Stages of Breast Cancer

“Staging” of breast cancer means finding out how far the cancer has grown or spread in the body.It helps decide the best treatment plan and gives an idea about the prognosis (likely outcome).Breast cancer is usually staged from 0 to IV (4) using clinical examination, imaging tests and pathology reports.

Stage 0 breast cancer is a non-invasive form of breast cancer.

• Cancer cells are present but are confined to the ducts or lobules of the breast.
   
• They have not invaded the surrounding normal breast tissue.
   
• The most common type is Ductal Carcinoma In Situ (DCIS).
   
• It is often detected on screening mammography before any lump is felt.
   

What it means for the patient:
If treated appropriately, Stage 0 breast cancer has an excellent prognosis, and the risk of developing invasive cancer in the future can be significantly reduced.

In Stage I, the cancer has started to invade the normal breast tissue, but it is still considered an early stage.

• The tumour is usually up to 2 cm in size.
   
• Cancer may not have spread to the lymph nodes,
  or there may be minimal involvement of a few lymph nodes.
   

What it means for the patient:
Outcomes in Stage I are generally very good with timely and appropriate treatment.
Treatment options may include:

• Breast-conserving surgery (lumpectomy) or mastectomy
   
• Sentinel lymph node biopsy
   
• Radiation therapy after breast-conserving surgery
   
• Hormonal therapy, chemotherapy or targeted therapy depending on tumour biology
   

Stage II breast cancer is still potentially curable, but the disease is more advanced than Stage I.

• The tumour may be between 2 cm and 5 cm,
  and/or
   
• Cancer may have spread to 1–3 nearby (axillary) lymph nodes.
   
• In some cases, the tumour may be larger but without lymph node involvement, depending on the exact TNM (Tumour–Node–Metastasis) combination.
   

What it means for the patient:
Stage II breast cancer is usually treated with a combination approach, which may include:

• Breast-conserving surgery or mastectomy
   
• Sentinel lymph node biopsy or axillary lymph node dissection
   
• Chemotherapy (before or after surgery) in selected patients
   
• Radiation therapy
   
• Hormonal and/or targeted therapy based on receptor status (ER/PR/HER2)
   

The aim is cure and long-term disease control.

Stage III breast cancer is called locally advanced disease.
Here, the cancer is more extensive in the breast and/or lymph nodes, but it has not yet spread to distant organs.

Features may include:

• Tumour is larger than 5 cm, and/or
   
• Cancer has spread to multiple lymph nodes (axillary, internal mammary or supraclavicular), and/or
   
• Involvement of the skin or chest wall, which may cause:
   
  • Redness
     
  • Swelling
     
  • Thickening of the skin
     
  • “Peau d’orange” appearance (skin looks like orange peel)
     
• Certain cases are classified as inflammatory breast cancer, which is an aggressive form of locally advanced disease.
   

What it means for the patient:
Stage III breast cancer usually needs multimodality treatment, such as:

• Neoadjuvant chemotherapy (chemotherapy given before surgery) to shrink the tumour
   
• Surgery (breast-conserving surgery or mastectomy with lymph node surgery)
   
• Radiation therapy
   
• Hormonal therapy and/or targeted therapy depending on tumour type
   

The goal is to control the disease locally and improve the chances of long-term survival.

Stage IV breast cancer, also called metastatic breast cancer, means the cancer has spread beyond the breast and nearby lymph nodes to other parts of the body.

Common sites include:

• Bones
   
• Liver
   
• Lungs
   
• Brain
   

What it means for the patient:
Stage IV breast cancer is generally not considered curable, but it is often treatable.
The main aims of treatment are:

• To control the cancer
   
• To relieve symptoms
   
• To improve and maintain quality of life
   
• To prolong survival
   

Treatment is usually based on systemic therapies, such as:

• Hormonal therapy
   
• Chemotherapy
   
• Targeted therapy
   
• Immunotherapy
  along with radiation therapy or surgery in selected cases for symptom relief.