Breast Cancer (cont.)
Jerry R. Balentine, DO, FACEP
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Breast cancer facts
- What is breast cancer?
- What are the different types of breast cancer?
- What causes breast cancer?
- What are breast cancer risk factors?
- What are breast cancer symptoms and signs?
- How is breast cancer diagnosed?
- How is breast cancer staging determined?
- What is the treatment for breast cancer?
- What is the prognosis of breast cancer?
- Can breast cancer be prevented?
- What research is being done on breast cancer? Should I participate in a clinical trial?
- I may have breast cancer. What questions should I ask my doctor?
- Is the doctor sure I have breast cancer?
- What type of breast cancer do I have?
- What difference does a precise diagnosis make?
- What has been done to exclude cancer in other areas of the same breast or in my other breast?
- What type of medical team do I need for the most accurate diagnosis?
- Is my family history relevant to my breast cancer diagnosis?
- What other studies should be done on my tissue biopsy?
- How urgent is it that I make decisions and begin treatment?
- Should I stop taking hormone therapy (HT)?
- Even though my breast tumor does not have hormone receptors, should I take tamoxifen to reduce the risk of a new tumor?
- I have a ductal carcinoma in situ (DCIS), a type of localized cancer. Why have I been advised to have a mastectomy when other women with invasive cancer have lumpectomies?
- Should I start chemotherapy before surgery?
- If I am advised to have a mastectomy, what are the risks and benefits of immediate breast reconstruction?
- Should my lymph nodes be removed?
- What is a sentinel lymph node biopsy and what are its benefits and risks?
- Are there any other questions I should ask my doctor?
- Breast Cancer FAQs
- Find a local Oncologist in your town
How is breast cancer staging determined?
Staging is the process of determining the extent of the cancer and its spread in the body. Together with the type of cancer, staging is used to determine the appropriate therapy and to predict chances for survival.
To determine if the cancer has spread, several different imaging techniques can be used.
Chest X-ray: It looks for spread of the cancer to the lung.
Mammograms: More detailed and additional mammograms provide more images of the breast and may locate other abnormalities.
Computerized tomography (CT scan): These specialized X-rays are used to look at different parts of your body to determine if the breast cancer has spread. It could include a CT of the brain, lungs, or any other area of concern.
Bone scan: A bone scan determines if the cancer has spread (metastasized) to the bones. Low level radioactive material is injected into the bloodstream, and over a few hours, images are taken to determine if there is uptake in certain bone areas, indicating metastasis.
Positron emission tomography (PET scan): A radioactive material is injected that is absorbed preferentially by rapidly growing cells (such as cancer cells). The PET scanner then locates these areas in your body.
Staging system:
This system is used by your health care team to summarize in a standard way the extent and spread of your cancer. This staging can then be used to determine the treatment most appropriate for your type of cancer.
The most widely used system in the U.S. is the American Joint Committee on Cancer TNM system.
Besides the information gained from the imaging tests, this system also uses the results from surgical procedures. After surgery, a pathologist looks at the breast cancer and associated lymph nodes under the microscope. This information gained is incorporated into the staging as it tends to be more accurate than the physical exam and X-ray findings alone.
TNM staging:
T: This describes the size of the tumor. It is followed by a number from 0 to 4. Higher numbers indicate a larger tumor or greater spread:
-
TX: Primary tumor cannot be assessed
T0: No evidence of primary tumor
Tis: Carcinoma in situ
T1: Tumor is 2 cm or less across
T2: Tumor is 2 cm to 5 cm
T3: Tumor is more than 5 cm
T4: Tumor of any size growing into the chest wall or skin.
N: This describes the spread to lymph nodes near the breast. It is followed by a number from 0 to 3.
-
NX: Nearby lymph nodes cannot be assessed (for example if they have
previously been removed).
- Cancer has spread to 10 or more axillary lymph nodes with at least one cancer spread larger than 2 mm.
- Cancer has spread to lymph nodes under the collar bone (clavicle) with at least one area of cancer spread greater than 2 mm.
N0: There has been no spread to nearby lymph nodes. In addition to the numbers, this part of the staging is modified by the designation "i+" if the cancer cells are only seen by immunohistochemistry (a special stain used by pathologists during microscopic examination) and "mol+" if the cancer could only be found using PCR (special laboratory detection technique to detect cancer at the molecular level).
N1: Cancer has spread to one to three axillary lymph nodes (underarm lymph nodes) or tiny amounts of cancer are found in internal mammary lymph nodes (lymph nodes near breastbone).
N2: Cancer has spread to four to nine axillary lymph nodes or the cancer has enlarged the internal mammary lymph nodes.
N3: Any of the conditions below:
M: This letter is followed by a 0 or 1, indicating whether the cancer has spread to other organs.
-
MX: Metastasis cannot be assessed.
M0: No distant spread is found on imaging procedures or by physical exam.
M1: Spread to other organs is present.
Once the T, N, and M categories have been determined they are combined into staging groups. There are five major staging groups, stage 0 to stage IV, which are subdivided into A and B, or A and B and C, depending on the underlying cancer and the T, N, and M scale.
Cancers with similar stages often require similar treatments.
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