Breast Cancer: Grades and Stages
Once your healthcare provider knows you have cancer, the next step is to find out the grade and stage of the cancer. Stage is a way to note the size of the tumor, and if it has spread. Grade is a way to note how abnormal the cancer cells look under a microscope. Staging and grading of cancer is important for deciding how to treat it, and how curable it is. The stage of a cancer is more important than grade in deciding on treatment.
Staging and grading is done by a pathologist. This is a doctor with special training in identifying cells by looking at them under a microscope. When the pathologist has examined the cells removed during a biopsy, he or she will issue a report that includes the cancer's grade and stage.
Grades of breast cancer
The grade refers to how the cancer cells look when compared to normal breast cells. The grade of your cancer will help your doctor predict how fast the cancer may grow and spread. A scale of 1 to 3 is used to grade breast cancer. The lower the number, the more the cancer cells look like normal cells. This means the cancer is less likely to spread, and can be easier to treat and cure. This is because cancer cells that look more like normal cells tend to grow and spread slowly. Grade 3 cancer cells look very different from normal cells. This grade of cancer is more likely to spread.
What is staging?
The stage of a cancer is how much and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. He or she can also see if the cancer has grown into nearby areas, and if it has spread to other parts of your body. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.
Stages of breast cancer
The stage of your cancer describes the size of a tumor, and how much it has spread. Doctors use different rating systems to stage cancer. The system used most often for breast cancer is the TNM system:
T stands for tumor. This category notes the size of the tumor and if it has spread into nearby areas.
N stands for nodes. Lymph nodes are small organs around the body. They help the body fight infections. This category notes if cancer cells have spread to the nearby lymph nodes.
M stands for metastasis. This category notes if the cancer has spread to other organs in the body. This may include a lung, your bones, liver, or brain. It also includes lymph nodes that are not near your kidneys.
Numbers from 0 to 4 are then assigned to the T, N, and M categories. This information is then put together into what’s called stage grouping. The stage grouping is used to determine your overall stage.
Stage groupings for breast cancer
The stage groupings for breast cancer are:
Stage 0. This means that ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), or Paget's disease of the nipple has been found. There is no actual tumor, and there are no signs of cancer spreading to lymph nodes or tissue beyond the breast. With LCIS, you are at increased risk for breast cancer, but no cancer is actually present.
Stage IA. No cancer cells are found in the lymph nodes or distant sites. The tumor is less than 2 centimeters (cm) (3/4 of an inch) across.
Stage IB. Tiny amounts of cancer cells are found in 1 to 3 lymph nodes in the arm pit, but not in distant sites. The tumor is no more than 2 cm (3/4 of an inch) across.
Stage IIA. There is either no tumor or the tumor is less than 2 cm across, but there are cancer cells in the lymph nodes. This stage grouping also includes a tumor that is between 2 and 5 cm across. The cancer has not spread to distant sites.
Stage IIB. The tumor is 2 to 5 cm across, and has spread to lymph nodes. Or the tumor is more than 5 cm (2 inches) across, but it has not spread to the lymph nodes or to the chest wall or skin. The cancer has not spread to distant sites.
Stage IIIA. The tumor is not more than 5 cm (2 inches) across. The cancer in the underarm lymph nodes is extensive, or it has spread to other lymph nodes. Or the tumor is more than 5 cm (2 inches) across, and it has spread to other lymph node areas but not to the chest wall or skin. The cancer has not spread to distant sites.
Stage IIIB. This stage includes cancer that has spread to the chest wall or skin and possibly to nearby lymph nodes. Inflammatory breast cancer is a type of breast cancer in this stage, unless it has spread to distant lymph nodes or organs.
Stage IIIC. This stage includes tumors of any size and cancer in many different lymph nodes but not in distant sites.
Stage IV. This is cancer that has spread to other organs and maybe to distant lymph nodes. In this case, the size of the tumor and the extent of the spread to the lymph nodes are less important than the fact that cancer has spread from the breast to other organs of the body. When breast cancer spreads, it's called metastatic cancer. The first place that breast cancer usually spreads to is the nearby lymph nodes. In some cases, it spreads to distant parts of the body, like the liver, bones, brain, lungs, or other organs. It may also spread to the skin. Although the cancer has spread, it's not considered a different kind of cancer. For instance, if breast cancer spreads to the liver, it is not considered liver cancer. It's called metastatic breast cancer.
Talking with your healthcare provider
Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Make sure to ask any questions or talk about your concerns.
March 21, 2017
Cunningham, Louise, RN,Stump-Sutliff, Kim, RN, MSN, AOCNS