Stages of breast cancer
There are different types of breast cancer, but we also talk about stages of breast cancer. The stage is used to assess the extent of the disease at the time of diagnosis. The size, infiltration of the tumor, possible lymph nodes and the presence of metastases are the essential criteria for accurately estimating the degree and progress of cancer.
The different stages of breast cancer
Spread of the disease symbolized and defined by the TNM classification
Once the clinical and mammographic data are collected, the tumor is classified according to the TNM classification (tumor [tumour], nodes [ganglia], Metastasis [metastasis]):
T: Refers to the size of the tumor, the quotation from T0 to T4. Thus evaluating the size and infiltration of the tumor gives an indication of the evolution of the disease.
N: Refers to the presence or not of lymphadenopathy, i.e. if lymph nodes are affected. The determination of the lymph nodes, their number and their location makes it possible to know more about the spread of cancer. The axillary ganglia (at the armpit level) are the first to be affected. The quotation goes from N0 to N3.
M: for metastasis. Cancer cells develop beyond the lymphatic system and lymph nodes invade other organs; The most commonly affected being the liver, bones and lungs. M0 is noted for the absence of metastases, M1 for the presence of metastases.
These 3 criteria are combined to obtain a global stage between 0 and 4 (the Roman numerals are preferably used: 0, I, II, III, IV). This staging can be used to assess whether breast cancer is at an early, advanced or metastatic stage.
Five-stage breast cancer status
A low number indicates a cancer that begins. A higher number describes more advanced cancer. Low values are always statistically associated with better prognosis.
Stage 0 Breast cancer: pre-cancerous stage, in situ or non-invasive breast cancer.
Stage I breast cancer: Invasive cancer located inside the breast only. Tumors are less than 2 cm long.
Stage II breast cancer: larger-sized cancer, or that has reached lymph nodes. Tumors are 2 to 5 cm long, or have reached 1 to 3 ganglia.
Stage III Breast cancer: locally advanced cancer. Tumors are more than 5 cm long, or have reached more than 4 lymph nodes.
Stage IV breast cancer: Advanced metastatic cancer, spread in other organs forming metastases.
Good to know: 6 out of 10 breast cancers are diagnosed at an early stage (limited local extension), 3 out of 10 at an intermediate stage (regional extension) and 1 in 10 at an advanced stage (more frequently among women over 74 years of age).
Classification of breast cancer by grade
The prognostic grade SBR (Scarff Bloom and Richardson) specifies the aggressive nature of breast cancer. It is based on the nature of the cancer cell. Different criteria, describing the cell from a microscopic point of view, allow to define 3 grades:
Grade I: Low grade tumor, well differentiated, which does not seem to grow rapidly nor too likely to propagate.
Grade II: Intermediate grade tumor, moderately differentiated.
Grade III: A high-grade, slightly differentiated or undifferentiated tumor that tends to develop rapidly and is likely to spread.
A well-differentiated cancer cell resembles a normal cell and acts in the same way. In this case, the tumor develops and spread slowly.
A poorly differentiated or undifferentiated cancer cell does not resemble the tissue cells where it has formed and above all does not behave like them. Undifferentiated cancers develop and often spread rapidly.
Classification of breast cancer according to the condition of the receptors
More precision on the type of breast cancer
Cancer tissue samples are collected at the time of the biopsy. They will be used by the pathologist to determine whether or not the tumor is sensitive to certain substances. In other words, they will specify if the cancer cell carries the receptors to these substances.
Some breast cancers are formed of cells that have female hormone receptors. They are called positive hormone receptor (RH +) cancers. These are hormone-dependent breast cancers. They can be positive:
Estrogen: cancers with positive estrogen receptors (ER +)
To progesterone: cancers to positive progesterone receptors (PR +)
Estrogen and progesterone.
When these receptors are present, the female hormones will encourage the development of cancer. It also tells us that hormone therapy is likely to work on this type of cancer.
Importance of receptor research to the HER2 protein
Some tumors produce a very large number of a particular receptor called HER2. This receptor commands cancer cells to multiply very quickly. Positive HER2 tumors are most often aggressive.
The knowledge of the stage, the grade, the status in hormonal receptors and the number of HER2 receptors allows to optimise the therapeutic management and to refine the prognosis.
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