If you are diagnosed with breast cancer, it is important to know how far the cancer has spread. The physician stages the tumor based on its size, the character of its cells, and the extent of metastasis. Knowing the stages help them to decide the best treatment options.

The staging of breast cancer is divided into five. Stages 0,1 & 2 refers the term ‘early breast cancer’ while the stages III & IV denotes the ‘Advanced breast cancer’.

Stage 0

At stage 0 cancer cells are present in either the lining of a breast lobule or duct. But they have not spread to the surrounding fatty tissue.  Two types of Stage 0 cancer are lobular carcinoma in situ (LCIS) and  Ductal Carcinoma in situ (DCIS).  LCIS does not behave as a cancer but indicates high risk for breast cancer. This risk of cancer is increased for both breasts. Some women with LCIS may take a drug called tamoxifen, which can reduce the risk of developing breast cancer.

In DCIS the cancer cells are confined to milk ducts in the breast and have not spread into the fatty breast tissue or to any other part of the body. women with DCIS are at an increased risk of getting invasive breast cancer. Some women with DCIS have breast-sparing surgery followed by radiation therapy. Or they may choose to have a mastectomy

Stage I

The primary cancer is 2cm or less in diameter and has not spread to the lymph nodes.

Stage II

Stage II is further divided in to two

Stage IIA :  The cancer is no larger than 2 centimeters but has spread to the lymph nodes under the arm (the axillary lymph nodes). OR
The cancer is between 2 and 5 centimeters but has not spread to the lymph nodes under the arm.

Stage IIB : The cancer is between 2 and 5 centimeters, and has spread to the lymph nodes under the arm. OR
The cancer is larger than 5 centimeters, but has not spread to the lymph nodes under the arm.

Women with early stage breast cancer may have breast-sparing surgery followed by radiation therapy to the breast, or they may have a mastectomy. Many women with stage I and most with stage II breast cancer have chemotherapy and hormonal therapy after primary treatment with surgery or surgery and radiation therapy.

Stage III & IV is known as ‘Advanced Breast cancer’

Stage IIIA : The cancer is smaller than 2 inches (5 centimeters) and has spread to the axillary lymph nodes (the lymph nodes under the arm), and the lymph nodes are attached to each other or to other structures. OR
The cancer may be larger than 2 inches (5 centimeters) and has spread to the axillary lymph nodes and the lymph nodes may be attached to each other or to other structures.

Stage IIIB : It has spread to tissues near the breast (the skin or chest wall, including the ribs and muscles in the chest) OR
spread to lymph nodes inside the chest wall along the breastbone.

Patients with stage III breast cancer usually have both treatment to remove or destroy the cancer in the breast and to stop the disease from spreading. Surgery and/or radiation therapy, chemotherapy, hormonal therapy are the standard treatments.

Stage IV

This stage is known as metastatic. Cancer has spread from the breast and lymph nodes under the arm to other parts of the body, such as bone, liver, lung, or brain.

The treatment of Stage IV breast cancer focuses on extending survival time and relieving symptoms.

Treatment

Women are recommended to examine their breasts once in a month to detect any changes or lumps. If breast self -examination detects a lump, the family doctor should be consulted. In choosing therapy, the  physician takes into consideration the stage of the disease, the woman’s age and menopausal status. Breast cancer is usually treated surgically along with chemotherapy, radio therapy and hormone therapy. Radio therapy kills cancer cells using gamma radiation. Chemotherapy may use Cytotoxic drugs to kill cancer cells both in the breast and elsewhere in the body. Modern treatments have greatly improved the quality and quantity  of life for breast cancer patients.

Surgery
Surgery is the first line of attack against breast cancer. There are two main type of surgeries for breast cancer

Lumpectomy (Breast-conserving surgery) :  Any form of surgery that removes only part of the breast is considered “breast-conserving” or “breast preservation” surgery.  Lumpectomy is the most common surgery used for best cancer today. It is used for patients with early stage invasive breast cancers. A part of the breast which contains the tumor and some normal tissues that  surrounds the tumor is removed during the surgery. Usually women with tumors 5 cm (2 inches) or less in diameter with positive or negative axillary lymph nodes, are gone under this treatment. After the surgery,  the patient may receive five to seven weeks of radiotherapy in order to eliminate any cancer cells that may be present in the remaining breast tissue.

Mastectomy : A method of surgery which involves the removal of the breast cancer and a larger portion of the normal breast tissue around the breast cancer or entire breast. Breast cancer surgery is done under general anesthesia and usually takes two to three hours. The surgeon may also remove the lining over the chest muscles below the tumor and some lymph nodes under the arm. Women who undergo a mastectomy have the option of breast reconstruction.

Side effects include, wound infection, hematoma (accumulation of blood in the wound), and seroma (accumulation of clear fluid in the wound).

Chemotherapy
It is a combination of drugs which is effective to kill or slow the growth of rapidly multiplying cells. The drugs are given directly to vein or orally. The drug will travel to entire body through blood stream and will destroy the cancer cells beyond the breast. Chemotherapy is given in cycles of treatment followed by a recovery period. The entire chemotherapy treatment generally lasts three to six months, depending on the type of drugs given. When breast cancer is limited to the breast or lymph nodes, chemotherapy may be given after a lumpectomy or mastectomy. This is known as adjuvant treatment and may help reduce the chance of breast cancer recurrence.

The side effects will depend up on the type and amount of drugs you are given. The side effects include

* Nausea and vomiting
* Loss of appetite
* Hair loss
* Mouth sores
* Changes in menstrual cycle
* Higher risk of infection (due to decreased white blood cells)
* Bruising or bleeding
* Fatigue

Radiation Therapy
Radiotherapy is a highly effective treatment option which uses high levels of radiation to kill cancer cells or keep them from growing and dividing thus reducing damage to healthy cells. It is usually given to the breast to destroy cancer cells that may remain in your breast after breast conserving surgery, or in any breast tissue left on your chest after mastectomy. Having radiotherapy after surgery reduces the chance that reoccurrence in the same place  in the next 10 years. Radiation therapy is usually delayed until chemotherapy is complete. Early side effects of radiotherapy include skin reactions, tiredness and breast tenderness. These are usually mild and pass after a few weeks. Radiation therapy is not given during pregnancy because it can harm a fetus.

Two main types of radiotherapy are used to treat breast cancer: External Radiotherapy and Internal Radiotherapy

External Radio therapy : This is the usual method of radio therapy. In this therapy, radiation is focused from a source outside the body on the area affected by the cancer. Patients need to face the therapy at least six to eight weeks continuously. Deodorants and antiperspirants can interfere with external beam radiation therapy of the underarm area, so you should avoid using them until treatments are complete. In some women, the breast becomes smaller and firmer after radiation therapy.

Internal Radio Therapy ( Brachytherapy ) : This is a method of placing radioactive seeds directly into the breast tissue next to the cancer. The radiation is sealed in needles, seeds, wires, or catheters. This type of radiation has the advantage of delivering the radiation from a close distance, and thereby deliver a higher dose of radiation while not causing as much damage to other structures. Some of the radioactive substances used for internal radiation treatment include cesium, iridium, iodine, phosphorus, and palladium. The side effects of implant therapy depend on the area being treated.