Clinical oncologist Dr. Choy discusses the four stages of breast cancer and answers common questions pertaining to breast cancer stages and breast cancer surgeries.Read more
Breast cancer is the second leading cause of cancer death in women after lung cancer. Breast cancer can occur in both men and women, but it’s far more common in women. Breast cancer is a common cancer in Hong Kong and around the world. In 2016, there were more than 4,100 cases diagnosed in Hong Kong, and the incidence rate is on the rise. Female breast cancer cases diagnosed in Hong Kong has increased by 3.5 times from 1,152 in 1993 to 4,123 in 2016. There are about 11 women diagnosed with breast cancer every day.
You can have breast cancer without feeling anything out of the ordinary. However, please consult a doctor if you have developed above symptoms that last for more than a few days.
It is called pre-cancer, this is the earliest stage of breast cancer. It involves abnormal cells that have not spread into breast tissue from the ducts or lobules where they began. Stage 0 breast cancer also has not spread to lymph nodes or other parts of the body. Stage 0 breast cancer is non-invasive, like ductal carcinoma in situ (DCIS).
It is an invasive cancer, meaning it is invading healthy breast tissue, but it has not spread outside the breast. This stage also has two categories, 1A and 1B, based on whether there is any evidence of small clusters of breast cancer cells in nearby lymph nodes.
Surgery is the main treatment for stage I breast cancer. These cancers can be treated with either breast-conserving surgery (BCS; sometimes called lumpectomy or partial mastectomy) or mastectomy. The nearby lymph nodes will also need to be checked, either with a sentinel lymph node biopsy (SLNB) or an axillary lymph node dissection (ALND).
In some cases, breast reconstruction can be done at the same time as the surgery to remove the cancer. But if you will need radiation therapy after surgery, it is better to wait to get reconstruction until after the radiation is complete.
Radiation therapy is usually given after surgery to lower the chance of the cancer coming back in the breast and to also help people live longer.
Chemotherapy: If the tumor is larger than 1 cm (about 1/2 inch) across, adjuvant chemotherapy (chemo) is sometimes recommended. For women who have a hormone receptor-positive (ER-positive or PR-positive) breast cancer, most doctors will recommend hormone therapy (tamoxifen or an aromatase inhibitor, or one followed by the other) as an adjuvant (additional) treatment, no matter how small the tumor is.
Breast cancer is growing but is only in the breast or nearby lymph nodes. This stage has two categories, 2A and 2B, based on how large the tumor is and whether or not it has spread to nearby lymph nodes.
Stage II cancers are treated with either breast-conserving surgery (BCS; sometimes called lumpectomy or partial mastectomy) or mastectomy. The nearby lymph nodes will also need to be checked, either with a sentinel lymph node biopsy (SLNB) or an axillary lymph node dissection (ALND).
Women who have BCS are treated with radiation therapy after surgery. Women who have a mastectomy are typically treated with radiation if the cancer is found in the lymph nodes. Some patients who have a SLNB that shows cancer in a few lymph nodes may not have the rest of their lymph nodes removed (ALND) to check for more cancer. In these patients, radiation may be discussed as a treatment option after mastectomy.
Systemic therapy is recommended for women with stage II breast cancer. Some systemic therapies are given before surgery (neoadjuvant therapy), and others are given after surgery (adjuvant therapy).
Breast cancer is an advanced cancer. It’s in the lymph nodes but has not spread to other organs. This stage is divided into three categories, 3A, 3B and 3C, based on the size of the tumor and how many and which lymph nodes are involved.
Stage III cancers is treatment with surgery first. Because these tumors are fairly large and/or have grown into nearby tissues, this usually means getting a mastectomy. For women with fairly large breasts, BCS may be an option if the cancer hasn’t grown into nearby tissues. SLNB may be an option for some patients, but most will need an ALND. Surgery is usually followed by adjuvant chemotherapy, and/or hormone therapy, and/or trastuzumab. Radiation is recommended after surgery.
Breast cancer has traveled to distant sites in the body, often the bones, liver, brain, or lungs. This is called metastatic breast cancer. Although this stage is considered incurable, new treatments allow patients to live longer with their disease.
Stage IV cancers have spread beyond the breast and nearby lymph nodes to other parts of the body. When breast cancer spreads, it most commonly goes to the bones, liver, and lungs. It may also spread to the brain or other organs. Treatment may include hormone therapy, chemotherapy, targeted therapy, or some combination of these. Local treatments such as surgery or radiation might also be used to help prevent or treat symptoms.
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