Various stages & sub-stages of breast cancer in details especially characterization by the T-N-M scale.

1. Cancer Research
STAGES OF
BREAST CANCER

2. STAGES OF
BREAST CANCER
Mr. Shaktiprasad Pradhan
M.Pharm, Ph.D*
Research Professional, UDPS
shakti.pharma16@gmail.com
Utkal University, Bhubaneswar
Odisha, India

3. .
INTRODUCTION
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4. Breast Cancer
Cancer is the most dreaded disease of the current time &
caused by abnormalities in the genetic material of the
cells due to the effects of carcinogens, such as tobacco
smoking & chewing, radiation, chemicals or infectious
agents etc.
Cancer is usually classified according to the tissue from
which the cancerous cells originate that is location as well
as the normal cell type they most resemble which is
histology.
Breast cancer is the cancer that starts in the cells of the
breast & the most common cause of cancer among
women worldwide, both in incidence and death.
(Cont.)
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5. Breast cancer causes change in the size or shape of the
breast, a lump or thickening in the breast or armpit,
discharge from the nipple, change in the colour or texture
of the skin of the breast or areola such as scaly, dimpled,
puckered or wrinkled.
Simple Breast Cancer
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6. .
Breast cancer is the second most common type of
cancer and the fifth most common cause of cancer
death globally apart from sexes.
In India Breast cancer, is the most extensive cancer
category contributing about 18% of all cancers & 27% of
all women malignancies worldwide according to the
World Health Organization (WHO).
Breast cancer is increasing particularly in developing
countries where the majority of cases are diagnosed in
late stages.
However, breast cancer is the most detectable & most
treatable kind of cancer among all human malignancies.
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7. .
IMPORTANCE OF
BREAST CANCER
STAGING
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8. Importance of Breast Cancer Staging
Breast cancer is classified according to various
characteristics like hormone sensitive nature, level of
HER2 proteins that play a role in breast cancer growth,
genetic makeup of the cancer cells etc.
But a stage will be assigned to a breast cancer patient
after the physical exam and the initial results from
mammogram or other diagnostic imaging test.
The stage may be adjusted, after lab reports from
the breast biopsy or surgery.
In determining the stage of breast cancer, the T-N-M
scale is taken in to account which is:
 T meaning tumor size.
 N relating to the involvement of nearby lymph nodes.
 M referring to metastasis. (Cont.)
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Tumors are measured in millimetres and centimetres
(10mm. equals to 1cm.).
In metastasis the cancer has spread beyond the breast to
other parts of body.
Determination of the different stages of breast cancer is
quite significant, as they provide vital informations like:
Whether the breast cancer is invasive or non-invasive
type?
How large the tumor is?
Whether the lymph nodes are involved or not?
Whether the breast cancer has spread to nearby tissue
or organs?
The stages help in a great extent to decide, how to move
forward with treatment & management including surgery,
chemotherapy, radio therapy etc. if needed.
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11. .
STAGES OF BREAST
CANCER
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12. Stages of Breast Cancer
There are five main stages of the breast cancer,
starting from zero and going up to four represented
by the Roman numerals I, II, III and IV also there
are several variables within some stages.
Breast Cancer Stage-0
 This is the very beginning stage of the breast cancer.
 This stage expresses non-invasive breast cancers or
pre-cancers & includes the most common form of non-
invasive cancer which is ductal carcinoma in situ
(DCIS).
 Within stage 0, the cancer cells or other abnormal
cells remain confined to the ducts in the breast &
there is no evidence that they have invaded
neighbouring normal tissue. 12

13. .
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14. .Breast Cancer Stage-I
 This is a very early stage of invasive breast cancer.
 The tumor cells have spread to the normal
surrounding breast tissue but are still contained in
a small area.
 The stage-I breast cancer is divided into two sub-
stages:
I. Sub-stage-IA: The primary tumor measures up
to 20mm or 2cm wide, roughly about the size of
a grape, but there’s no cancer in the lymph
nodes.
II. Sub-stage-IB: A small tumor which is smaller
than 20mm or 2cm & small clusters of cancer
cells are found in nearby lymph nodes. 14

15. .
Breast Cancer Stage-II
 Stage-II of the breast cancer illustrates the cancer in
a limited region of the breast but has grown larger.
 This stage reflects how many lymph nodes of the
breast may contain cancer cells & this is divided into
two sub-stages.
 Sub-stage -IIA is based on one of the following criteria:
A tumor is smaller than 20mm or 2cm along with
cancer that has spread to between one & three
nearby lymph nodes, or
A tumor is in between 20 to 50mm or 2 & 5cm, but
hasn’t spread to any lymph nodes.
 Sub-stage-IIB is based on one of the following criteria:
A tumor of 20 to 50mm or 2 to 5cm is present in the
breast, along with cancer that has spread to between
one and three nearby lymph nodes.
A tumor in the breast is larger than 50mm or 5cm,
but cancer has not spread to any lymph nodes. 15

16. .Breast Cancer Stage-III
 In stage-III of the breast cancer, the cancer has
spread further into the breast or the tumor is a
larger size than earlier stages.
 This stage is divided into three sub-stages.
 Sub-stage-IIIA is based on one of the following
criteria
• Without or with a tumor in the breast of any size,
cancer is also found in four to nine nearby lymph
nodes.
• A breast tumor is larger than 50mm or 5cm, and the
cancer has spread to between one and three nearby
lymph nodes or any breastbone nodes.
 Sub-stage-IIIB is characterized by a tumor has
spread to the chest wall behind the breast.
(Cont.) 16

17. . Additionally, these factors contribute to assigning this
stage.
• Cancer may also have spread to the skin of the breast,
causing swelling or inflammation.
• It may have broken through the skin, causing an
ulcerated area or wound.
• It may have spread to as many as nine underarm
(axillary) lymph nodes or to nodes near the breastbone.
 Sub-stage-IIIC is characterized by a tumor of any size
in the breast, or no tumor present at all.
 Cancer has spread to one of the following places
• Ten or more underarm (axillary) lymph nodes.
• Lymph nodes near the collarbone.
• Some underarm lymph nodes and lymph nodes near the
breastbone.
• The skin. 17

18. .Breast Cancer Stage-IV
 Stage-IV is the most advanced stage of breast
cancer which can have a tumor of any size.
 It has spread to nearby and distant lymph nodes as
well as distant organs and to distant parts of the
body beyond the breast involving the
lungs, liver, brain, bones etc.
 Breast cancer may be in the stage-IV, when it is
first diagnosed, or it can be a recurrence of a
previous breast cancer that has spread.
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REFERENCES
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22. References
 World Health Organization, International Agency for
Research on Cancer, 2020.
 American Cancer Society: Breast cancer overview. 2020.
 Pradhan, Tripathi, Pradhan, Nature an Immunobooster for
Breast Cancer, Book. Partridge India Publication, 2015.
 www.nationalbreastcancer.org/about-breast-cancer/
 www.cancer.net/cancer-types/breast-cancer/introduction.
 Pradhan D., et al., Inhibition of proteasome activity by the
dietary flavonoid Quercetin associated with growth
inhibition in cultured breast cancer cells and xenografts.
JYP.2015, 7(3): 225-233.
 Pradhan S., et al., Antiproliferation activity of Ocimum
gratissimum aqueous extract on human breast cancer
MCF-7 cell line. WJPR, 2018, 7(9): 421-428.
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23. .
Thank You
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