Staging

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A. The definition for staging and the classification of stages for breast cancer follow the system of the International Union Against Cancer. This system is based on the tumor, nodes, and metastases (TNM) nomenclature.

Definitions for Breast Cancer Staging

Tumor

TIS

Carcinoma in situ (intraductal carcinoma, Iobular)

T0

No evidence of primary tumor

T1

Tumor <2 cm in greatest dimension

T2

Tumor >2 cm but <5 cm in greatest dimension

T3

Tumor >5 cm in greatest dimension

T4

Tumor of any size with direct extension into chest wall or skin

Nodes

N0

No regional lymph node metastases

N1

Metastases to movable ipsilateral axillary node(s)

N2

Metastases to ipsilateral axillary lymph node(s), fixed to one another or other structures

Metastases

M0

No distant metastases

M I

Metastases to movable ipsilateral axillary node(s);

metastases to ipsilateral axillary lymph node(s); fixed to one another or other structures; or metastases to ipsilateral internal mammary lymph node(s);

distant metastases

Classification of Breast Cancer Staging

Stage

Description*

0

TIS, N0, M0

I

TI, N0, M0

IIA

T0, NI, M0

IIB

T2, NI, M0, or T3, N0, M0

IIIA

T0, N2, M0, or TI, N2, M0, or T2, N2, M0, or T3, NI, or N2, M0

IIIB

T4, any N, M0 or any T, N3

IV

Any T, any N, MI

*Tumor/nodes/metastases

B. The HER-2 gene (c-erbB-2, HER-2/neu) has been identified, and the HER-2 receptor is correlated with aggressive biological behavior of the cancer and a poor clinical outcome.

C. The staging of breast cancer dictates not only the prognosis but also directs treatment modality recommendations. The prognosis for women is based on their age, tumor type, initial tumor size, presence of nodes and staging, and hormone-receptor status. The overall 10-year survival rates for the more common breast cancer stages are greater than 90% for stage 0, greater than 75% for stage I, greater than 50% for stage IIA, and approximately 50% for stage IIB.

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