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Understanding the Stages of Breast Cancer

Posted Aug 24 2008 1:49pm
ANNOUNCER: Breast cancer, while a very specific diagnosis, can be discovered at different levels of progression, or stages.

MARISA WEISS, MD: The staging system is some way of giving the doctor and the patient a sense of what the outlook looks like, what's the nature of the problem. Is it an easily treated problem, or is it a more serious problem? And based on the stage of the cancer, that is how treatment plans are determined and designed.

ANNOUNCER: As soon as possible, doctors want to determine how far the cancer has spread.

LAWRENCE WICKERHAM, MD: At the time of diagnosis and initial surgical treatment, we measure the size of the cancer under the microscope and evaluate lymph nodes in the armpit, and other parts of the body, increasingly, to determine whether or not there are cancer cells present in these lymph nodes. They also often do other tests, X-rays, scans to see if there is any evidence of breast cancer outside of the breast.

MARISA WEISS, MD: The pathology laboratory also looks at other factors. It gives us an idea about the personality or the nature of the cancer problem in terms of how fast is it growing. Does it have gene abnormalities present? Are there hormone receptors in place? How does it compare under the microscope to a normal set of cells.

ANNOUNCER: After testing, cancers are, in a sense, rated according to a determined system called TNM.

MARISA WEISS, MD: The TNM classification system refers to the "T" being the tumor size, the "N" being what's happening in the lymph nodes, and the "M" meaning what's happening in the rest of the body. Is there any evidence of metastases?

ANNOUNCER: Cancers are then grouped into stages to determine prognosis and treatment.

MARISA WEISS, MD: The earliest stages of breast cancer include cancer that stays within the milk pipe or the lobule in which it started. There is no sign of invasion. We call that stage 0 because there are no signs of invasion.

ANNOUNCER: This stage of breast cancer is called DCIS or ductal carcinoma in situ: a cancer of the milk ducts that has stayed where it started.

Stage I disease means that the cancer is limited to the breast itself. It does not involve lymph nodes in the armpit and has not spread to other areas in the body. It also means the tumor is less than 2 centimeters in size.

In stage II breast cancer, the tumor is larger, 2 to 5 centimeters in size, and/or may have spread to lymph nodes on the same side as the affected breast. Still, for cancers 2 to 5 centimeters in size, without spread to the lymph nodes, 5-year survival is 76 to 88 percent.

In stage III breast cancers, the tumor is still larger, greater 5 centimeters in size and lymph nodes are involved. Still, without evidence of distant metastases, 5-year survival is 49 to 56 percent.

MARISA WEISS, MD: And then there is metastatic breast cancer. That's stage IV breast cancer in which cancer has spread beyond the breast and immediately adjacent lymph nodes. Her chance of living 5 years can range. It can be around 25 to 40 percent for someone who has metastatic breast cancer.

ANNOUNCER: Determining the different stage of breast cancer helps the tailor the treatment approach.

LAWRENCE WICKERHAM, MD: The classification by stage is an important factor in prognosis, how the patient is going to do over the long-term and can be a factor in choices of therapy

MARISA WEISS, MD: For a woman who has early stage breast cancer there are two categories of treatment. We can treat the whole breast by removal of the whole breast, that's call mastectomy. Or you can treat the whole breast by removal of the lump and radiation to the remainder of the breast tissue.

In terms of the systemic therapy, there are hormonal therapies where estrogen is either reduced or its effect is blocked from the cancer cell. There is also chemotherapy.

ANNOUNCER: Treatment for later stage breast cancer usually focuses less on surgery and more on other types of treatments.

MARISA WEISS, MD: If the cancer is hormone receptor positive, it involves hormonal therapies. If it's not, or if the cancer is aggressive, chemotherapy is usually initiated either one agent, one chemotherapy, at a time or sometimes in combination.

And then there are local therapies that are pulled in as needed. So let's say someone has metastatic breast cancer to the back. We may use radiation to help with back pain.

ANNOUNCER: Today, as we discover more about the nature of breast cancer, the chances of each woman being a cancer survivor improve.

MARISA WEISS, MD: For women with breast cancer today, they have so many more treatment options than they ever had before, within each category of surgery, radiation, hormonal therapies, chemotherapies, immune therapies as well as complementary medicine.

I'm optimistic, but I also know that this is a complicated disease that's going to take a long time to figure out.

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