Staging, grading & treatment

How advanced and aggressive is your tumour?

In addition to figuring out what kind of tumour you have (carcinoma in situ or invasive), your cancer team can learn a lot about the stage of advancement your tumour has reached and can also predict, by way of grading, its possible future behaviour.

With this information, your doctors can create a treatment plan specifically for you and give you an indication of the outcome.

How doctors determine stage

Stage depends on:

  • the size of the Tumour in the breast,
  • whether the cancer is found in the axillary (underarm) lymph Nodes, and
  • whether the cancer is found in other organs – Metastasis

The TNM (Tumour, Nodes, Metastasis) system of staging assesses the size of a tumour, the number of lymph nodes affected, whether the cancer has spread and, if so, how far.

Cancers can also be measured on a scale of 0 to 4. A high number indicates that the tumour is large and has spread beyond the breast and lymph nodes, leading to secondary breast cancer.

How doctors determine grade

Aggressiveness is the term used to express how quickly an invasive cancer is likely to develop. The appearance of the cells under a microscope allows doctors to grade aggressiveness on a scale of 1 to 3. The higher the grade, the greater the chance of the cancer cells growing and spreading quickly.

Cancer spread can also be defined as node positive or node negative. Node positive means that cancer cells have reached the armpit lymph nodes; node negative means they haven’t and that the cancer is less likely to recur once treated.

Assessment of the lymph nodes in the armpit is crucial to staging and helping to predict the outcome of breast cancer.

Treatment

Make an informed decision.  How breast cancer is treated depends on the type of cancer you have and other variables specific to you.

Your doctor will discuss with you your treatment options and their various side effects. Understand them and make informed choices by asking questions, voicing your concerns and weighing the benefits against the risks.

Be sure to involve your key support people in the discussion. They often see and hear things you don’t.

Playing an active role in your breast cancer care and including your inner circle of support can be your greatest source of empowerment throughout your treatment.

Your treatment options

There are two main types of treatment:

  • Local (surgery and radiation)
  • Systemic (chemotherapy, hormone therapy and targeted therapy)

Local
Surgery and radiation therapy are local treatments because they treat a small area of the body.

  • Surgery to remove the cancerous tissue is the most common form of treatment. There are two types of surgery: lumpectomy and mastectomy. Often surgery is used along with chemotherapy, radiation therapy, hormone therapy or targeted therapy.
    • Lumpectomy involves the surgical removal of the cancerous tumour in the breast and some surrounding normal tissue. Usually underarm lymph nodes or a sample of nodes are also removed. Radiation is almost always used to decrease the chance of recurrence.
    • Mastectomy involves surgical removal of the entire breast containing the breast cancer. Underarm lymph nodes or a sample of nodes are also removed. Studies have shown that lumpectomy and mastectomy are equal in effectiveness. Radiation may not be required.
  • Radiation Therapy uses high-energy X-rays to destroy any cancer cells that may remain in the breast after surgery. This reduces the chance of recurrence.

Systemic
Chemotherapy, hormone therapy and targeted therapy are systemic because they target your whole body. They are used to get rid of or disable cancer cells that may have spread from the breast to other areas of the body.

  • Chemotherapy uses drugs to stop the growth and spread of cancer cells throughout your body. Its aim is to lower the risk of secondary cancer. It can be given before or after surgery.
  • Hormone Therapy uses drugs to block the production of estrogen and other female hormones that promote the growth of certain kinds of cancer cells after surgery. It may also involve taking a drug, such as tamoxifen, over the course of a few months or years.
  • Tamoxifen is commonly used to treat hormone-sensitive breast cancer in its early stages. Side effects can include weight gain and menopausal symptoms like hot flashes.
  • Targeted Therapy is a new treatment approach that targets the genes and proteins in the cancer cells in an effort to stop their growth and spread. When certain cells are blocked, the cancer cannot grow. As of now, Herceptin (trastuzumab) is the only widely available form of targeted treatment for early breast cancer. It is most commonly used in women with HER2+ breast cancer.
Breast cancer now what?

Breast cancer now what? the website where you will find information, online support and resources for young women with breast cancer.