Determining breast-cancer stage
When receiving treatment
for breast cancer,
women will learn about
cancer staging. According
to the nonprofit organization
Breastcancer.org, determining
the stage of the cancer helps
patients and their doctors figure
out the prognosis, develop a
treatment plan, and even decide
if clinical trials are a valid option
.T
ypically expressed as a
number on a scale of 0 through
IV, breast-cancer stage is determined
after careful consideration
of a host of factors. The
staging system, sometimes referred
to as the TNM system,
is overseen by the American
Joint Committee on Cancer and
ensures that all instances
of breast cancer are described
in a uniform
way. This helps to
compare treatment results
and gives doctors
and patients a better
understanding of breast
cancer and the ways to
treat it.
Breastcancer.org
notes that the TNM system
was updated in 2018, but
before then was based on three
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clinical characteristics:
T: The size of the tumor and
whether or not it has grown into
nearby tissue.
N: Whether the cancer is
present in the lymph nodes.
M: Whether the cancer has
metastasized, or spread to others
parts of the body beyond the
breast.
Each of those factors is still
considered when determining
breast cancer stage, but starting
in 2018, the AJCC added
additional characteristics to its
staging guidelines, which make
staging more complex but also
more accurate:
Tumor grade
This is a measurement of
how much the cancer cells look
like normal cells.
Estrogen- and progesterone
receptor status
This indicates if the
cancer cells have receptors
for the hormones
estrogen and progesterone.
If cancer cells
are deemed estrogenreceptor
positive, then
they may receive signals from
estrogen that promote their
growth. Similarly, those deemed
progesterone-receptor-positive
may receive signals from progesterone
that could promote
their growth.
Testing for hormone receptors,
which roughly two out of
three breast cancers are positive
for, helps doctors determine
if the cancer will respond to hormonal
therapy or other treatments.
Hormone-receptor-positive
cancers may be treatable
with medications that reduce
hormone production or block
hormones from supporting the
growth and function of cancer
cells.
HER2 status
This helps doctors determine
if the cancer cells are
making too much of the HER2
protein. HER2 proteins are receptors
on breast cells made
by the HER2 gene. In about 25
percent of breast cancers, the
HER2 gene makes too many
copies of itself, and these extra
genes ultimately make breast
cells grow and divide in ways
that are uncontrollable. HER2-
positive breast cancers are
more likely to spread and return
than those that are HER2-
negative.
Oncotype DX score
The oncotype DX score helps
doctors determine a woman’s
risk of early stage, estrogenreceptor
positive breast cancer
recurring and how likely she
is to benefit from post-surgery
chemotherapy. In addition, the
score helps doctors figure out if
a woman is at risk of ductal carcinoma
in situ recurring or at
risk for a new invasive cancer
developing in the same breast.
The score also helps doctors
figure out if such women will
benefit from radiation therapy
or DCIS surgery.
Determining breast-cancer
stage is a complex process, but
one that can help doctors develop
the most effective course of
treatment. More information is
available at www.breastcancer.
org.
Determining the stage of the cancer helps patients and their doctors
fi gure out the prognosis, develop a treatment plan and even decide if
clinical trials are a valid option.
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