Understanding of Breast Cancer

by Kerry Andersen

Stage One. Metastatic. DCIS. Amid dealing with emotional thoughts of mortality, quick and overwhelming treatment decisions, and fear of the unknown, women diagnosed with breast cancer also face having to quickly learn a new vocabulary of sometimes confusing medical jargon and definitions.
What does it all mean?

Staging describes the size of a tumor and how far it has spread, helping doctors determine the best course of treatment. Understanding the stages of breast cancer is crucial for women (and those who support them) to navigate their diagnosis. Each stage presents different challenges and, combined with early detection and advancements in treatment, provides a crucial road map to recovery.

Stage 0: Ductal Carcinoma In Situ (DCIS)

Stage 0 breast cancer, also known as ductal carcinoma in situ (DCIS), is the earliest form of breast cancer. In DCIS, abnormal cells are confined within the milk ducts and have not invaded nearby tissue. While DCIS is non-invasive, it still requires treatment to prevent progression to invasive breast cancer. Treatment options often include surgery (lumpectomy or mastectomy) followed by radiation therapy to reduce the risk of recurrence.

Because stage 0 breast cancer is localized and non-invasive, the prognosis is generally excellent. However, regular follow-up is necessary to monitor any changes that could signal a more aggressive cancer.

Stage I: Early Invasive Breast Cancer

Stage I breast cancer is the earliest form of invasive cancer. In this stage, cancer cells have begun to invade surrounding breast tissue but are still small and have not spread to lymph nodes.

Stage I is subdivided into two categories:

· Stage IA The tumor is two centimeters or smaller and has not spread beyond the breast.

· Stage IB Small clusters of cancer cells (larger than 0.2 millimeters but smaller than two millimeters) are found in nearby lymph nodes, but no tumor is detectable in the breast or the tumor in the breast is two centimeters or smaller.

Treatment options typically include surgery, often combined with radiation therapy, hormone therapy, or chemotherapy, depending on the cancer’s specific characteristics. The outlook for Stage I breast cancer is favorable, with high (99%) survival rates, especially when detected early.

Stage II: Localized Spread

Stage II breast cancer indicates that the tumor has grown larger or spread to nearby lymph nodes but has not spread to distant organs.

There are two subcategories:

· Stage IIA The tumor is either two to five centimeters but has not spread to nearby lymph nodes, or it is smaller than two centimeters but has spread to one to three lymph nodes.

· Stage IIB The tumor is larger (between two and five centimeters) and has spread to one to three lymph nodes, or it is larger than five centimeters but has not spread to any lymph nodes.

Treatment for Stage II breast cancer typically includes surgery along with lymph node removal. Chemotherapy, hormone therapy, and radiation are often recommended based on the tumor’s size and hormone receptor status. The prognosis remains positive with survival rates as high as 93%, particularly with prompt and effective treatment.

Stage III: Advanced Local Spread

Stage III breast cancer is locally advanced, meaning it has spread more extensively within the breast and to nearby lymph nodes but has not yet reached distant organs.

This stage is divided into subcategories:

· Stage IIIA The tumor may be any size, but cancer has spread to four to nine axillary lymph nodes or nearby breastbone lymph nodes. Alternatively, the tumor may be larger than five centimeters with cancer in one to three lymph nodes.

· Stage IIIB The tumor has spread to the chest wall or skin, causing swelling or ulceration, and may have spread to up to nine lymph nodes.

· Stage IIIC Cancer has spread to ten or more axillary lymph nodes, lymph nodes near the collarbone, or internal mammary lymph nodes.

Treatment for Stage III breast cancer is more aggressive and typically involves a combination of surgery, chemotherapy, radiation therapy, hormone therapy, and sometimes targeted therapies such as HER2 inhibitors. While Stage III breast cancer is more challenging to treat, advances in therapy have improved five-year survival rates for women in this category to 70-86%.

Stage IV: Metastatic Breast Cancer

Stage IV breast cancer, also known as metastatic breast cancer, is the most advanced stage. In this stage, the cancer has spread beyond the breast and lymph nodes to other parts of the body, such as the bones, liver, lungs, or brain. At this point, the cancer is considered incurable, but treatment can help manage symptoms and prolong life.

Treatment at this stage focuses on controlling the spread of the disease and improving quality of life. Options may include hormone therapy, chemotherapy, targeted therapies, and immunotherapy. Palliative care is also an important aspect of treatment to manage pain and other symptoms.