Breast Cancer

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  • QWhat is stage 1 breast cancer?
    3 Answers
    A
    Cancer Treatment Centers of America (CTCA)
    A answered
    Stage 1 is an early stage of the disease, in which the tumor measures up to two centimeters and no lymph nodes are involved.

    Women with early stage breast cancer may have breast-sparing surgery (e.g., lumpectomy) followed by radiation therapy as their primary local treatment, or they may have a mastectomy (removal of the entire breast) with or without breast reconstruction to rebuild the breast. Sometimes radiation therapy is also given to the chest wall after surgery. In addition, chemotherapy and/or hormone therapy may also be given to try to destroy any remaining cancer cells and prevent the breast cancer from recurring.
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  • QHow is stage 1 breast cancer treated?
    2 Answers
    A
    Cancer Treatment Centers of America (CTCA)
    A answered
    Stage 1 breast cancer treatments may include a variety of options, such as the following:
    • Surgery: For stage 1 breast cancer, surgery is a standard approach. A mastectomy (complete removal of the breast) may be appropriate for some women. When the tumor is small, a lumpectomy to remove only the tumor and some of the surrounding tissue might be appropriate. If you choose to have a lumpectomy, your doctor may recommend a course of radiation after surgery to help ensure that all of the cancer cells are eliminated. Only very rarely is radiation given following a mastectomy. In addition, removal of the axillary lymph nodes might be recommended. Women who undergo a mastectomy may wish to have breast reconstruction surgery, a common and painless procedure.
    • Chemotherapy: To help reduce the risk of recurrence after surgery, a course of chemotherapy may be recommended.
    • Hormone Therapy: For women whose cancer cells test positive for estrogen and/or progesterone receptors, hormone therapy can help eliminate cancer cells from the body.
    • Immunotherapy: When the cancer cells contain excess amounts of the HER2 protein receptors, immunotherapy with an anti-HER2 drug may be recommended in combination with chemotherapy.
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  • QWhat are the types of stage 1 breast cancer?
    1 Answer
    A
    Cancer Treatment Centers of America (CTCA)
    A answered
    Stage 1 is divided into two categories:
    • Stage 1A: The tumor measures 2 cm or smaller (about the size of a pea or shelled peanut), and has not spread outside the breast.
    • Stage 1B: Small clusters of cancer cells measuring no more than 2 mm, are found in the lymph nodes, and either there is no tumor inside the breast, or the tumor is small, measuring 2 cm or less.
    The survival rate for stage 1A breast cancer may be slightly higher than for stage 1B. However, all women with stage 1 breast cancer are considered to have a good prognosis.

    At stage 1, TNM designations help describe the extent of the disease. (In the TMN system, T describes the size of the original tumor; lymph node -- N -- indicates whether the cancer is present in the lymph nodes; and metastasis -- M -- refers to whether cancer has spread to other parts of the body.) For example, there may or may not be cancer cells in the lymph nodes, and the size of the tumor may range from 1 cm to 2 cm. Most commonly, stage 1 breast cancer is described as:
    • T: T1, T2, T3 or T4, depending on the size and/or extent of the primary tumor.
    • N0: Usually, cancer has not spread to the lymph nodes
    • M0: The disease has not spread to other sites in the body
  • QWhat are TNM designations for stage 4 breast cancer?
    1 Answer
    A
    Cancer Treatment Centers of America (CTCA)
    A answered
    At stage 4, TNM designations help describe the extent of the disease. (In the TMN system, T describes the size of the original tumor; lymph node -- N -- indicates whether the cancer is present in the lymph nodes; and metastasis -- M -- refers to whether cancer has spread to other parts of the body.) Higher numbers indicate more extensive disease. Most commonly, stage 4 breast cancer is described as:
    • T: T1, T2, T3 or T4, depending on the size and/or extent of the primary tumor.
    • N1: Cancer has spread to the lymph nodes
    • M1: The disease has spread to other sites in the body
  • QWhat is stage 4 breast cancer?
    2 Answers
    A
    Cancer Treatment Centers of America (CTCA)
    A answered
    In stage 4 (metastatic), the cancer has spread beyond the breast, underarm and internal mammary lymph nodes to other parts of the body near to or distant from the breast. The tumor may have spread to the supraclavicular lymph nodes (nodes located at the base of the neck, above the collarbone), bones, liver, lungs, skin or brain.

    Women with metastatic breast cancer will receive treatment based on where the cancer has spread. The bone is the most common site of spread from breast cancer. Treatments for metastatic breast cancer to bone may include orthopedic oncology, hormone therapy, chemotherapy, targeted therapy, radiation therapy or a combination of treatments.
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  • QHow is stage 4 breast cancer treated?
    1 Answer
    A
    Cancer Treatment Centers of America (CTCA)
    A answered
    Women who are diagnosed with stage 4 breast cancer have several treatment options. Because the cancer has spread to other parts of the body, focused treatments like surgery and radiation are not an option. Stage 4 breast cancer treatments may include:
    • Chemotherapy: Chemotherapy is the main treatment for stage 4 breast cancer. These drugs can kills cancer cells and slow down the growth of the cancer. Chemotherapy is often given in combination with hormone therapy or immunotherapy.
    • Hormone Therapy: For women whose cancer cells test positive for estrogen and/or progesterone receptors, hormonal therapy can help eliminate cancer cells from the body. These drugs prevent the tumor from getting the hormone it needs to grow. For women with stage 4 breast cancer, hormone therapy is given in combination with chemotherapy.
    • Immunotherapy: When the cancer cells contain excess amounts of the HER2 protein receptors, immunotherapy with an anti-HER2 drug may be recommended in combination with chemotherapy to help kill cancer cells and slow down the growth of the cancer.
    • Clinical trials: Many clinical trials are open to women with stage 4 breast cancer. Enrolling in a clinical trial may give you access to new therapies. Your doctor can provide information about ongoing studies that may be available to you.
    • Additional care: Many drugs are available to help ease pain and the side effects of stage 4 breast cancer treatment. Your doctor can discuss treatments for nausea, vomiting, fatigue and infections.
  • QHow are the stages of breast cancer determined?
    7 Answers
    A
    Dr. Bryan A. Shouse, MD - Frankfort, KY - Thoracic Surgery (Cardiothoracic Vascular)
    A Thoracic Surgery (Cardiothoracic Vascular), answered on behalf of
    How Are the Stages of Breast Cancer Determined?
    The stages of breast cancer are determined by the size of the tumor, if lymph nodes are involved and if the tumor has spread. Watch Bryan Shouse, MD, of Frankfort Regional Medical Center, explain more about these stages.
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  • QWhat is the most common staging system for breast cancer?
    2 Answers
    A
    Dr. Vincent T DeVita Jr - New Haven, CT - Oncology
    A , Oncology, answered
    A staging system is a standardized way for the cancer care team to summarize information about how far a cancer has spread. The most common system used to describe the stages of breast cancer is the
    American Joint Committee on Cancer (AJCC) TNM system.

    The stage of a breast cancer can be based either on the results of physical exam, biopsy, and imaging tests (called the clinical stage), or on the results of these tests plus the results of surgery (called the pathologic stage). The staging described here is the pathologic stage, which includes the findings after surgery, when the pathologist has looked at the breast mass and nearby lymph nodes. Pathologic staging is likely to be more accurate than clinical staging, as it allows the doctor to get a firsthand impression of the extent of the cancer.

    The TNM staging system classifies cancers based on their T, N, and M stages:

    • T stands for tumor (its size and how far it has spread within the breast and to nearby organs).
    • N stands for spread to lymph nodes (bean-shaped collections of immune system cells).
    • M is for metastasis (spread to distant organs).

    Additional letters or numbers appear after T, N, and M to give more details about the tumor, lymph nodes, and metastasis:

    • The letter T followed by a number from 0 to 4 describes the tumor's size and spread to the skin or to the chest wall under the breast. Higher T numbers mean a larger tumor and/or wider spread to tissues near the breast.
    • The letter N followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are affected.
    • The letter M followed by a 0 or 1 indicates whether the cancer has spread to distant organs -- for example, the lungs or bones.

    Primary tumor (T)
    TX: Primary tumor cannot be assessed.
    T0: No evidence of primary tumor.
    Tis: Carcinoma in situ (DCIS, LCIS, or Paget disease of the nipple with no associated tumor mass)
    T1: Tumor is 2 cm (3/4 of an inch) or less across.
    T2: Tumor is more than 2 cm but not more than 5 cm (2 inches) across.
    T3: Tumor is more than 5 cm across.
    T4: Tumor of any size growing into the chest wall or skin. This includes inflammatory breast cancer.
     
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  • QWhy is ductal carcinoma in situ called stage 0 cancer?
    1 Answer
    A
    Dr. Mehmet Oz, MD - New York, NY - Cardiology (Cardiovascular Disease)
    A , Cardiology (Cardiovascular Disease), answered

    The breast is comprised of lobular tissue that makes milk and ducts that carry milk out to the nipple. Ductal carcinoma in situ (DCIS) takes hold inside of the milk ducts. The cells that line the ducts sometimes grow to fill the ducts (atypical ductal hyperplasia) or become abnormal DCIS cells. Some argue that DCIS should lose to word "carcinoma" because it behaves more like a precursor, marker or future risk factor for invasive breast cancer. By definition, DCIS is not a life-threatening disease in itself because, as the name says, it stays put (in situ is Latin for "in the original place"). This is why DCIS is also called stage 0 or non-invasive cancer.

     

     

  • QHow does ductal carcinoma in situ become invasive?
    1 Answer
    A
    Dr. Mehmet Oz, MD - New York, NY - Cardiology (Cardiovascular Disease)
    A , Cardiology (Cardiovascular Disease), answered

    Ductal carcinoma in situ (DCIS) could break the boundary of the milk duct(s) of the breast, spreading into other parts of the breast and beyond to become invasive or infiltrating breast cancer. It's just that it is hard to know which ones are aggressive enough to breakthrough and which ones will have a low risk of ever becoming invasive. It could also take many years to become invasive.