14. Classification of Breast Cancer

CLASSIFICATION OF BREAST CANCER:

The most important task of your team, at this time, is to accurately classify your breast cancer. Necessary information includes grading, staging, and determination of the hormonal status of your cancer. This information aids the physician in planning treatment, determining your prognosis, evaluating the results of cancer treatment, and standardizing communication among healthcare providers for consultation, referral, and research.

GRADING:

Grading is based on the microscopic structure of the tumor, according to the visual appearance of the cells. The pathologist is interested in how the cell compares to normal cells. Normal cells are well differentiated and are usually less aggressive. The pathologist also investigates how many cells are dividing and how actively they are dividing. The most aggressive cancers tend to have a lot of cells dividing at the same time, because they are growing very rapidly. Less aggressive tumors tend to have very few dividing cells. The pathologist also looks to see if there is cancer at the margin of the tissue that has been removed. If there are cancer cells only in the middle, there is a clean margin. Pathologists usually grade on a scale of 1-3, with the higher number being the most aggressive in appearance.

STAGING:

Staging is based on measurement of the tumor, lymph node involvement, and the metastatic spread (TNM). Using this system, the breast cancer is categorized as follows:

T Tumor size, depth, and invasion to adjacent tissue
N Node involvement –number of positive nodes following axillary dissection
M Metastases to distant lymph nodes, liver, lungs, and/or bone

The Grade and the Stage are not the same. For example, a person could be ranked Grade I, meaning a less aggressive tumor with well-differentiated cells but a Stage IIIA because the tumor is larger than 5 centimeters.

In describing the following stages, traditional treatment and information on survival is identified. Please note that all women are different. As a result, sometimes different treatment will be prescribed. Unfortunately, not all women will survive the length of time listed; others will live longer. This information is given as a general guideline

STAGE O

The cells look like cancer but have NOT spread outside the breast ducts. It is very early breast cancer. This noninvasive breast cancer is called DCIS (Ductal Carcinoma in Situ). It puts the woman at a higher risk of developing invasive breast cancer.
Survival: Virtually no one dies of breast cancer within five years of treatment for DCIS. No one knows what percentage of DCIS lesions eventually become invasive.
Treatment: Patients may be treated with a mastectomy or a lumpectomy with radiation therapy. Tamoxifen is also used in the treatment of DCIS to reduce the risk of developing invasive breast cancer.

STAGE I

The tumor is smaller than or equal to 2 cm (approximately one inch). It is invasive beyond the duct wall into the breast tissue, but has not spread outside the breast to the lymph nodes of the armpit. This is also described as early breast cancer.
Survival: Survival depends on the ER, PR, HER 2, and S–Phase of the tumor. These will be discussed later in this pamphlet.
Treatment: A mastectomy or lumpectomy with radiation and lymph node sampling are the surgical treatment options. Adjuvant means “in addition to.” Adjuvant therapies are given in addition to surgery or surgery plus radiation therapy to decrease the risk of the breast cancer returning. Adjuvant chemotherapy and/or hormonal therapy is recommended for most women. In some instances, Herceptin (trastuzumab) may also be recommended.

STAGE II

When cancer is identified in the lymph nodes, it is categorized as Stage II. It is also stage II when the tumor is larger than 2 cm. but smaller than or equal to 5 cm, or independent of size, it has spread to one to three of the lymph nodes.
Survival: Survival depends on the ER, PR, HER 2, S-Phase, size of tumor and number of lymph nodes involved.
Treatment: A mastectomy or lumpectomy with radiation and lymph node sampling are surgical treatment options. Additional (adjuvant) chemotherapy and/or hormonal therapy is almost always indicated. Adjuvant chemotherapy generally lasts months. Adjuvant hormonal therapy generally lasts years. Herceptin may also be prescribed.

STAGE III

In general, tumors larger than 5 cm (two inches) or tumors with involvement in four or more lymph nodes are characterized as Stage III. When cancer has spread to the chest wall, including the ribs and certain muscles of the chest, it is called Stage III. Inflammatory breast cancer is Stage IIIB. In this rare type of cancer, the skin of the breast is red and swollen, or edematous.
Survival: Survival depends on the ER, PR, HER 2, S-Phase, size of tumor and number of lymph nodes involved.
Treatment: Treatment for Stage III breast cancer may include a mastectomy or lumpectomy with radiation. It is often necessary to give chemotherapy before surgery (neoadjuvant chemotherapy) to shrink the tumor. Adjuvant chemotherapy (lasting months) and /or hormonal therapy (lasting years) is almost always recommended. Herceptin may also be prescribed.

STAGE IV

Regardless of the size of the tumor, cancer has spread beyond the breast to the liver, lungs, brain, or any distant site other than the axillary lymph nodes.
Survival: Survival depends on where – or to which organs the breast cancer has spread. Stage IV cancer is treatable but not curable.
Treatment: Chemotherapy and/or hormonal therapy will almost always be recommended. Treatment is necessary for the rest of your life. Palliative treatment with radiation or sometimes surgery may be prescribed. Most treatments try to induce remission. Again, Herceptin may also be prescribed. Clinical trials are exploring the effectiveness of new medications. Great strides are being made, even with this advanced diagnosis

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Florida Breast Institute

201 14th Street SW
Largo, FL 33770

Telephone: (727) 588-5200

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