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Once breast cancer has been diagnosed, certain tests will be performed to find out whether the cancer cells have spread within the breast or to other parts of the body.
Cancer can spread through the breast tissue, through the lymph system and also by getting into the blood stream and traveling to other parts of the body.
Tests used to determine how far the cancer has spread may include:
• A biopsy of the first lymph node to which the cancer is likely to spread (known as the sentinel lymph node),
• X-rays or CT scans
• A bone scan to measure rapidly dividing cells within the bone
• A PET (Positron Emission Tomography) scan to locate malignant tumour cells around the body.
The information gathered from the staging test/s will determine how far the cancer has spread, and the most effective treatment plan can be determined.
Stage 0 is known as ‘carcinoma in situ’ and there are three types of breast carcinoma in situ. The first type is ‘ductal carcinoma in situ’ (DCIS), a non-invasive type of breast cancer in which abnormal cells are found only in the lining of a breast duct and have not spread.
The second type is called ‘lobular carcinoma in situ’ (LCIS) where abnormal cells are found only in the lobules of the breast.
The third type of carcinoma in situ cancer is called ‘Paget disease of the nipple’ where abnormal cells are found in the nipple only.
If diagnosed with stage 1 breast cancer this will mean cancerous cells have formed a mass within the breast. Stage I is divided into two sub-stages: IA and IB.
In stage IA, the tumour is 2cm or smaller and the cancer has not spread outside the breast.
In stage IB, small clusters of breast cancer cells are found in the lymph nodes and there is either no tumour found in the breast - or the tumour within the breast is less than 2 cm in width.
• Stage 2A
In patients with stage 2A, either no tumour will be found in the breast or the tumour is smaller than 2cm. Additionally, the cancer will have been found in several axillary lymph nodes (a lymph node in the armpit region) or it has been found in the lymph nodes near the breastbone.
Stage 2A can also mean the tumour is between 2cm and 5cm in size, and it has not spread to the lymph nodes.
• Stage 2B
Stage 2B may mean the tumour is between 2cm and 5cm in size, with small clusters of breast cancer cells have been found in the lymph nodes. Additionally, Stage 2B could refer to a tumour that is between 2cm and 5cm and the cancer has reached up to three axilliary lymph nodes or the lymph nodes near the breastbone.
A patient who has been diagnosed with a breast tumour larger than 5cm, but the cancer has not spread to the lymph nodes, will also be at Stage 2B.
• Stage 3A
In this stage, the tumour found is larger than 5cm and cancer has spread into up to three axillary lymph nodes or lymph nodes near the breastbone. The breast cancer will also be deemed ‘Stage IIIA’ if the cancer has spread to four to nine axillary lymph nodes or is present in the lymph nodes near the breastbone. In this latter scenario, there may or may not be a tumour in the breast.
Finally this stage can also indicate that a tumour larger than 5cm has been found with only small clusters of breast cancer cells in the lymph nodes.
• Stage 3B
In stage 3B, the breast cancer tumour may be any size, with cancer cells found in the chest wall and/or nearby the skin of the breast, causing swelling or an ulcer. This may also be Inflammatory Breast Cancer.
At this stage, the cancer may have spread to up to nine axillary lymph nodes or the lymph nodes near the breast bone.
• Stage 3C
Breast cancer at Stage 3C may have spread to the skin of the breast and caused swelling or an ulcer and/or spread to the chest wall. There will not necessarily be a tumour mass within the breast.
Alternatively, the cancer may have spread to the axillary lymph nodes, the lymph nodes above or below the collarbone, or axillary lymph nodes and lymph nodes near the breastbone.