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    You Have Stage I Breast Cancer .... And This is the Good News

    You've been through all of the tests and biopsies and your oncologist has informed you that your breast cancer is a Stage I. Is this good news? Well it would be better if there was no cancer at all, but let's take a look at the staging of breast cancer to find out what Stage I means.

    This is the information from the National Cancer Institute:
    Stage Information

    The American Joint Committee on Cancer (AJCC) staging system provides a strategy for grouping patients with respect to prognosis. Therapeutic decisions are formulated in part according to staging categories but primarily according to lymph node status, estrogen- and progesterone-receptor levels in the tumor tissue, menopausal status, and the general health of the patient.

    The AJCC has designated staging by TNM classification.

    T stands for the primary Tumor, N is for the Regional lymph nodes involved and M means the Distant metastasis. Every tumor is classified by the size and characteristics of the primary tumor, if any lymph nodes are involved and if the tumor has spread. If the tumor is small with no nodes involved and no metastasis... You may very well be in stage I.

    TNM definitions:
     
    Primary tumor (T):

    TX: Primary tumor cannot be assessed 
    T0: No evidence of primary tumor 
    Tis: Carcinoma in situ; intraductal carcinoma, lobular carcinoma in situ, or
           Paget's disease of the nipple with no associated tumor.
    Note: Paget's disease associated with a tumor is classified according to the size of the tumor.
    T1: Tumor 2.0 cm or less in greatest dimension
         T1mic: Microinvasion 0.1 cm or less in greatest dimension
         T1a: Tumor more than 0.1 
    but not more than 0.5 cm in greatest dimension
         T1b: Tumor more than 0.5 cm 
    but not more than 1.0 cm in greatest dimension
         T1c: Tumor more than 1.0 cm 
    but not more than 2.0 cm in greatest dimension
    T2: Tumor more than 2.0 cm but not more than 5.0 cm in greatest dimension
    T3: Tumor more than 5.0 cm in greatest dimension
    T4: Tumor of any size with direct extension to (a) chest wall or (b) skin, only as described below.
    Note: Chest wall includes ribs, intercostal muscles, and serratus anterior muscle but not pectoral muscle.
          T4a: Extension to chest wall
          T4b: Edema (including peau d'orange) or 
                   ulceration of the skin of the breast 
                   or satellite skin nodules confined to the same breast
          T4c: Both of the above (T4a and T4b)
          T4d: Inflammatory carcinoma*

    *Note: Inflammatory carcinoma is a clinicopathologic entity characterized by diffuse brawny induration of the skin of the breast with an erysipeloid edge, usually without an underlying palpable mass.1 Radiologically there may be a detectable mass and characteristic thickening of the skin over the breast. This clinical presentation is due to tumor embolization of dermal lymphatics with engorgement of superficial capillaries.

     

    Regional lymph nodes (N):

    NX: Regional lymph nodes cannot be assessed (e.g., previously removed)
    N0: No regional lymph node metastasis
    N1: Metastasis to movable ipsilateral axillary lymph node(s)
    N2: Metastasis to ipsilateral axillary lymph node(s) fixed to each other or to other structures
    N3: Metastasis to ipsilateral internal mammary lymph node(s)

    Pathologic classification (pN):

    pNX: Regional lymph nodes cannot be assessed (not removed for pathologic study or previously removed)
    pN0: No regional lymph node metastasis
    pN1: Metastasis to movable ipsilateral axillary lymph node(s)
         pN1a: Only micrometastasis (none larger than 0.2 cm)
         pN1b: Metastasis to lymph node(s), any larger than 0.2 cm
         pN1bi: Metastasis in 1 to 3 lymph nodes, any more than 0.2 cm and all less than 2.0 cm in greatest dimension
         pN1bii: Metastasis to 4 or more lymph nodes, any more than 0.2 cm and all less than 2.0 cm in greatest dimension
         pN1biii: Extension of tumor beyond the capsule of a lymph node metastasis less than 2.0 cm in greatest dimension
         pN1biv: Metastasis to a lymph node 2.0 cm or more in greatest dimension
     pN2: Metastasis to ipsilateral axillary lymph node(s) fixed to each other or to other structures
    pN3: Metastasis to ipsilateral internal mammary lymph node(s)
     

     

    Distant metastasis (M):

    MX: Presence of distant metastasis cannot be assessed
    M0: No distant metastasis
    M1: Distant metastasis present (includes metastasis to ipsilateral supraclavicular lymph nodes)
     

    Now that we know what the T, N and M stand for we can take a look at how the stage of a cancer is determined.

    For that we need to look at the AJCC stage groupings. Just scroll back up to see what Tis and N0 and M0 mean.

     
    Stage 0
         Tis, N0, M0

    Stage I
         T1,* N0, M0

    Stage IIA
         T0, N1, M0 T1,* N1,** M0 T2, N0, M0

    Stage IIB
         T2, N1, M0
         T3, N0, M0

    Stage IIIA
         T0, N2, M0 T1,* N2, M0 T2, N2, M0 T3, N1, M0 T3, N2, M0

    Stage IIIB
         T4, Any N, M0
         Any T, N3, M0

    Stage IV
         Any T, Any N, M1

    *T1 includes T1mic
    **The prognosis of patients with pN1a disease is similar to that of patients with pN0 disease.

    Ok? So,
    Tis: Carcinoma in situ; intraductal carcinoma, lobular carcinoma in situ, or Paget's disease of the nipple with no associated tumor.
    N0: No regional lymph node metastasis
    M0: No distant metastasis
    is equal to a Stage 0 Breast cancer diagnosis. Stage 0 has an excellent prognosis.

    Now take a look at your Stage I diagnosis: Stage I=T1,* N0, M0
    T1: Tumor 2.0 cm or less in greatest dimension
    T1mic: Microinvasion 0.1 cm or less in greatest dimension
    T1a: Tumor more than 0.1 but not more than 0.5 cm in greatest dimension
    T1b: Tumor more than 0.5 cm but not more than 1.0 cm in greatest dimension
    T1c: Tumor more than 1.0 cm but not more than 2.0 cm in greatest dimension
    N0: No regional lymph node metastasis
    M0: No distant metastasis
    A small tumor with no lymph nodes involved and no metastasis - the chances are excellent that a lumpectomy will remove all of the cancer and although your doctor may recommend preventive radiation or chemotherapy, the odds are in your favor that you will be celebrating many anniversaries as a breast cancer survivor.
     

    References:

    1.Breast. In: American Joint Committee on Cancer: AJCC Cancer Staging Manual.
    Philadelphia, Pa: Lippincott-Raven Publishers, 5th ed., 1997, pp 171-180.

     

    also see -> Stage II Breast Cancer


    June 30, 2000

    Last updated March 31, 2006

    Elsewhere on the Web:

    Understanding Cancer Types and Staging
    Breast Cancer Stages
    Treatment by Breast Cancer Stage


     

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