Staging is a way of describing the how extensive the breast cancer is, including the size of the tumor, whether it has spread to lymph nodes, if it has spread to distant parts of the body, and what its biomarkers are. Staging can be done either before or after a patient undergoes surgery. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer. TNM staging system The most common tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:
- Tumor (T): How large is the primary tumor in the breast? What are its biomarkers?
- Node (N): Has the tumor spread to the lymph nodes? If so, where, what size, and how many?
- Metastasis (M): Has the cancer spread to other parts of the body?
Here are more details on each part of the TNM system for breast cancer:
Tumor (T)
Using the TNM system, the “T” plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Tumor size is measured in centimeters (cm). A centimeter is roughly equal to the width of a standard pen or pencil. Stage may also be divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information in listed below. TX: The primary tumor cannot be evaluated. T0 (T plus zero): There is no evidence of cancer in the breast. Tis: Refers to carcinoma in situ. The cancer is confined within the ducts of the breast tissue and has not spread into the surrounding tissue of the breast. There are 2 types of breast carcinoma in situ: Tis (DCIS): DCIS is a non-invasive cancer, but if not removed, it may develop into an invasive breast cancer later. DCIS means that cancer cells have been found in breast ducts and have not spread past the layer of tissue where they began. Tis (Paget’s): Paget disease of the nipple is a rare form of early, non-invasive cancer that is only in the skin cells of the nipple. Sometimes Paget disease is associated with an invasive breast cancer. If there is an invasive breast cancer, it is classified according to the stage of the invasive tumor. T1: The tumor in the breast is 20 millimeters (mm) or smaller in size at its widest area. This is a little less than an inch. This stage is then broken into 4 substages depending on the size of the tumor: T1mi is a tumor that is 1 mm or smaller. T1a is a tumor that is larger than 1 mm but 5 mm or smaller. T1b is a tumor that is larger than 5 mm but 10 mm or smaller. T1c is a tumor that is larger than 10 mm but 20 mm or smaller. T2: The tumor is larger than 20 mm but not larger than 50 mm. T3: The tumor is larger than 50 mm. T4: The tumor falls into 1 of the following groups: T4a means the tumor has grown into the chest wall. T4b is when the tumor has grown into the skin. T4c is cancer that has grown into the chest wall and the skin. T4d is inflammatory breast cancer.
Node (N)
The “N” in the TNM staging system stands for lymph nodes. These small, bean-shaped organs help fight infection. Lymph nodes near where the cancer started are called regional lymph nodes. Regional lymph nodes include: Lymph nodes located under the arm, called the axillary lymph nodes Lymph nodes located above and below the collarbone Lymph nodes located under the breastbone, called the internal mammary lymph nodes Lymph nodes in other parts of the body are called distant lymph nodes. The information below describes the staging. NX: The lymph nodes were not evaluated. N0: Either of the following: No cancer was found in the lymph nodes. Only areas of cancer smaller than 0.2 mm are in the lymph nodes. N1: The cancer has spread to 1 to 3 axillary lymph nodes and/or the internal mammary lymph nodes. If the cancer in the lymph node is larger than 0.2 mm but 2 mm or smaller, it is called "micrometastatic" (N1mi). N2: The cancer has spread to 4 to 9 axillary lymph nodes. Or, it has spread to the internal mammary lymph nodes, but not the axillary lymph nodes. N3: The cancer has spread to 10 or more axillary lymph nodes, or it has spread to the lymph nodes located under the clavicle, or collarbone. It may have also spread to the internal mammary lymph nodes. Cancer that has spread to the lymph nodes above the clavicle, called the supraclavicular lymph nodes, is also described as N3. If there is cancer in the lymph nodes, knowing how many lymph nodes are involved and where they are helps doctors to plan treatment. The pathologist can find out the number of axillary lymph nodes that contain cancer after they are removed during surgery. It is not common to remove the supraclavicular or internal mammary lymph nodes during surgery. If there is cancer in these lymph nodes, treatment other than surgery, such as radiation therapy, chemotherapy, and hormonal therapy, are generally used.
Metastasis (M)
The “M” in the TNM system describes whether the cancer has spread to other parts of the body, called distant metastasis. This is no longer considered early-stage or locally advanced cancer. For more information, see this website's Guide to Metastatic Breast Cancer. MX: Distant spread cannot be evaluated. M0: There is no evidence of distant metastases. M0 (i+): There is no clinical or radiographic evidence of distant metastases. However, there is microscopic evidence of tumor cells in the blood, bone marrow, or other lymph nodes that are no larger than 0.2 mm. M1: There is evidence of metastasis to another part of the body, meaning there are breast cancer cells growing in other organs.
Cancer stage grouping
Doctors assign the stage of the cancer by combining the T, N, and M classifications, the tumor grade, and the results of ER/PR and HER2 testing. This information is used to help determine your prognosis (see Diagnosis). The simpler approach to explaining the stage of breast cancer is to use the T, N, and M classifications. This is the approach used below to describe the different stages. Most patients are anxious to learn the exact stage of the cancer. If you have surgery as the first treatment for your cancer, your doctor will generally confirm the stage of the cancer when the testing after surgery is finalized, usually about 5 to 7 days after surgery. When systemic treatment is given before surgery, which is typically with medications and is called neoadjuvant therapy, the stage of the cancer is primarily determined clinically. Doctors may refer to stage I to stage IIA cancer as "early stage" and stage IIB to stage III as "locally advanced."
Stage 0: Stage zero (0) describes disease that is only in the ducts of the breast tissue and has not spread to the surrounding tissue of the breast. It is also called non-invasive or in situ cancer (Tis, N0, M0).
Stage IA: The tumor is small, invasive, and has not spread to the lymph nodes (T1, N0, M0).
Stage IB: Cancer has spread to the lymph nodes and the cancer in the lymph node is larger than 0.2 mm but less than 2 mm in size. There is either no evidence of a tumor in the breast or the tumor in the breast is 20 mm or smaller (T0 or T1, N1mi, M0).
Stage : Any 1 of these conditions: There is no evidence of a tumor in the breast, but the cancer has spread to 1 to 3 axillary lymph nodes. It has not spread to distant parts of the body. (T0, N1, M0). The tumor is 20 mm or smaller and has spread to 1 to 3 axillary lymph nodes (T1, N1, M0). The tumor is larger than 20 mm but not larger than 50 mm and has not spread to the axillary lymph nodes (T2, N0, M0). Stage IIB: Either of these conditions: The tumor is larger than 20 mm but not larger than 50 mm and has spread to 1 to 3 axillary lymph nodes (T2, N1, M0). The tumor is larger than 50 mm but has not spread to the axillary lymph nodes (T3, N0, M0). Stage IIIA: The cancer of any size has spread to 4 to 9 axillary lymph nodes or to internal mammary lymph nodes. It has not spread to other parts of the body (T0, T1, T2, or T3; N2; M0). Stage IIIA may also be a tumor larger than 50 mm that has spread to 1 to 3 axillary lymph nodes (T3, N1, M0). Stage IIIB: The tumor has spread to the chest wall or caused swelling or ulceration of the breast, or it is diagnosed as inflammatory breast cancer. It may or may not have spread to up to 9 axillary or internal mammary lymph nodes. It has not spread to other parts of the body (T4; N0, N1, or N2; M0). Stage IIIC: A tumor of any size that has spread to 10 or more axillary lymph nodes, the internal mammary lymph nodes, and/or the lymph nodes under the collarbone. It has not spread to other parts of the body (any T, N3, M0). Stage IV (metastatic): The tumor can be any size and has spread to other organs, such as the bones, lungs, brain, liver, distant lymph nodes, or chest wall (any T, any N, M1). Metastatic cancer found when the cancer is first diagnosed occurs about 6% of the time. This may be called de novo metastatic breast cancer. Most commonly, metastatic breast cancer is found after a previous diagnosis of early breast cancer. Learn more about metastatic breast cancer.