Knowing the stage of your breast cancer helps your medical team determine how big the cancer is and if it has spread. This helps them guide your therapy and provide reliable prognostic information.
In general, staging is done following your surgery, either after lumpectomy or mastectomy. It usually includes evaluation of the lymph nodes in your armpit (axillary lymph nodes), and possibly other radiology tests and blood work.
All breast cancers are staged using a system defined by the American Joint Committee on Cancer. The system was most recently modified in 2002, and its classifications are based on what's called a "TNM system." TNM refers to tumor size (T), number of lymph nodes involved (N), and whether your cancer has metastasized (or spread) to other parts of your body (M).
The following is an overview of the TNM system*.
T: The size of the cancer.
T0: No cancer is present.
Tis: Non-invasive cancer, also known as carcinoma in situ, is present.
T1: Invasive cancer measuring 2 centimeters or smaller is present. This is further sub-divided into four groups:
Tmic: microinvasive cancer, meaning the invasive cancer is 1 millimeter or smaller.
T1a: the invasive cancer measures greater than 1 millimeter but not greater than 5 millimeters.
T1b: the invasive cancer measures greater than 5 millimeters but not greater than 1 centimeter.
T1c: the invasive cancer measures greater than 1 centimeter but not greater than 2 centimeters.
T2: Invasive cancer is present, measuring greater than 2 centimeters but not greater than 5 centimeters.
T3: Invasive cancer is present, measuring greater than 5 centimeters.
T4: Invasive cancer is invading the chest wall or skin; also includes inflammatory cancer.
N: The number of lymph nodes involved by cancer.
N0: No cancer found in nodes. In 2002, an addition was made for the diagnosis of isolated tumor cells (ITCs):
N0i+: Cells found in the node measuring 0.2 millimeters or less, found either on routine pathology or using immunohistochemistry.
N1: Cancer is present in 1-3 nodes in the armpit area (also known as axillary lymph nodes).
N1mic: The cancer present in the node measures greater than 0.2 millimeters but not greater than 2 millimeters. This is also known as a micrometastasis.
N2: Cancer is present in 4-9 axillary nodes.
N3: Cancer is present in 10 or more axillary nodes.
M: The presence or absence of distant metastases.
M0: No distant metastases are present.
M1: Distant metastases are present.
Once you know your T, N, and M status, you can determine your breast cancer stage as follows:
Stage 0: Tis, N0, M0
Stage I: T1, N0, M0.
Stage IIA: T0/T1 with N1, M0 or T2, N0, M0
Stage IIB: T2, N1, M0 or T3, N0, M0
Stage IIIA: T0/T1/T2 with N2, M0 or T3 with N1 or N2 and M0
Stage IIIB: T4 with N0/N1/N2, M0
Stage IIIC: Any T with N3, M0
Stage IV: Any T, any N with M1
All breast cancers are staged using a system defined by the American Joint Committee on Cancer. The system was most recently modified in 2002, and its classifications are based on what's called a "TNM system." TNM refers to tumor size (T), number of lymph nodes involved (N), and whether your cancer has metastasized (or spread) to other parts of your body (M).
The following is an overview of the TNM system*.
T: The size of the cancer.
T0: No cancer is present.
Tis: Non-invasive cancer, also known as carcinoma in situ, is present.
T1: Invasive cancer measuring 2 centimeters or smaller is present. This is further sub-divided into four groups:
Tmic: microinvasive cancer, meaning the invasive cancer is 1 millimeter or smaller.
T1a: the invasive cancer measures greater than 1 millimeter but not greater than 5 millimeters.
T1b: the invasive cancer measures greater than 5 millimeters but not greater than 1 centimeter.
T1c: the invasive cancer measures greater than 1 centimeter but not greater than 2 centimeters.
T2: Invasive cancer is present, measuring greater than 2 centimeters but not greater than 5 centimeters.
T3: Invasive cancer is present, measuring greater than 5 centimeters.
T4: Invasive cancer is invading the chest wall or skin; also includes inflammatory cancer.
N: The number of lymph nodes involved by cancer.
N0: No cancer found in nodes. In 2002, an addition was made for the diagnosis of isolated tumor cells (ITCs):
N0i+: Cells found in the node measuring 0.2 millimeters or less, found either on routine pathology or using immunohistochemistry.
N1: Cancer is present in 1-3 nodes in the armpit area (also known as axillary lymph nodes).
N1mic: The cancer present in the node measures greater than 0.2 millimeters but not greater than 2 millimeters. This is also known as a micrometastasis.
N2: Cancer is present in 4-9 axillary nodes.
N3: Cancer is present in 10 or more axillary nodes.
M: The presence or absence of distant metastases.
M0: No distant metastases are present.
M1: Distant metastases are present.
Once you know your T, N, and M status, you can determine your breast cancer stage as follows:
Stage 0: Tis, N0, M0
Stage I: T1, N0, M0.
Stage IIA: T0/T1 with N1, M0 or T2, N0, M0
Stage IIB: T2, N1, M0 or T3, N0, M0
Stage IIIA: T0/T1/T2 with N2, M0 or T3 with N1 or N2 and M0
Stage IIIB: T4 with N0/N1/N2, M0
Stage IIIC: Any T with N3, M0
Stage IV: Any T, any N with M1
For more information on breast cancer and breast cancer staging visit Seattle Breast Pathology Consultants
* A more detailed discussion of the staging system and recent modifications can be found at: S. Eva Singletary and James L. Connolly. CA Cancer J Clin 56;37-47, 2006.
© 2009 Seattle Breast Pathology Consultants, LLC. All rights reserved.
Thomas J. Lawton MD
* A more detailed discussion of the staging system and recent modifications can be found at: S. Eva Singletary and James L. Connolly. CA Cancer J Clin 56;37-47, 2006.
© 2009 Seattle Breast Pathology Consultants, LLC. All rights reserved.
Thomas J. Lawton MD
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