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Types and Stages FAQs

Updated April 7, 2010

What are the different types of breast cancer?

What are the different stages of breast cancer, and what do they mean?

Why is staging necessary?

What other tests can doctors use to determine what treatment I should have?

Q: What are the different types of breast cancer?

A: Benign tumors do not contain cancer, meaning the cells that cause the tumors to grow do not invade surrounding tissue or spread throughout the body.

Lobular carcinoma in situ (LCIS) is when abnormal cells are present in the milk-producing glands of the breasts (breast lobules). These cells have not developed the ability to spread outside of the lobules to other tissues in the breast or body. Although LCIS is technically not cancer and rarely becomes invasive cancer, a diagnosis of LCIS increases your overall risk of developing breast cancer in either breast later in life.

Ductal carcinoma in situ (DCIS), also called intraductal carcinoma, is when abnormal cells develop within the milk ducts of the breast but have not developed the ability to grow out of the milk ducts into other tissues in the breast. Because these cells cannot spread at this stage, DCIS is considered non-invasive breast cancer. In some cases, DCIS may become invasive cancer if it is not removed, although doctors are still learning how to predict which DCIS will become invasive. Factors that seem to play a role in predicting future invasive breast cancers include the size of the area affected by DCIS, the degree of cancerous change in the abnormal cells and, in women having surgery that conserves the breast, how close the margins (the edge of the tissue removed in breast cancer surgery) are to the tumor that has been removed. Because of this uncertainty, if you have DCIS, you may be given the option to undergo certain breast cancer treatments.

Malignant tumors are capable of growing beyond their original site in your breast and into other tissues. This is called invasive or infiltrating cancer.

  • Carcinoma is a term that describes most malignant tumors. It defines a group of cancers that develop from cells that line normal surfaces. Ductal carcinomas develop from cells that line the ducts that carry milk to the nipple. Lobular carcinomas, which are less common, develop from cells that line the glands that produce milk.
  • Sarcomas, which are very rare in breast cancer, are malignant tumors that originate in bone, muscle, fat or connective tissue.
  • Paget’s disease, which is a rare but slowly growing breast cancer, begins in the milk ducts of the nipple. The nipple can look red, itch, ooze and become crusty, and it can sometimes burn. Usually only one nipple is affected.
  • Inflammatory breast cancer is a rare but very aggressive type of breast cancer where the cells block the lymph vessels in the skin of the breast. The breast often looks inflamed, swollen and red, like the peel of an orange, and can sometimes feel painful and warm.
  • Lymphomas, which are very rare in breast cancer, are malignant tumors that originate in tissue that produces and stores white blood cells that fight infections and other diseases (lymphoid tissue).

Reviewed by Rick Michaelson, MD

Q: What are the different stages of breast cancer, and what do they mean?

A: After you undergo tests to diagnose the breast cancer, your doctor will run a series of pathology tests on the tissue removed from your breast and underarm during your biopsy. Using the information from all these tests, your doctors will assign a stage to your breast cancer using the TNM system.

  • T stands for the size of the tumor and whether it has invaded the skin over the breast or the muscle beneath the breast
  • N stands for the number of lymph nodes under the arm (axillary nodes) that involve the cancer or whether the tumor has spread to the nodes at the base of the neck (supraclavicular nodes)
  • M stands for metastasis, or whether the cancer has traveled from your breast and lymph nodes to another area in your body

The stages of breast cancer are:

Stage O: The breast cancer remains inside the ducts or lobules of the breast and has not invaded the nearby fatty tissue of the breast. These cancers are called in situ, and are considered non-invasive.

Stage I: The breast cancer is a small tumor that is up to two centimeters across. It has grown out of the wall of the ducts or lobules into the surrounding fatty tissue of the breast (and is therefore considered invasive). The lymph nodes do not contain cancer.

Stage IIA: The breast cancer is invasive and has either:

  • Formed a tumor that is between two centimeters and five centimeters across and is not present in the axillary lymph nodes under the arm.
  • Formed a tumor that is less than two centimeters across and is present in 1-3 axillary lymph nodes under the arm.
  • Not formed a visible tumor in the breast but is present in 1-3 axillary lymph nodes under the arm.

Stage IIB: The breast cancer is invasive and has either:

  • Formed a tumor that is between two centimeters and five centimeters across and is present in 1-3 axillary lymph nodes under the arm.
  • Formed a tumor that is larger than five centimeters across and is not present in the axillary lymph nodes under the arm.

Stage IIIA: The breast cancer is invasive and has either:

  • Formed a tumor that is larger than five centimeters across and is present in 1-9 axillary lymph nodes under the arm.
  • Formed a tumor that is less than five centimeters across and is present in 4-9 axillary lymph nodes under the arm.
  • Not formed a visible tumor in the breast but is present in 4-9 axillary lymph nodes under the arm.

Stage IIIB: The breast cancer is present in the skin on top of the breast or the muscle underneath the breast. The cancer also may be present in lymph nodes in your armpit or within the breast. This cancer is often called locally advanced disease. Inflammatory breast cancer is considered a form of stage IIIB breast cancer.

Stage IIIC: The tumor is any size (or can’t be found) and is present in 10 or more nodes under the arm and/or in nodes at the base of the neck (supraclavicular nodes).

Stage IV: The cancer has traveled beyond the breast and surrounding lymph nodes to other organs in the body, such as the bones, lungs, liver or brain. This cancer is also referred to as advanced, or metastatic, disease. If you have this stage of breast cancer, visit an area of our website (link to: Metastatic disease landing page) with information specific to your situation.

Reviewed by Rick Michaelson, MD

Q: Why is staging necessary?

A: Doctors use staging to determine the extent of your breast cancer. This information helps them plan your treatment and predict your long-term outcome.

Reviewed by Rick Michaelson, MD

Q: What other tests can doctors use to determine what treatment I should have?

A: If you have estrogen receptor (ER) positive, HER2 negative, node negative breast cancer, your doctors may order a genomic test called Oncotype DX that may help predict the likelihood that your breast cancer may return, or recur. Results can help your doctors determine whether you should proceed with hormonal therapy alone, or whether chemotherapy should be added to your treatment regimen. It may also help estimate the likelihood that chemotherapy will be of use.

Oncotype DX is a gene assay, a laboratory test performed on your tumor tissue to determine the unique gene expression profile of your tumor. Oncotype DX may help predict the risk of distant metastases within ten years of your diagnosis if tamoxifen alone is used. If that risk is unacceptably high, chemotherapy may be recommended.

Oncotype DX evaluates the activity of 21 genes from a sample of tumor tissue to determine a Recurrence Score, a number between 0 and 100 that corresponds to your likelihood of breast cancer recurrence within ten years of initial diagnosis:

  • Scores of 17 and below indicate low risk for recurrence
  • Scores between 18 and 30 indicate intermediate risk
  • Scores of 31 and above indicate high risk

Each number represents a specific risk of recurrence—for example, a woman with a score of 20 has a different risk than a woman with a score of 25, even though both are in the intermediate-risk category. By determining your risk of recurrence, Oncotype DX can provide your doctors with information they need to design the most effective treatment plan to control your disease.

Until recently, the test was only approved for use with ER+, lymph node-negative early-stage breast cancer. However, results of a recent study presented at the Annual Meeting of the American Society of Clinical Oncology (ASCO) suggest that Oncotype DX may help determine your risk of recurrence if your cancer is node-positive, particularly if you are postmenopausal. The results also suggest that Oncotype DX may help determine if you would do well with a combination of chemotherapy and hormonal treatment versus an alternative chemotherapy regimen or other strategies, available to try in a clinical trial. To learn more, talk with your healthcare team about open clinical trials that might be right for you.

Reviewed by Rick Michaelson, MD

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