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Breast cancer staging
The stage of breast cancer, along with its type, determines treatment options. Here's a summary of factors considered in breast cancer staging.
By Mayo Clinic staffAfter discovering that you have breast cancer, your doctor will decide what additional tests may be helpful to find out if the disease has spread outside the breast. Called staging, this process provides information on the extent of the disease. The cancer stage — noted as a number from 0 to IV — is based on the size of the tumor and whether the cancer has spread to the lymph nodes. Breast cancer staging helps you and your doctor plan your treatment and understand the most likely outcome (prognosis).
To determine your cancer stage, your doctor will ask questions about your medical history, do a careful physical examination and review all the tests you've had as well as the results from the biopsy of the tumor or suspicious area. Additional tests, such as X-rays and blood work, may be needed. In general, the stage isn't fully known until after the operation to remove the tumor in your breast and sample the lymph nodes under your arm.
Breast cancer staging is complicated, and the classification system sometimes changes as doctors learn more about breast cancer. All the numbers and letters can be confusing, but these details help you and your doctor know as much as possible about your cancer.
Breast cancer staging tests
Most women with a new diagnosis of breast cancer don't need all the diagnostic tests available. Usually the information from the surgical pathology report, physical exam, medical history, blood tests and a chest X-ray is enough.
- Blood tests. These may include a complete blood count (CBC), which gives a picture of your general health, and a blood chemistry test to assess your kidney and liver function. If other evidence suggests that your cancer has spread to distant parts of your body, you may have your blood tested for abnormal levels of substances known as tumor markers. Unfortunately, the available tumor markers aren't reliable for breast cancer — they don't show the presence or absence of breast cancer. As a result, the tumor markers are used only in very specific circumstances, rather than for most women with breast cancer.
- Chest X-ray. This may be done to find out if the cancer has spread to your lungs.
- Additional tests. These may include a bone scan to check for spread of cancer to your bones, and other imaging tests — computerized tomography (CT), MRI or positron emission tomography (PET) — to see if the cancer has spread to other organs. Not all women or men with breast cancer should have these tests done. Your doctor can help you determine if these tests are necessary.
Staging classification
The most common staging method, called the TNM staging system, includes three key components:
- Tumor (T). How big is the tumor, and has it spread to the skin or chest wall muscle? Tumor size is one of the most important predictors of how a cancer will behave.
- Node (N). Have cancer cells spread to nearby lymph nodes? Doctors count how many lymph nodes under the arm (axillary lymph nodes) test positive for cancer, because their status strongly relates to prognosis. Breast cancers may be described as "node positive" or "node negative."
- Metastasis (M). Has the cancer spread to other, distant areas of the body?
The number assignments in these categories indicate the degree of tumor growth or spread. For example, N0 means no axillary lymph nodes are affected, while N1 means 1 to 3 nodes are positive and N2 means 4 to 9 positive nodes.
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