Breast cancer stages

Synonyms in a broader sense

TNM classification, carcinoma in situ, breast carcinoma, bone metastases, lung metastases, lymph node metastases, liver metastases

Introduction

A breast cancer disease can be at different stages of progress at the time of diagnosis, therefore the findings are divided into different tumor stages. This stage classification has been standardized for most types of cancer; this is called the TNM classification. The same factors are always considered: Numbers are assigned to each letter, e.g. for T the numbers 0 – 4 etc.

However, the criteria for when a finding is T1 or T2, for example, are different for different types of tumours. In addition, each of the capital letters can be preceded by a small p. The p stands for a histopathologically evaluated tumour, i.e. the pathologist evaluates the entire finding (after surgical removal) or a biopsy and classifies the tumour on the basis of this. There are also other letter additions. The table below makes the classification even more comprehensible:

  • T stands for the tumour size
  • N stands for Nodi (Latin=node) and indicates whether there are already daughter tumours in the lymph nodes,
  • M stands for metastasis – i.e. daughter tumour – and indicates whether the cancer has already spread to other organs, e.g. the liver.

TNM Classification

TX or pTX: The finding cannot be assessed, e.g. because of a poor x-ray T0 or pT0: There is no indication of a tumor Tis or PTis: It is a carcinoma in situ or Paget’s disease T1 or pT1: The tumor is smaller than 2 cma: Smaller than 0.5 cmb Between 0.5 cm – 1 cm in sizec: Between 1 cm – 2 cm T2 or pT2: The tumour is larger than 2 cm but not larger than 5 cm T3 or pT3: The tumour is larger than 5 cm T4 or pT4: The tumour is of any size and has spread into the surrounding tissue (not breast tissue) e.g. sternum, breast muscle, ribs etc. a: Grown into the breast wall: Grown into the skinc: Grown into the skin and breast wall: Breast cancer is accompanied by inflammation (exception M. Paget) For a better idea, the following size comparisons can be made: T1 = approximately the size of a coffee bean T2 = between the size of a grape and a peach stone T3 = between the size of a fig and an apricot

Lymph nodes

The subsequent assessment of the lymph nodes is based on imaging procedures and clinical examinations. NX: Lymph nodes cannot be assessed N0: No evidence of lymph node metastases N1: Metastases in axial lymph nodes that are displaceable against the surrounding tissue N2: Metastases in axial lymph nodes that are intertwined with each other or with other structures N3: Metastases in lymph nodes that lie along the internal mammary artery that supplies the breast with blood If a finding is removed surgically, the lymph nodes are often removed in the same operation, e.g. from the armpit. (See breast cancer surgery) It is generally required that in the case of axillary dissection (the technical term for the removal of lymph node tissue from the armpit) at least 10 lymph nodes are removed and sent for examination by the pathologist. The classification differs from the above-mentioned for pN1, here the pathologist can specify further gradations. pN1: Metastases in mobile lymph nodes from the armpit a: Only micrometastases smaller than 0.2 cm b: Metastases in lymph nodes at least one of which is larger than 0.2 mm