It is ESSENTIAL to know the stage of your breast cancer because it helps your doctors to evaluate and plan your treatment.

How Breast Cancer is Staged & Graded by your Doctor(s)

Staging depends on where the cancer starts and how much of the cancer has spread out of the breast to the rest of the body. The most commonly used staging system is based on the American Joint Committee on Cancer (AJCC) TNM system for both clinical (cTNM) and pathological (pTNM) findings.

• The clinical staging is done before the surgery using results based on the clinical assessment, imaging tests (such as mammogram, ultrasound, CT, MRI or PET scans) and a breast biopsy.
• The pathological staging is done after the surgery and is based on the results of the cell type, cancer grade, number of lymph node involvement and immunohistochemistry analysis

These are some important information used to describe your cancer;

• Size of tumour (T)
• Spread of lymph nodes (N)
• Spread to other part of the body (M)
• Progesterone Receptor (PR) status
• Estrogen Receptor (ER) status (ER+ suggests it may respond to hormone therapy)
• HER-2 status (excess HER-2 protein suggests a more aggressive cancer)
• Cancer grade (higher grades suggest a more aggressive cancer)

Summary of the Number Staging System

• Stage 0. The cancer is NOT invasive and has NOT spread beyond the ducts or lobules.  These will include DCIS and LCIS breast cancer
• Stage 1. The cancer cells have invaded into the breast tissue 
• Stage 2A. The breast cancer is smaller than 2 cm but has spread to 1-3 lymph nodes or the breast cancer is between 2 to 5 cm but has NOT spread to any lymph nodes
• Stage 2B. The breast cancer is between 2 to 5 cm but has spread to 1-3 lymph nodes or the breast cancer is larger than 5 cm but has NOT spread to any lymph nodes
• Stage 3. The breast cancer has spread to lymph nodes, skin or chest wall (this is known as locally advanced disease)
• Stage 4. The breast cancer has spread beyond to other organs such as the lung, liver, brain or bone

Summary of the TNM Staging System

• T: T1-T4, depending on the size and/or extent of the primary tumour
• N: N1-3 depending whether the cancer has not spread to the lymph nodes
• M: M0-1 depending on whether the cancer has spread to rest of the body

Stage	Subset	Findings
T	T0	NO evidence of tumour
	T1	Size is less than 2 cm
	T2	Size is 2 to less than 5 cm
	T3	Size is 5 cm or larger
	T4	Cancer involve skin or chest wall
N	N0	Has NOT spread to lymph nodes
	N1	Spread to 1-3 lymph nodes
	N2	Spread to 4-9 lymph nodes
	N3	Spread to 10 or more lymph nodes
M	M0	NO distant spread
	M1	Spread to distant organs

Why is Cancer Staging IMPORTANT for you?

Cancer staging gives information on how much cancer and type of cancer cells is in your body, where the cancer is located and where the cancer has spread to (or if there is any spread at all). All this information will allow the Cancer Surgeon and Cancer Specialist to discuss the treatment plan & options with you to achieve the best outcome for you.

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