A breast cancer diagnosis is overwhelming enough on its own. But throw in the new terminology that family and patients must comprehend to process and understand the disease, and that overwhelming factor is ramped up tenfold.
One of the hardest to grasp concepts can be the “stages” of breast cancer. Doctors use stages to classify the progress of the cancer, as well as the origins and prognosis. From zero to four, each stage can be broken down into even more categories and types, depending on factors like size, the involvement of lymph nodes and whether the cancer has spread.
Here, Dr. Lise Alschuler, a naturopathic physician, author of “Five to Thrive: Your Cutting-Edge Cancer Prevention Plan” (Active Interest Media Inc. 2011) and breast cancer survivor herself, walks us through each stage.
Many people are unaware of the very first stage of breast cancer, stage 0. Considered a precancerous condition, “not all of it goes on to become cancer,” Alschuler says. While patients may still be offered treatment such as radiation or a lumpectomy, Alschuler calls this more of a “wait and watch” period, before an official diagnosis can be confirmed.
“The main difference between stage 0 and stage 1 is that (the cancer) is now invasive,” Alschuler says.
A stage 1 diagnosis means that a group of cells have been mutated enough that they are able to grow into a tumor. Stage 1 tumors are considered fairly small — less than 2 centimeters in the greatest diameter. At this point, they have not spread to the lymph nodes, or if they have, there are only microscopic cells that have moved.
There are two types of stage 2 breast cancer: type A and type B. In type A, the tumor is larger than type B, but there are no cancer cells in the nodes, or cells are in the nodes but on the same side as the tumor and in small numbers. In type B, the tumor is between 2 to 5 centimeters, but there is more lymph node involvement. There is also a rare type of B with a large tumor but no node involvement.
Stage 2 is still considered early stage breast cancer, according to Alschuler, meaning it’s a potentially curable disease. But it does still involve aggressive treatment, she says. When a sample is taken through a biopsy, the pathologist will give a grade to the tumor. “The higher the grade, the more aggressive,” Alschuler says.
Not everyone with the same stage is treated the same. At stage 2, the treatments differ; a patient may undergo chemotherapy, or a mastectomy, or maybe just radiation. “The intent of the treatment in these stages is to cure because it hasn’t spread yet,” Alschuler says.
A stage 3 diagnosis indicates a 5-centimeter or larger tumor. The tumor is on the same side as the lymph nodes where it has spread, usually in the armpit area. There are more nodes involved, typically more than three, usually four to nine. Sometimes in stage 3, the tumor has grown deeper into the chest wall or up into the skin, affecting different types of tissue. At this stage, a different type of breast cancer may be on display: inflammatory. “Inflammatory breast cancer is a different type
of cancer cell,” Alschuler says. “It tends to be more aggressive, and more resistant to treatment. There are not as many effective treatments available for this type.”
The cancer is still treatable at stage 3, but it generally has a greater degree of risk for reoccurrence. It’s more aggressive than the other stages, with systemic treatment. Alschuler says it’s very rare that doctors wouldn’t recommend chemo at this point.
Stage 4, the final stage of diagnosis, is the most serious and the most progressed. Any size of tumor or lymph node involvement can appear at this stage, but the main indicator of stage four is that the cancer has spread, typically to the bone or liver.
Alschuler says to expect very aggressive treatment at this point. “The treatment is typically sequential at this stage,” she explains. “You’ll go through an initial round of treatment, get a break, then go back into it. It’s about managing the growth so people can live with the disease as long as possible.”
While this may be the final stage of diagnosis, Alschuler points out that, rare as it may be, a full recovery is still possible.