c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Breast Cancer: Staging: 1

A D V E R T I S E M E N T

   
 

The size of a breast cancer and evidence of its spread are the criteria by which it is classified into stages. The current staging scheme is the American Joint Committee on Cancer TNM system. The letter T stands for tumor, N for lymph nodes, and M for metastasis. In most cases, cells from the primary tumor spread first to the regional lymph nodes, and then to distant sites in the body. The tumor is graded from 0 (no tumor found) to 4 (involvement of the skin or chest wall).

TNM criteria are:

T0:  no evidence of primary tumor
Tis:  carcinoma in situ 

T1:  < 2cm

T1a:  < 0.5cm
T1b:  0.5-1cm
T1c:  1-2cm

T2:  2-5cm

T3:  >5cm 

T4:  any size, extension to skin or chest wall (excluding pectoralis muscle)

T4a:  extension to chest wall
T4b:  skin edema, ulceration or satellite nodules 
T4c:  both a and b
T4d:  inflammatory carcinoma

N0:  no regional lymph node metastasis

N1:  cancer in movable nodes, same side 

N2:  cancer in fixed nodes

N3:  cancer in internal mammary nodes, same side 

M0:  no metastasis

M1:  distant metastasis (including supraclavicular nodes, same side)

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Breast Cancer: Staging: 2

A D V E R T I S E M E N T

   
 

There are key elements to note in each of the stages. Stage 0 is very early cancer at a pre-invasive level called carcinoma in situ. It most often originates in the ducts (ductal carcinoma in situ, DCIS) and less commonly in the glandular lobules (lobular carcinoma in situ, LCIS).

The former by definition has not spread, is usually detected early by mammography and is highly curable. The latter is also called lobular neoplasia and is not technically considered a cancer, but it is associated with a high incidence (25% in 25 years from diagnosis) of invasive cancer developing in either breast. DCIS is often difficult to differentiate microscopically from LCIS, and a second expert opinion is sometimes beneficial.    

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Breast Cancer: Staging: 3

A D V E R T I S E M E N T

   
 

Thanks to early detection through breast self-examination, yearly M.D. examination and mammography, up to half the breast cancers now detected are DCIS. Treatment for DCIS may be lumpectomy plus radiation  (breast conserving therapy) or total mastectomy. If the DCIS is multi-focal (multiple sites within one quadrant) or multi-centric (in more than one quadrant), it may mitigate for total mastectomy. Tamoxifen may also be added under current clinical protocols.    

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This page was last modified on 7/12/1999.