Breast cancer is staged from 0 to 4, based on various factors including the size of the tumor, the involvement of axillary lymph nodes, the involvement of the breast skin, and the presence of distant organ spread (metastasis). The staging of breast cancer is considered both clinically and pathologically. All treatment approaches are determined based on the results of this staging.
Early-stage breast cancer refers to stage 1, stage 2A, and stage 2B breast cancers. This means that in early-stage breast cancer, the tumor is smaller than 2 cm and has not spread to the axillary lymph nodes (stage 1). It can also include tumors smaller than 2 cm with involvement of three or fewer lymph nodes under the arm, or tumors between 2-5 cm in size without lymph node metastasis (stage 2A). Furthermore, it encompasses tumors larger than 2 cm but smaller than 5 cm with involvement of 1-3 lymph nodes, or tumors larger than 5 cm with no axillary lymph node involvement (stage 2B).
In summary, early-stage breast cancer is defined as a tumor that is small or, if larger, has limited involvement of axillary lymph nodes, which are lymph nodes located under the arm.
Breast cancer stages are as follows:
In this stage, the cancer is confined to the ducts or lobules and has not spread beyond these areas. It is also referred to as in situ carcinoma.
Stage 1 breast cancer typically involves tumors that are less than 2 cm in size, with no spread to axillary lymph nodes. If there is limited lymph node involvement (referred to as microinvasion),it is still classified as stage 1.
Stage 2 breast cancer involves tumors that are between 2 to 5 cm in size, and there may or may not be lymph node involvement in the axillary region.
In stage 3 breast cancer, the tumor is larger, typically exceeding 5 cm, and lymph node involvement is present in the axillary region.
Stage 4 breast cancer is characterized by the presence of metastasis to distant organs, such as the bones, liver, lungs, etc., irrespective of the size of the primary tumor in the breast.
These stages are used to classify and determine the extent and severity of breast cancer, which plays a critical role in treatment planning and prognosis.
Breast cancer treatment varies depending on the stage of the disease. Staging can be done through clinical staging, pathological staging, and post-treatment staging if preoperative therapy has been administered. However, clinical staging is crucial for primary treatment selection.
Depending on the stage of breast cancer, various surgical methods can be applied to the patient. These may include breast-conserving surgery, simple mastectomy, modified radical mastectomy (which involves the removal of the breast and clearance of the axillary lymph nodes),subcutaneous mastectomy (preserving the breast skin),and breast prosthesis applications.
Taking into consideration the extent of axillary lymph node involvement and the stage of the tumor, additional treatment methods such as radiotherapy, chemotherapy, and hormone therapy can be added to breast cancer treatment.
In stage 1 breast cancer, where the tumor size is typically 2 cm or smaller, the treatment approach is determined based on whether breast-conserving surgery is suitable for the patient. Simultaneously, sampling of the axillary lymph nodes (sentinel lymph node biopsy) is performed to decide whether it should be included in the treatment plan. Subsequently, radiotherapy is administered. Depending on the specific case, additional treatment methods such as chemotherapy or hormone therapy may be added. Patients in this stage generally have a better overall survival compared to more advanced stages. It is common to perform breast-conserving surgery in this stage, followed by the necessity of radiotherapy.
In stage 2 breast cancer, the tumor in the breast typically falls within the range of 2 to 5 cm, and there may or may not be involvement of axillary lymph nodes. This stage is categorized as stage 2 breast cancer. The treatments for stage 2 breast cancer can be similar to those used for stage 1 breast cancer. However, if the tumor is large and has spread to the lymph nodes, additional complementary treatment methods like chemotherapy, radiotherapy, and hormone therapy are often added to the treatment plan.
In stage 3 breast cancer, the tumor in the breast has typically grown beyond 5 cm or may be smaller in size, but there can be adhesions with surrounding tissues and axillary lymph nodes. Additionally, in this stage, the tumor can vary in size and extend to the breast skin, chest wall, surrounding muscles, breast parenchyma, and axillary lymph nodes. Treatment for patients in this stage is determined based on the size and spread of the tumor.
Depending on the extent of the tumor and its spread, treatments such as modified radical mastectomy, chemotherapy, and hormone therapy can be considered. If the tumor is larger, with extensive involvement of surrounding structures and lymph nodes, neoadjuvant chemotherapy, also known as preoperative chemotherapy, may be administered to shrink the tumor before planning surgical procedures such as mastectomy or lumpectomy.
In stage 4 breast cancer, the presence of metastasis to distant organs (such as bones, liver, lungs, etc.) is observed, regardless of the size of the primary tumor in the breast. The goal of treatment for stage 4 breast cancer is to improve the patient's overall survival and quality of life.
Depending on the patient's general condition and symptoms, treatment methods such as mastectomy, chemotherapy, and hormone therapy may be administered. The treatment plan is tailored to the individual patient's specific needs and health status.
Mastectomy (breast cancer surgery) can be performed at any stage of breast cancer, depending on the specific characteristics and requirements of the patient. In stage 4 breast cancer, where there is distant organ spread, mastectomy may be carried out as a part of treatment to reduce tumor burden or address necrosis and wound-related issues resulting from the tumor in the breast. In such cases, a surgical method called "salvage mastectomy" or "toilet mastectomy" may be applied to manage the condition.
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Prof. Dr. Sezai AydınGeneral Surgery Turkey
PROF. DR. SEZAI AYDIN
