in the breast. 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 tumor is five centimeters or smaller and has spread to axillary lymph nodes that are clumped together or sticking to other structures, OR
    •  the tumor is larger than five centimeters and has spread to axillary lymph nodes that are clumped together or sticking to other structures.

     

    Stage III

    Divided into subcategories known as IIIA, IIIB, and IIIC.

     

    Stage IIIA describes invasive breast cancer in which:

     

    • no tumor is found in the breast. 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 tumor is 5 centimeters or smaller and has spread to axillary lymph nodes that are clumped together or sticking to other structures, OR
    • the tumor is larger than 5 centimeters and has spread to axillary lymph nodes that are clumped together or sticking to other structures.

     

    Stage IIIB describes invasive breast cancer in which:

     

    • the tumor 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 to be at least stage IIIB.

     

    Stage IIIC describes invasive breast cancer in which:

     

    • there may be no sign of cancer in the breast or, if there is a tumor, 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.

     

     

    Stage IV

    Describes invasive breast cancer in which:

     

    • the cancer has spread to other organs of the body – usually lungs, liver, bone, or brain.

     

    ”Metastatic at presentation” means that the breast cancer has spread beyond the breast and nearby lymph nodes, although this is 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 to be Stage IV.

     

    Additional staging information

    For breast cancer, ”early” or ”earlier” stage, ”later,” or ”advanced” stage breast cancer are terms used. Although these are not medically precise and may be used differently by different physicians, here is a general idea of how they apply to the official staging system:


    Early stage

    • Stage 0
    • Stage I
    • Stage II
    • Some stage III


    Later or advanced stage

    • Other Stage III
    • Stage IV

     

    TNM staging system

     

    Physicians use a staging system to identify how far a cancer has spread, with the most frequent system used being the TNM staging system. You may hear the cancer described by three characteristics:

     

    • Size (T stands for tumor)
    •  Lymph node involvement (N stands for node)
    • Whether it has metastasized (M stands for metastasis)
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    My treatment options

     

    Decisions about surgery depend on many factors. You and your doctor will determine the kind of surgery that is most appropriate for you. This depends on the stage of the cancer and behavior of the cancer, and what is acceptable to you.

     

    Surgery

    Surgery is usually the first line of attack against breast cancer. There are two options:

     

    Mastectomy is an operation to remove the entire breast, including the nipple. Often times the glands under the arm, called axillary nodes, are removed. Mastectomy usually requires a hospital stay. Women who undergo a mastectomy have the option of breast reconstruction. Mastectomy is more refined and less intrusive than it used to be because, in most cases, the muscles under the breast are no longer removed.

     

     

    Breast conservation therapy (BCT) / Lumpectomy This option removes the breast tumor and a margin of surrounding normal tissues. Radiation therapy usually follows to eliminate any cancer cells in the remaining breast tissue. The purpose of breast conservation therapy is to leave the breast intact and at the same time give women the same cure rate as with a mastectomy. The surgeon may remove the lymph nodes at the same time or later. Most patients can have BCT rather than mastectomy with excellent results and years of clinical study have proven that BCT offers the same cure rate as mastectomy.

     

    Chemotherapy

     

    Chemotherapy is treatment with medicines that prevent cancer cells from growing and spreading by destroying the cells or stopping them from dividing. It is used to treat all stages of breast cancer, including cancer that has come back in the breast area and breast cancer that has spread to other parts of the body. Chemotherapy treatments are tailored specifically for each person’s unique situation.

     

    Radiation therapy

     

    Radiation therapy is a highly effective way to destroy cancer cells that may stick around after surgery. Radiation therapy uses a high-energy beam to damage cancer cells. These beams damage a cell’s DNA so that the cell stops to divide.

     

    Over time, the radiation damages cells that are in the path of its beam, even the normal cells. But radiation affects cancer cells more than normal cells.

     

    Despite what many woman fear, radiation therapy is relatively easy to tolerate and its side effects are limited to the treated area. Radiation can reduce the risk of breast cancer recurrence by about 70%.

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    What are the post-treatment issues?

     

    Breast cancer survivors go through the experience of breast cancer differently, but there may be some common issues to deal with immediately or long after treatment is over. You may not have to face any one of them. However, being aware of the possibilities puts you in a better position.LymphedemaWomen treated for breast cancer may be at risk for arm, breast, and chest swelling called lymphedema. The risk of lymphedema is higher for women who have surgery and radiation therapy to treat breast cancer. The problem can happen right after surgery, or months or even years later.


    Safety precautions

    You will need to protect the arm and hand on the treated side for the rest of your life. You must take extra caution to protect your hand and arm from injury, cuts, scrapes and insect bites. You may be more vulnerable to infection in that arm. It is crucial to remind healthcare workers to avoid drawing blood and measuring your blood pressure on that arm.

     


    Signs of lymphedema

    Heavy swelling, discomfort, or achy-feeling skin changes texture, skin feels tight, hard, or looks red, less flexibility, clothes or bra doesn’t fit the same, bracelet or ring suddenly feels tight.Psychological issuesBreast cancer patients tend to face two common psychosocial issues. First is how the cancer will affect the immediate family. The second is how it will affect the woman’s sense of herself as a woman.
    Anxiety is another issue. Many breast cancer patients say that, after their adjuvant treatment, any minor physical ailment will concern them as a first sign of recurrence. Such concerns disrupt sleep, ability to work and so on.


    The type of social support system a woman has available to her is crucial. A good social network can reduce or prevent psychosocial stressors. It’s stressful enough to receive a diagnosis of breast cancer to worry that is cancer taking your life, and then to worry about how that may affect your children. Then, there are also concerns about having to go through the treatments and suffer the side effects of therapy. On top of all that, a woman is just trying to keep everything straight in her life.


    Once the treatment is complete, there’s often an emotional release of all the tension and anxiety held in during the treatment process. Months after treatment is completed women often feel depressed, have crying spells, anxiety, and trouble with sleep. It would be advantageous for women to prepare for this, anticipating it in advance, so that they know it is a normal reaction. Many times women do not feel they’ll go back to normal, which is a very typical and healthy response to the situation.

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    What about reconstructive surgery?

     

    The choice to have breast reconstruction is up to you.


    Breast reconstruction surgery rebuilds the breast so that it is of a similar size and shape as before. The nipple and areola can also be added. Most women who have had a mastectomy can opt for reconstruction. Women who have had a lumpectomy may not need reconstruction.


    Immediate or delayed breast reconstruction

    Immediate reconstruction is done at the same time as the mastectomy. Its advantage is that the chest tissue is undamaged by radiation therapy or scarring and often means the final result looks better.
    Since radiation therapy given after breast reconstruction surgery can cause complications there is also delayed reconstruction. This means that the rebuilding is started later.

     

     

    Types of breast reconstruction

    Several types of operations are available to reconstruct your breast. You can use a breast implant, your own tissue flap, or a combination of the two. A tissue flap is a section of your own skin, fat, and muscle which is moved from your tummy, back, or other area of your body.
    The most common implant is a saline-filled implant, a silicone shell filled with salt water. Silicone gel-filled implants are another option for breast reconstruction and are not as common as they were in the past.


    Factors to think about before having implants

    Implants may not last a lifetime, and you may need more surgery to replace them later. You can have local complications with breast implants such as rupture, pain, or infection, and you might not be satisfied with the result. More images will be needed when you take your mammogram (e.g., at your mammography screening). This means higher dose in total.

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    Breast cancer statistics

     
    • The odds of breast cancer being the cause of a woman’s death is about 1 in 35
    • The odds of a woman getting breast cancer at some point in her life is about 1 in 8
    • The odds of a woman developing breast cancer rises significantly with age
    • If found in its earliest stages, the five-year survival rate for breast cancer is 98%
    • Breast cancer death rates have dropped steadily since 1990, according to the American Cancer Society, because of earlier detection and better treatments
    • Breast cancer is the second top cause of cancer deaths in women
    • Breast cancer is the second most common cancer for women
    • Breast cancer is a disease afflicting both genders. However, among women the ailment is found 100 times more often than in men

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