Clinical Staging

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Stage (anatomic extent of disease) is defined on the basis of the primary tumor size (Ti-4), presence and extent of lymph node involvement (Ni-3 or pNi-3 if pathologic examination of lymph nodes is conducted), and presence or absence of distant metastases (M0-1) (Table 89-3). For a more complete description of the staging system,

the reader is referred to the guidelines. Although many possible combinations of T and N are possible within a given stage, simplistically, stage 0 represents carcinoma in situ (Tis) or disease that has not invaded the basement membrane. Stage I represents small primary tumor without lymph node involvement, and the majority of stage II disease involves regional lymph nodes. Stages I and II are often referred to as early breast cancer. It is in these early stages that the disease is curable. Stage III, also referred to as locally advanced disease, usually represents a large tumor with extensive nodal involvement in which either node or tumor is fixed to the chest wall. Stage IV disease is characterized by the presence of metastases to organs distant from the primary tumor and is often referred to as advanced or metastatic disease, as described earlier. Most cancer today presents in early stages, where the prognosis is favorable (Table 89-4).

Table 89-2 Guidelines for Early Detection of Breast Cancer

flinoriLin Canter iocieiy "

U.S. ^menllvc jeivkei task Farce'1

National ¿inter Institute14

ffif

Aqe Xhye«s and ofciei: Flkk/benefil

All «5«: i

MR

dfcv&QO

CBE

Afje XMo V>. Ewry 1 yean

All «3«: 1 irPiomnvYYJrd -A-lthi

All ages: Fvciy yiiar

Aye 40 years and okk-i. Era y

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y.birlrrn 1171.11:>

A^y* 40 yi\sr\ ,iiul oldii IniCfvfll iKfl

A: h11 |-i ■. MH T llk3n r'tpLi il El: 40

Ai]c id i^i 1 -2 UMii

designated

Lucry 1-2 yeas li or without t tit i

Age iii ami olden

Every f-i yean

Table 89-3 TNM Stage Grouping for Breast Cancer

BSE, brrat vli enamfiaLion, fBE, clinical breas.1 examination Nfl. not recommended: fc InsiiUkient dala 1o leconmend tof a aijjirht.

Table 89-3 TNM Stage Grouping for Breast Cancer

Ti|r no evidence of Eumor;Ti r carcinoma in situ or Paget's disease of the nipple with no tumor; Tlf less than or equal to 2 cm; J2, greater than-2 to 5'ciTi;T{r greatsi than 5 cm;T,r any size; direct extension to chest wail (excluding pectoral muscle) or skin infiliraiion; regional lymph nodes (N); N„ regional lymph nodes cannot be assessed (e.g.r previously removed}; N^ no regional lymph node metastasis; pfi metastasis in one \o Three lymph nodes; N metastasis in four to nine lymph nodes; N.. metastasis in 10 or more lymph nodes; metastasis (M); M0, no distant metastases; Mr distant metastasis.

Adapted with permission of the American Joint Committee on Cancer {AJCOr Chicago, IL The original source for this material is the A JCC Cancer Staging Manual 6th ed (2002). Published by Springer-

Prognostic Factors

A number of potential prognostic factors have been identified for breast cancer. Prognostic factors are measurements available at diagnosis or time of surgery that in the absence of adjuvant therapy are associated with recurrence rate, death rate, or other clinical outcome.

Table 89-4 Estimated Stage at Presentation and 5-Year Disease-Free Survival (DFS): Breast Cancer

Stage i Stage II ttagc III Stage IV

40 40 15 5

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