Know the Stage of Breast Cancer - Hello Sehat
Just like other cancers, how bad your breast cancer is based on its stage. The stage shows how many cancer cells are in the breast and how they have spread. Each stage gives rise to different symptoms of breast cancer, so that different treatments will be chosen. The following is a review of the stages or stages of breast cancer that you need to know.
General staging of breast cancer
The stage in breast cancer is the stage that determines whether the cancer cells have spread from the breast to other parts of the body. Based on the American Joint Committee on Cancer (AJCC), the division of breast cancer stages uses the “TNM” system, namely:
- T (Tumor) – shows the size of the tumor and whether it has grown and spread to nearby tissue.
- N (Node/ lymph nodes) – indicates cancer cells that have spread to the lymph nodes.
- M (Metastasis) – indicates metastasis or spread of cancer cells to other organs outside the breast, such as the lungs.
Each letter above will be accompanied by a number, which describes how far the breast cancer has progressed. For example, To, T1, T2, N0, N1, M0, M1, and so on. The number 0 means that it does not exist or has not spread. As for the higher the number, the bigger or worse the development.
Apart from referring to the TNM system, the classification of the stages of breast cancer will also consider the following information:
- Estrogen receptor (ER) status, whether cancer has a protein called estrogen receptor.
- Progesterone receptor (PR) status, whether cancer has a protein called progesterone receptor.
- Her2 / neu status, whether the cancer has made too much protein called Her2.
- Cancer grade, whether the cancer cells look like normal cells or not.
Differences in each stage of breast cancer
Once the TNM stage and cancer cell status are determined, these results are combined into a process called “stage grouping“Or the grouping stage.
Stage grouping is a common method for determining the stage of cancer, including breast cancer. The usual grouping starts from stages 0-4. The higher the stage number, the more severe and severe the breast cancer is experienced.
Stage 0 breast cancer
Stage 0 is used to describe non-invasive or breast cancer carcinoma in situ. This means that cancer cells or non-cancerous abnormal cells have not yet developed and have not spread to nearby healthy tissue and outside the breast.
Types of breast cancer that often occur at this stage, namely ductal carcinoma in situ /ductal carcinoma in situ (DCIS). In addition, there are two other possible types of carcinoma in situ, namely LCIS (lobular carcinoma in situ) and Paget’s disease or disease of the nipple.
Ductal carcinoma in situ is a very early and highly curable type of cancer. However, if not treated immediately, the cancer can spread to the surrounding breast tissue. Treatment of breast cancer at this stage is generally in the form of lumpectomy, mastectomy, or radiation therapy.
While lobular carcinoma in situ is not generally considered cancer. However, when diagnosed with LCIS, you are at higher risk of developing breast cancer. Therefore, doctors will usually recommend routine breast cancer checks, such as mammography.
Stage 1
Stage 1 is the earliest stage of breast cancer that has the potential to spread (invasive). At this stage, the tumor is still very small in size and has not spread to the lymph nodes. However, the cancer cells have spread beyond the original location and spread to the surrounding healthy breast tissue.
Tumors that tend to be small at this stage make breast cancer still quite difficult to detect. However, early detection with breast self-examination and routine screening is very important so that its appearance can be diagnosed early.
Stage 1 breast cancer is divided into two categories, namely:
Stage 1A
Stage 1A means that the tumor is 2 cm or more and has not spread beyond the breast. Based on the TNM system, stage 1A breast cancer is described as T1 N0 M0.
In addition, types of breast cancer that are classified as positive for estrogon receptors or positive for progesterone receptors are also likely to be classified in stage 1A.
Stage 1B
Stage 1B breast cancer is characterized by one of two conditions:
- There are cancer cells in the lymph nodes with a cell size of about 0.2-2 mm, but no tumor was found in the breast.
- There is a tumor in the breast measuring 2 cm or smaller and there are cancer cells about 0.2-2 mm in size in the lymph nodes near the breast.
Based on the TNM system, stage 1B is the same as T0 N1mi M0 or T1 N1mi M0.
Typically, the survival rate for stage 1A breast cancer is slightly higher than that of 1B. But in general, women who are at this stage still have a good quality of life.
Breast cancer in stage 1 is still highly curable. At this stage, the treatment given is generally in the form of breast cancer surgery (lumpectomy or mastectomy and removal of lymph nodes /lymph node biopsy), breast cancer radiation therapy, chemotherapy, hormone therapy, or targeted therapy.
Stage 2
Stage 2 is also known as invasive breast cancer. At this stage, cancer cannot be classified as a late stage, but it is past its initial stage.
In stage 2, the tumor size is larger than the previous stage. Cancer cells have also spread to the lymph nodes, even though they are still in the closest area, but have not spread to more distant parts of the body.
Stage 2 breast cancer is divided into:
Stage 2A
In general, breast cancer stage 2A can be described by one of the following conditions:
- There is no tumor in the breast, but the cancer cells have spread to 1-3 lymph nodes near the armpit or sternum.
- There is a tumor in the breast that is less than 2 cm in size and there are cancer cells in the lymph nodes near the armpit.
- There is a tumor measuring 2-5 cm and has not spread to the surrounding lymph nodes.
Based on the TNM system, stage 2A is the same as: T0 N1 Mo, T1 N1 M0, or T2 N0 M0.
Stage 2B
In stage 2B breast cancer, possible conditions include:
- The tumor is between 2-5 cm in size and found cancer cells measuring 0.2-2 mm in the lymph nodes.
- The tumor is between 2-5 cm in size and the cancer cells have spread to 1-3 lymph nodes in the armpit or near the sternum.
- The tumor is larger than 5 cm and has not spread to the lymph nodes.
Based on the TNM system, stage 2B is described as T2 N1 M0 or T3 N0 M0.
The life expectancy of stage 2 breast cancer can be up to five years after diagnosis, with the help of medication. The treatment that is usually given is breast cancer surgery, both lumpectomy, mastectomy, and lymph node removal. You may also need to undergo breast cancer chemotherapy or hormone therapy before surgery and targeted therapy (if you are HER2 positive).
Stage 3
Stage 3 is also known as locally advanced breast cancer. This means that the tumor or lump found can be larger or the spread of cancer cells to the lymph nodes is more. However, this spread has not yet reached other organs.
Stage 3 is generally divided into three categories, namely:
Stage 3A
Stage 3A conditions usually include:
- There was no tumor in the breast or there was a tumor with a small or large size, but cancer cells were found in 4-9 lymph nodes around it.
- The tumor is larger than 5 cm and there are small clusters of cancer cells found in nearby lymph nodes.
- The tumor is larger than 5 cm and can be found in 1-3 lymph nodes in the lymph nodes under the arm or near the sternum.
Based on the TNM system, stage 3A can be described as T (0-2) N2 M0, T3 N1 M0, or T3 N2 M0.
Stage 3B
In stage 3B breast cancer, the size of the tumor can be small or large. In addition, at this stage cancer cells also usually:
- Has spread to the chest wall and / or breast skin.
- May have spread to 9 lymph nodes near the armpit or to lymph nodes near the breastbone.
- Cancer has spread to the skin of the breast and causes inflammation of the breast cancer.
At this stage, the TNM system can be described as T4 N0 M0, T4 N1 M0, or T4 N2 M0.
Stage 3C
This stage usually includes:
- There is no sign of cancer in the breast. If there is a tumor, it can vary in size and may have spread to the chest wall and / or breast skin.
- Cancer cells have spread to 10 or more lymph nodes in the armpit.
- Cancer cells may have spread to lymph nodes above or below the collarbone.
- Cancer cells may have spread to lymph nodes in the armpit or lymph nodes near the breastbone.
- Cancer has spread to the skin of the breast or is also known as inflammatory breast cancer.
Based on the TNM system, stage 3C is the same as T (1-4) N3 M0.
Breast cancer at this stage is not always operable. If it cannot be treated with surgery, treatment is usually done with therapy, such as chemotherapy, radiation therapy, hormone therapy, or targeted therapy.
With this treatment, the life expectancy of stage 3 breast cancer can be longer. According to Cancer Research UK, more than 70% of patients at this stage can survive up to five years after being diagnosed.
Stage 4
Stage 4 breast cancer is also known as metastatic breast cancer. Cancer cells generally have developed long enough in the breast to finally be categorized at this stage.
Stage 4 breast cancer is the most recent stage and is a serious, life-threatening condition. At this stage, cancer has spread from the breast and surrounding lymph nodes to other organs, such as the lungs, lymph nodes that are far from the breast, skin, bones, liver, or brain.
This spread can be to one or more of these body organs. At this stage, the TNM system can be described as T (1-4) N (1-3) M1.
Symptoms of metastatic breast cancer are generally different. In addition to the symptoms of breast cancer in general, patients at this stage often experience symptoms in other parts of the body, depending on which organs have been exposed.
If it has spread to the bones, people with breast cancer at this stage may feel pain in certain parts of the bone. If you go to your lungs, you may feel a cough or shortness of breath, while if you go to your heart you may feel fatigue, fever, decreased appetite, and so on.
In fact, cancer that has spread to the lungs can make your lungs vulnerable to infections, such as pneumonia.
Treatment stage 4
Patients with stage 4 or metastatic breast cancer cannot be completely cured. The life expectancy rate is only about 25% which can last for 5 years after being diagnosed.
However, treatment still needs to be undertaken to relieve symptoms, improve quality of life, and extend life expectancy, by shrinking and slowing the growth of cancer cells.
Generally, stage 4 breast cancer patients receive systemic therapy, which is hormone therapy, chemotherapy, targeted therapy, immunotherapy, or a combination of these. Surgery and / or radiation therapy may also be needed for certain conditions. Talk to your doctor about the type of treatment that’s right for you.
Apart from medical treatment, you also need to adopt healthy habits to support your body’s fitness, such as a healthy diet and regular exercise. Ask your doctor about sports that you can still do according to your condition.
In general, the earlier breast cancer is discovered, the higher the chance of cure. Therefore, every little complaint you feel, you should immediately consult a doctor to prevent severe breast cancer.
If after going through treatment and signs of cancer are not found, you also need to maintain a healthy body. The reason is, cancer cells are still possible to recur or come back.
