It’s easy to feel overwhelmed by all the new terms, acronyms, and numbers coming at you if you or someone you care about has been diagnosed with breast cancer. This includes the very specific way your doctor will classify your cancer, including staging and grading it. “It’s helpful to understand that first,” says Parvin Peddi, M.D., a medical oncologist and director of breast medical oncology at Providence Saint John’s Health Center in Santa Monica, CA. “Sometimes, there’s confusion about stage and grade.” “The size and location of the breast cancer are the focus of stage. Grade is about the biology of the cancer and how aggressive it is.”
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There are four stages of breast cancer, each numbered from 0 to 4, with substages within some of them. Dr., treatment decisions will be influenced in part by the stage of your cancer. Peddi says. It can also be informative for monitoring whether your cancer is progressing. Let’s take a closer look at the meanings of each stage and the other factors that go into your diagnosis. Staging TNM The TNM Staging System
There are different systems for staging breast cancer. The one used most often is the American Joint Committee on Cancer’s TNM system, says Teresa Hubka, D.O., president-elect of the American Osteopathic Association and founder of Comprehensive Wellness Care, a practice specializing in OB/GYN and reproductive health in Chicago. The letters stand for:
T: tumor characteristics, including size and whether it has spread to neighboring tissue
N: if cancer has reached nearby lymph nodes, and if so, the number and extent of the spread
M: whether there are distant metastases, which means the cancer has spread to other parts of the body
Based on the TNM information, a physical exam, and imaging results, you will be given a numerical stage designation of zero to four, which represents how far your cancer has progressed. Stages 2, 3, and 4 are further subdivided using letters (A, B, C). These are used to further characterize the size of the primary tumor and whether cancer cells have spread into the lymph nodes.
Stage 0
Stage 0
According to the National Breast Cancer Foundation (NBCF), stage 0 cancers are called “carcinoma in situ.” Carcinoma is another word for cancer and “in situ” means “in the original place.” Together, these terms indicate that cancer cells have not expanded beyond their original location in the breast tissue. (Breast cancer originates in either the lobules, which produce milk, or the milk ducts, the tubes that carry milk from the lobule to the nipple.)
Ductal carcinoma in situ, or DCIS, is the most common type of breast cancer and is highly treatable if it remains in this stage, says Dr. Hubka. Lobular carcinoma in situ, also called LCIS, is not technically considered cancer because the abnormal cells rarely spread to surrounding breast tissue if left untreated, the Cleveland Clinic notes. However, it does indicate you may have an increased risk of developing breast cancer.For some people, breast cancer may return after treatment, sometimes years later, according to the American Cancer Society (ACS). This is called a recurrence and it can come back in any stage—for example, you may have had stage 1 cancer and the recurrence is stage 2.
Recurrent breast cancer can sometimes be hard to treat, per the ACS, especially if the cancer returns in other parts of the body—which would then necessitate the same type of treatment as metastatic breast cancer.
At any stage, treatment of a recurrence will depend on many factors, including what was done for the cancer initially. For instance, if you had breast-conserving surgery previously, in which just the tumor was removed, a recurrence is usually treated with mastectomy, the ACS notes.
Other options for treatment may involve hormone therapy, targeted therapy (which stops the HER2 protein), immunotherapy that harnesses your body’s immune response more effectively, chemotherapy, or some combination of these.