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Breast Evaluation and Treatment Program

Breast Cancer

Stages and Treatment Options

If a woman is diagnosed with breast cancer, her doctor will do more tests to find out if the cancer has spread from the breast to other parts of the body.

This process is called staging.

To plan treatment, the doctor needs to know the stage of the disease. The following stages are used to describe breast cancer:

Carcinoma in Situ: About 15 to 20 percent of breast cancers are very early cancers. The term carcinoma in situ refers to the fact that the cancer is still in the site where it started.

There are two types of breast cancer in situ:

Ductal carcinoma in situ: Ductal carcinoma in situ is also known as intraductal carcinoma. Treatment may be one of the following:

• Breast-conserving surgery with radiation therapy
• Surgery to remove the whole breast (total mastectomy)

Lobular carcinoma in situ: Lobular carcinoma in situ is not actually a cancer, but rather an overgrowth of abnormal cells that is viewed as a sign that a woman is at increased risk of developing cancer. Nevertheless, for the purpose of classification, the disease is often called breast cancer in situ, carcinoma in situ, or Stage 0 breast cancer. Sometimes lobular carcinoma in situ is found when a biopsy is done for another lump or abnormality found on the mammogram. Patients with this condition have a 25 percent chance of developing breast cancer in either breast in the next 25 years.

The need for treatment and treatment options for lobular carcinoma in situ are varied and quite controversial. They include the following:

• Tamoxifen therapy to reduce the risk of the cancer developing.
• Biopsy to diagnose the lobular carcinoma in situ followed by regular examinations and yearly mammograms to find any changes as early as possible.
• A large clinical trial (such as the STAR trial) comparing Tamoxifen and Raloxifene therapies to prevent cancer development and address some of the side effects of treatment.
• If a patient has a strong family history of breast cancer, bilateral mastectomy may be recommended.

In addition to surgery, patients may be treated with accompanying (adjuvant) therapies such as the following:

• Chemotherapy
• Tamoxifen therapy
• A clinical trial of adjuvant chemotherapy in certain patients
• A clinical trial of no adjuvant therapy for patients with a good chance of recovery
• A clinical trial of treatment to keep the ovaries from working

Treatment for Stage II cancers is usually one of the following:

• Breast-conserving surgery to remove only the cancer and some surrounding breast tissue (lumpectomy) or to remove part of the breast (partial or segmental mastectomy). The surgery is followed by radiation therapy. Some of the lymph nodes under the arm are also removed. This treatment has the same long-term cure rates that mastectomy has. A doctor's recommendation about which procedure to have is based on the tumor's size and location and its appearance on a mammogram.

• Surgery to remove the whole breast (total mastectomy) or the whole breast and the lining over the chest muscles (modified radical mastectomy). Some of the lymph nodes under the arm are also taken out.

Stage IIIA: Stage IIIA cancers include cancers with the following characteristics:

• The cancer is smaller than 5 centimeters across and has spread to the lymph nodes under the arm. The lymph nodes are attached to each other or to other structures.

• The cancer is larger than 5 centimeters and has not spread to the lymph nodes under the arm.

Treatment for Stage IIIA cancers may be one of the following:

• Chemotherapy given prior to surgery, followed by adjuvant chemotherapy and radiation therapy, with or without hormone therapy. This is the preferred treatment approach.

• Surgery to remove the whole breast, the lining over the chest muscles, and many of the lymph nodes (modified radical mastectomy) or the whole breast, the chest muscles, and all of the lymph nodes (radical mastectomy) after chemotherapy.

• Radiation therapy given after surgery after chemotherapy.

• A clinical trial testing new chemotherapy with or without hormonal drugs, or a clinical trial testing chemotherapy before surgery (neoadjuvant therapy).

• A clinical trial of high-dose chemotherapy with bone marrow or peripheral stem cell transplantation.

Stage IIIB: Stage IIIB cancers include cancers with the following characteristics:

• The cancer has spread to tissues near the breast (skin or chest wall, including the ribs and the muscles in the chest).
• The cancer has spread to lymph nodes inside the chest wall along the breast bone.

Treatment at Stage IIIB will probably include a biopsy and one of the following:

• Chemotherapy followed by surgery and radiation therapy, with or without hormones to shrink the tumor
• Tamoxifen therapy followed by additional therapy
• A clinical trial testing new chemotherapy drugs and biological therapy, new drug combinations, and new ways of giving chemotherapy
• A clinical trial of high-dose chemotherapy with bone marrow or peripheral stem cell transplantation

Stage IV: Stage IV breast cancers have spread to other organs of the body, most often the bones, lungs, liver, or brain. Sometimes the tumor has spread locally to the skin and lymph nodes inside the neck, near the collarbone.

Treatment at this stage will probably include a biopsy and one of the following:

• Combination chemotherapy
• Radiation therapy or, in some cases, a mastectomy to reduce the symptoms
• Tamoxifen therapy or other antiestrogens
• A clinical trial testing new chemotherapy and hormonal drugs and new combinations of drugs and biological therapy
• A clinical trial of high-dose chemotherapy with bone marrow or peripheral stem cell transplantation

Inflammatory Breast Cancer is a rare form of breast cancer that is classified by itself. The breast looks as if it is inflamed because of its red appearance and warmth. The skin may show signs of ridges and wheals or it may have a pitted appearance. Inflammatory breast cancer tends to spread quickly. Treatment usually combines chemotherapy, hormonal therapy, radiation therapy, and sometimes surgery. The treatment approach is usually similar to treatment for Stage IIIB or IV breast cancer.

Recurrent cancer is cancer that has come back (recurred) after it has been treated. It may come back in the breast, in the soft tissues of the chest (the chest wall), or in another part of the body. The choice of treatment depends on hormone receptor levels, the kind of treatment the patient had before, the length of time from first treatment to when the cancer came back, where the cancer recurred, whether the patient still has menstrual periods, and other factors.

Treatment may be one of the following:

• Tamoxifen therapy
• Surgery and/or radiation therapy (for the small group of patients whose cancer has come back only in one place)
• Other types of hormone therapy
• Combination chemotherapy
• Re-treatment with previously used therapies
• A clinical trial of newly developed chemotherapy or biologic therapy

This page was last updated on: March 3, 2008.

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