Breast Cancer Treatment By Stage

Breast Cancer Treatment By Stage

Breast Cancer Treatment By Stage

Breast cancer stages range from 0-4. Each stage has different symptoms and treatment options.

Breast cancer has four stages, and a doctor uses the TNM staging system to identify which of these four stages the breast cancer has reached.

The letters TNM mean the following:

  • T stands for tumor and indicates how much of the breast tissue is involved.
  • N stands for nodes and indicates whether cancer has spread to the lymph nodes.
  • M stands for metastasis and indicates whether cancer has spread to other parts of the body.

The TNM staging system also uses numbers. The numbers from 0-4 determine how advanced the cancer is.

The system is overseen by the American Joint Committee on Cancer (AJCC). This means all cancer doctors describe and classify the stages of cancer in the same way.

To determine which stage a person's breast cancer has reached, a doctor will perform tests. Tests include blood tests, CT and PET scans, MRI's, X-rays, including a mammogram, and ultrasounds.

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Stage 0 breast cancer

Stage 0 breast cancer,ductal carcinoma in situ (DCIS) is a non-invasive cancer where abnormal cells have been found in the lining of the breast milk duct. In Stage 0 breast cancer, the atypical cells have not spread outside of the ducts or lobules into the surrounding breast tissue. Ductal Carcinoma In Situ is very early cancer that is highly treatable, but if it’s left untreated or undetected, it can spread into the surrounding breast tissue.

What is Stage 0 LCIS?

Lobular carcinoma in situ at Stage 0 generally is not considered cancer. Although it has carcinoma in the name, it really describes a growth of abnormal but non-invasive cells forming in the lobules. Some experts prefer the name lobular neoplasia for this reason because it accurately refers to the abnormal cells without naming them as cancer. LCIS, however, may indicate a woman has an increased risk of developing breast cancer.

If you have been diagnosed with LCIS, your doctor may recommend regular clinical breast exams and mammograms. He or she may also prescribe Tamoxifen, a hormone therapy medication that helps prevent cancer cells from growing.

Treatment for stage 0 breast cancer

There is a variety of treatment options for stage 0 breast cancer, including:

Surgery

A lumpectomy involves removing cancerous cells from the breast. It is an option when the cells remain in one area. This is a relatively short and simple procedure, and a person should be able to go home after the surgery on the same day.

If cancerous cells appear throughout the breast, the doctor may recommend a mastectomy, which involves removing the entire breast. Plastic surgeons can rebuild the breast at the same time or a later date.

Stage 1 breast cancer

Stage 1 breast cancer is the earliest stage of what's considered invasive breast cancer. "Invasive" does not mean that the cancer has invaded other areas of your body. Rather, it simply means that the cells in your tumor have infiltrated the area past what's called the basement membrane.

When a tumor first begins, it has not yet grown past this membrane and isn't considered cancer, but rather carcinoma in situ. These tumors are referred to as stage 0 tumors. Carcinoma in situ is 100% curable with surgery since the cells are completely contained.

Stage 1 tumors are the earliest stage of true breast cancer. These tumors are small, and if they have spread at all to lymph nodes, the spread is only microscopic.

Staging

To understand how your doctor determines the stage of your cancer, and if you have a stage 1A or stage 1B tumor, it's helpful to know a little about something called the TNM system of classification.

  • T=Tumor Size: All stage 1 cancer is T0 or T1, meaning your tumor is 2 centimeters (cm, roughly an inch) or less in diameter.
  • N=Nodes: All stage 1 cancer is N0 or N1mi. N0 means it has not spread to any lymph nodes. N1 means that it has spread to lymph nodes nearby. The "mi" means micrometastases, which can only be seen under the microscope. Micrometastases are measure between 0.2 millimeters (mm) and 2 mm (0.2 cm) in diameter.
  • M=Metastases: M0 means that cancer has not metastasized (spread to other areas of the body).

 Treatment

Treatment options for stage 1 breast cancer fall into two main categories:

  • Local treatments: These treat cancer at the site and include surgery and radiation therapy
  • Systemic treatments: These treat cancer throughout the body and include chemotherapy, hormonal therapy, targeted therapy, and immunotherapy

If a tumor is very small, local treatments are usually all that's required. If the tumor is larger, more aggressive (has a higher tumor grade), has spread to lymph nodes, or has a molecular profile that indicates it's more likely to spread, systemic treatments are usually recommended.

With stage 1 breast cancers, the use of systemic therapy is considered adjuvant (add-on) therapy. The goal is to eliminate any cancer cells that may have spread beyond the breast but are too small to be detected.

In consult with your doctor, weigh the pros and cons of each option in relation to your case (e.g., family history, where you tumor is located, etc.)

Stage 2 breast cancer

Stage 2 breast cancer also has subcategories known as 2A and 2B.

Stage 2A breast cancer is an invasive cancer where:

  • There is no tumor growth in the breast itself, but cancerous masses that are over 2 mm in diameter are growing in up to three axillary lymph nodes (in and around the armpit) or lymph nodes near the breastbone.
  • There is a tumor in the breast that is under 2 cm in diameter that has spread to the axillary lymph nodes.
  • The tumor is 2–5 cm in diameter but has not spread to the axillary lymph nodes.

Stage 2B breast cancer is an invasive breast cancer where:

  • A tumor that measures 2–5 cm in diameter is growing in the lymph nodes alongside clusters of cancerous cells. These cancerous cells form groups between 0.2 mm–2 mm in size.
  • There is a tumor that is 2–5 cm in diameter, and cancerous cells have spread to one to three axillary lymph nodes or lymph nodes by the breastbone.
  • The tumor is larger than 5 cm, but cancerous cells have not spread to the axillary lymph nodes.

Treatment

Systemic therapy is recommended for women with stage II breast cancer. Some systemic therapies are given before surgery (neoadjuvant therapy), and others are given after surgery (adjuvant therapy). Neoadjuvant treatments are often a good option for women with large tumors, because they can shrink the tumor before surgery, possibly enough to make BCS an option. But this doesn’t improve survival more than getting these treatments after surgery. In some cases, systemic therapy will be started before surgery and then continued after surgery.

The drugs used will depend on the woman’s age, as well as tumor test results, including hormone-receptor status, HER2 status, and the score on a gene panel such as Oncotype DX). Treatment may include:

  • Chemotherapy: Chemo can be given before or after surgery.
  • HER2 targeted drugs: If the cancer is HER2-positive, HER2 targeted drugs are started along with chemo. Both trastuzumab (Herceptin) and pertuzumab (Perjeta) may be used as a part of neoadjuvant treatment. Then trastuzumab is continued after surgery for a total of 6 months to a year of treatment.
  • Hormone therapy: If the cancer is hormone receptor-positive, hormone therapy (tamoxifen, an aromatase inhibitor, or one followed by the other) is typically used. It can be started before surgery, but because it continues for at least 5 years, it needs to be given after surgery as well.

Stage 3 breast cancer

Stage 3 breast cancer refers to cancer in the breast that has spread to several nearby lymph nodes. Doctors also describe breast cancer as stage 3 if a tumor is larger than 5 centimeters and cancer has spread to any lymph nodes, but not to distant organs.

At stage 3, breast cancer may also spread to the chest wall or the skin of the breast.

Receiving a stage 3 cancer diagnosis can be distressing, but life expectancy and treatments are improving all the time.

This article looks at the survival rates for stage 3 breast cancer, as well as treatment options, remission, and ways of coping with the diagnosis.

Treatment

Treatment of stage 3 breast cancer typically involves a combination of medication and surgery, based on a person's particular circumstances.

Drug-based treatments can include chemotherapy, targeted cancer drugs, hormone therapy or a combination.

Chemotherapy involves destroying cancer cells with anticancer drugs. There are many side effects of chemotherapy, but they usually subside, once a person has finished treatment.

Side effects of chemotherapy can include:

  • increased risk of infection
  • anemia
  • bruising and bleeding
  • hair loss
  • nausea
  • mouth and dental problems
  • skin and nail changes
  • memory and concentration issues
  • menopause symptoms
  • fatigue

Stage 4 breast cancer

the five-year survival rate after diagnosis for people with stage 4 breast cancer is 22 percent.

This percentage is considerably lower than at earlier stages. At stage 3, the five-year relative survival rate is 72 percent. At stage 2, it’s over 90 percent.

Because survival rates are higher in the early stages of breast cancer, early diagnosis and treatment is crucial.

Understanding survival rates

Survival rates for breast cancer are based on studies of many patients with the condition. However, these statistics can’t predict your personal outcome, as each person’s prognosis is different.

Your life expectancy with metastatic breast cancer may be affected by:

  • your age
  • your general health
  • hormone receptors on cells with cancer
  • the types of tissue that the cancer has affected
  • your attitude and outlook

Treatment for stage 4 breast cancer

Typically, treatment for stage 4 breast cancer includes a combination of chemotherapy, radiation therapy, and hormone therapy (if appropriate).

Targeted therapy is a treatment that targets the protein that allows cancer cells to grow and this type of therapy may also be an option for people with stage 4 breast cancer.

Sometimes, surgeons will operate to try and remove tumors though this is not usually the first option for treatment.

Doctors, however, may recommend surgery to help with pain relief by treating some of the issues that may develop as a result of having stage 4 breast cancer. These include spinal cord compression, removing single masses caused by metastasis, and fixing any broken bones.

A doctor may also prescribe medication to treat related symptoms such as:

  • antidepressants to help mood
  • anticonvulsants to manage pain or neurologic conditions
  • local anesthetics to manage pain

10 common questions about Breast Cancer Treatment By Stage

1Can you die from stage 2 breast cancer?
According to the American Cancer Society, the five-year survival rate for stage 2 breast cancer is 93% for women who have completed treatment
2At what stage of cancer is chemotherapy used?
Metastatic cancer is considered stage IV. Chemotherapy is used to treat advanced-stage breast cancer by destroying or damaging the cancer cells as much as possible. Because chemotherapy medicines affect the entire body, chemotherapy is commonly used to treat advanced-stage breast cancer.
3What are the 4 stages of breast cancer?
The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero), which is noninvasive ductal carcinoma in situ (DCIS), and stages I through IV (1 through 4), which are used for invasive breast cancer.
4What is the best treatment for stage 0 breast cancer?
There are three main treatment options: Lumpectomy only, a surgery that removes the abnormal cells and a little of the normal tissue near them. Lumpectomy and radiation. Mastectomy, a surgery that removes the entire breast.
5Can you live 20 years with breast cancer?
It is often repeated that 98% of women with early stage breast cancer are alive at five years after diagnosis. However, an estimated 20% to 30% of women will have a recurrence of their disease, and may go on to die of the disease, but are included as survivors in these five-year survival statistics.
6How long does chemo last for Stage 2 breast cancer?
Typically, if you have early-stage breast cancer, you'll undergo chemotherapy treatments for three to six months, but your doctor will adjust the timing to your circumstances. If you have advanced breast cancer, treatment may continue beyond six months.
7Does breast cancer spread quickly?
Breast cancer usually spreads first to lymph nodes under the arm (lymph node-positive breast cancer). ... When a cancer spreads to regions such as the bones, brain, lungs, or liver, however, it is considered stage 4 or metastatic breast cancer and is no longer curable. Most breast cancers have the potential to spread.
8How is Stage 2 breast cancer treated?
Stage II cancers are treated with either breast-conserving surgery (BCS; sometimes called lumpectomy or partial mastectomy) or mastectomy. The nearby lymph nodes will also need to be checked, either with a sentinel lymph node biopsy (SLNB) or an axillary lymph node dissection (ALND)
9Which is the most aggressive form of breast cancer?
Most common invasive breast cancers. Invasive ductal carcinoma (also called infiltrating ductal carcinoma) begins in the milk ducts and is the most common invasive breast cancer. Invasive lobular carcinoma begins in the lobules and is the second most common invasive breast cancer.
10Can cancer spread while on chemo?
They found the number of blood vessel 'doorways' that allow cancer to spread throughout the body was increased in 20 patients receiving two common chemotherapy drugs. ... Most are diagnosed at an early stage, but the cancer has spread in around 6 to 7 per cent of cases, according to Cancer Research UK

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