Understanding the Stages of Breast Cancer and Their Impact on Treatment

The stages of breast cancer

The staging of breast cancer is mainly based on the size and location of the primary tumor. Whether the cancer spreads near the lymph nodes or other parts of the body, its tumor grade, which describes how abnormal the tumor cells are, and whether certain biomarkers are present. 

Stage 0

Stage 0 breast cancer is also known as a non-invasive stage, which means that cancer cells are present, but they have not spread to blood vessels, tissues, or surrounding healthy cells. According to many oncologists, this stage is very difficult to detect due to its lack of visible symptoms. 

The stage 0 is also called Carcinoma in situ, there are two types of carcinoma in situ’s are there:

1. Ductal Carcinoma In Situ (DCIS): This is a type of stage 0 cancer, where the cancer cells are found in the linings of the breast ducts, but these won’t spread outside the ducts. 
2. Lobular Carcinoma In Situ (LCIS): This is an unusual type of condition where the abnormal cells develop inside the lobules in the breast. A breast lobule is the milk gland; that’s where the milk is produced.

Treatment for stage 0

The need of getting treatment for stage 0 cancer won’t be the same for everyone, sometimes it depends upon the individual medical conditions.  

• If your breast cancer specialist recommends you treatments such as hormone therapy and surgery. Consider undergoing breast cancer surgeries and treatments to avoid any future medical issues.
• If the cells remain only in one area, the surgeons might perform a short procedure called a lumpectomy. This procedure is performed to remove cells from the breast.
• When the cancer cells appear throughout the breast, an oncologist might recommend a mastectomy. This procedure involves removing the entire breast. 
• A patient might choose to undergo breast reconstruction during the mastectomy or in a second surgery generally 6 to 12 months later.

Stage I 

In the stage I breast cancer the abnormal cancer cells might have started to spread to the lymph nodes. The stage I cancer is comparatively small, sometimes it may not have spread to the lymph nodes, or only a tiny part of cancer may have spread to a lymph node. 

Here are the symptoms of stage I cancer, such as:

Stage I symptoms

Stage I cancer is an early stage of cancer, and the symptoms may or may not appear in patients. 

Some common symptoms of Stage I cancer are:

A lump in the breast 

• Blood discharge or abnormal clear fluid discharge from the nipple 
• Changes in the breast size, shape or breast 
• A change in the skin texture or color of the breast

Treatment for Stage 1 

The Stage I breast cancer treatment might come with a variety of treatment options, mainly depending upon the patient’s medical conditions. However, a cancer specialist might perform a lumpectomy or mastectomy as a primary treatment plan for Stage I cancer.

The oncologist often recommends surgery for Stage I cancer depending upon these factors:

• The location of the primary cancer
• Breast size
• Family history of breast cancer
• Patient’s preference for the treatment

The doctor might also recommend radiation therapy, hormone therapy and chemotherapy, that mainly depends upon the patient's conditions. 

Stage II 

Stage II is a more advanced stage of breast cancer; in this stage, the cancerous cells have formed a tumor or tumors in the breast. In the second stage, the size of the tumor can be measured. The tumor size is either less than 2 centimeters, or it might have spread to the underarm’s lymph nodes. Sometimes the tumor is larger than 5 centimeters, but there are times it won’t spread across underarm lymph nodes. 

At Stage II, tumors can measure anywhere from 2 to 5 cm across, and they may or may not affect the nearby lymph nodes.

Symptoms of Stage II

Stage II cancer may or may not cause any specific symptoms. If any patient might see symptoms, these may include:

• A lump in the breast or armpit
• Change in the size and shape of the breast
• A change in the texture of the nipple
• Blood or white fluid discharge from the nipple
• Dimpling or puckering of the skin on the breast
• Inverted nipple or inward nipple (A change in color, swelling, or enlarged pores on nipples)

Treatment for Stage II 

The common type of treatment for Stage II cancer is performing a lumpectomy or mastectomy. Your cancer specialist might also recommend removing one or more lymph nodes. 

The doctor might also recommend a combination of treatment such as radiation therapy, chemotherapy, and hormone therapy, if the cancer is hormone receptive. 

In some specific cases, doctors perform neoadjuvant therapy, which is chemotherapy before surgery to reduce the size of a tumor.

Stage III 

The tumor in Stage III cancer is usually considered advanced breast cancer. The Stage III cancer is in nearby tissue and lymph nodes. This might have spread into nearby tissues like the skin over the breast or the muscle underneath.

Symptoms of Stage III 

The symptoms of Stage III cancer may include the same as stage 2 cancer, such as a new lump or changes in the color, shape, and size of the nipples or breast size, breast shape, or its skin texture.

The symptoms of Stage III cancer may include:

• Breast pain 
• Itchiness
• Irritation
• An open sore or ulcer in the breast

Treatment for Stage III 

The treatment for Stage III cancer mainly depends upon the type of cancer and other factors. 

The treatment options for Stage III cancer may include the following:

• Chemotherapy
• Surgery
• Radiation therapy (depends upon the cases)
• Targeted therapy
• Hormone therapy
• Neoadjuvant chemotherapy before surgery (this helps to shrink)

Stage IV 

Stage IV breast cancer is also known as metastatic breast cancer. In this stage, the cancer has spread to nearby lymph nodes, distant lymph nodes, and other organs such as bones, liver, lungs, or brain. This is the most advanced stage of breast cancer. 

This might also refer to previously treated cancer that recurs in the breast and affects other parts of the body. The cancer that has returned in other parts of the body is often called recurrent metastatic breast cancer.

Symptoms of stage IV 

The stage IV cancer can cause symptoms in other parts of the body, mainly depending on where the cancer has spread to.

 The symptoms can appear in body parts such as:

• Bones: The cancer has spread to the bones, might cause bone pain, joint swelling, feels weakness or fragile bones, and might experience weakness in the arms and legs. 
• Lungs: The cancer in the breasts might spread into the lungs, which can cause complications such as chronic coughing, chest pain, and shortness of breath.
• Liver: The cancer that spreads to the liver often causes issues such as jaundice. It can also cause itchiness in the skin, abdominal pain, nausea, and vomiting. 
• Brain: When cancer also spreads to the brain which causes symptoms such as memory loss, neurological issues such as behavioral changes. This also causes severe headaches and seizures.  

Treatment for Stage IV

The treatment for Stage IV cancer may include various treatments, mainly depending upon the patient’s medical conditions and preferences. The treatments can be performed alone or combined with other treatments.

These may include:

• Chemotherapy
• Hormone therapy
• Targeted therapy (these treatments are often used to target proteins that allow cancer to grow)
• Immunotherapy (This treatment is used to boost the immune system that helps to boost the body’s ability to fight cancer.)

In some rare cases of Stage IV cancer, the surgeon might remove tumors. However, this is not the primary option usually, but a surgeon may recommend surgery to relieve the pain. This might help with other issues which develop in this stage, such as: 

• Spinal cord compression
• Removes single masses caused by metastasis cancer
• Fix the broken bones 

There are some specific medications that are also used to treat Stage IV cancer. Most of them depend upon the individual's medical conditions and their discomfort.

Prognosis and survival rates of breast cancer

The prognosis of breast cancer is the best outcome or estimate of how your cancer will affect you and how your body might respond to the treatment. The survival rate of breast cancer is the percentage of patients with this cancer who are alive after their cancer diagnosis. Prognosis and survival rates depend on many factors.

The survival rates are often influenced by various factors such as invasive or non-invasive cancer, the cancer type, and the stage of cancer. According to NIC, approximately 91% of women with cancer in their breasts are alive five years after the diagnosis.

Impact of staging on Treatment and prognosis

Early detection of cancer, such as stage 0-I, might lead to higher survival rates and less aggressive treatments to cure cancer. Meanwhile, intermediate stages such as stage II to III often require a combination of treatments for better outcomes. 

However, the advanced stages of cancer, such as stage IV, focus more on extending life expectancy and cancer symptom management rather than curative approaches.