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Treatment Options by Cancer Stage

Different treatment options and sequences are considered for each stage of breast cancer.
 

Different treatment options and sequences are considered for each stage of breast cancer. The links below will give you a general idea of the treatments your doctor may recommend depending on the stage of the breast cancer. These treatment options are not exact — your own treatment plan may be different, depending on your specific situation.

 

Stage 0

Stage 0 breast cancer describes non-invasive breast cancers, such as DCIS (ductal carcinoma in situ). In stage 0, there is no evidence of cancer cells or non-cancerous abnormal cells breaking out of the part of the breast in which they started, or getting through to or invading neighboring normal tissue.

Treatment to the breast
  • total mastectomy (radiation after mastectomy rarely needed) or

  • lumpectomy plus radiation or

  • lumpectomy alone (with or without internal radiation — only for a limited subset of women)

Treatment to the lymph nodes
  • none required

Chemotherapy
Hormonal therapy
  • hormonal therapy usually prescribed; estrogen receptor status is not always known

Targeted therapy
Immunotherapy
Treatment to other parts of the body
  • does not apply

 

Stage IA and IB

Stage I describes invasive breast cancer (cancer cells are breaking through to or invading normal surrounding breast tissue). Stage I is divided into subcategories known as IA and IB.

In general, stage IA describes invasive breast cancer in which:

  • the tumor measures up to 2 centimeters (cm) and

  • the cancer has not spread outside the breast; no lymph nodes are involved

In general, stage IB describes invasive breast cancer in which:

  • there is no tumor in the breast; instead, small groups of cancer cells — larger than 0.2 millimeter (mm) but not larger than 2 mm — are found in the lymph nodes or

  • there is a tumor in the breast that is no larger than 2 cm, and there are small groups of cancer cells — larger than 0.2 mm but not larger than 2 mm — in the lymph nodes

Still, if the cancer is estrogen receptor-positive or progesterone receptor-positive, it is likely to be classified as stage IA.

Treatment to the breast
  • total mastectomy: radiation after mastectomy is only rarely needed or

  • lumpectomy plus radiation or

  • very occasionally, lumpectomy alone, with or without internal radiation — only for a limited subset of women

Treatment to the lymph nodes
Chemotherapy
  • chemotherapy may be given to reduce the risk of recurrence

Hormonal therapy
  • hormonal therapy is prescribed for people with hormone-receptor-positive cancer

Targeted therapy
  • targeted therapy medicines may be used to treat cancers that have certain characteristics (for example, cancers that are HER2-positive)

Immunotherapy
  • immunotherapy may be recommended before and after surgery if the cancer is triple-negative

Treatment to other parts of the body
  • does not apply

 

Stage IIA and IIB

Stage II is divided into subcategories known as IIA and IIB.

In general, stage IIA describes invasive breast cancer in which:

  • no tumor can be found in the breast, but cancer (larger than 2 millimeters [mm]) is found in 1 to 3 axillary lymph nodes (the lymph nodes under the arm) or in the lymph nodes near the breast bone (found during a sentinel node biopsy) or

  • the tumor measures 2 centimeters (cm) or smaller and has spread to the axillary lymph nodes or

  • the tumor is larger than 2 cm but not larger than 5 cm and has not spread to the axillary lymph nodes

Still, if the cancer tumor measures between 2 and 5 cm and:

it will likely be classified as stage IB.

Similarly, if the cancer tumor measures between 2 and 5 cm and:

it will likely be classified as stage IA.

In general, stage IIB describes invasive breast cancer in which:

  • the tumor is larger than 2 cm but no larger than 5 cm; small groups of breast cancer cells — larger than 0.2 mm but not larger than 2 mm — are found in the lymph nodes or

  • the tumor is larger than 2 cm but no larger than 5 cm; cancer has spread to 1 to 3 axillary lymph nodes or to lymph nodes near the breastbone (found during a sentinel node biopsy) or

  • the tumor is larger than 5 cm but has not spread to the axillary lymph nodes

Still, if the cancer tumor measures between 2 and 5 cm and:

it will likely be classified as stage IB.

Treatment to the breast
  • total mastectomy; radiation after mastectomy may be needed or

  • lumpectomy plus radiation, in some cases following chemotherapy to shrink a large single cancer

Treatment to the lymph nodes

and

  • possible radiation to supraclavicular and/or internal mammary lymph nodes

Chemotherapy
Hormonal therapy
  • hormonal therapy is prescribed for people with hormone-receptor-positive cancer

Targeted therapy
  • targeted therapy medicines may be used to treat cancers that have certain characteristics (for example, cancers that are HER2-positive)

Immunotherapy
  • immunotherapy may be recommended before and after surgery if the cancer is triple-negative

Treatment to other parts of the body
  • does not apply

 

Stage IIIA, IIIB, and IIIC

Stage III is divided into subcategories known as IIIA, IIIB, and IIIC.

In general, stage IIIA describes invasive breast cancer in which either:

  • no tumor is found in the breast or the tumor may be any size; cancer is found in 4 to 9 axillary lymph nodes or in the lymph nodes near the breastbone (found during imaging tests or a physical exam) or

  • the tumor is larger than 5 centimeters (cm); small groups of breast cancer cells (larger than 0.2 millimeter [mm] but not larger than 2 mm) are found in the lymph nodes or

  • the tumor is larger than 5 cm; cancer has spread to 1 to 3 axillary lymph nodes or to the lymph nodes near the breastbone (found during a sentinel lymph node biopsy)

Still, if the cancer tumor measures more than 5 cm across and:

it will likely be classified as stage IB.

In general, stage IIIB describes invasive breast cancer in which:

  • the tumor may be any size and has spread to the chest wall and/or skin of the breast and caused swelling or an ulcer

and

  • may have spread to up to 9 axillary lymph nodes or

  • may have spread to lymph nodes near the breastbone

Still, if the cancer tumor measures more than 5 cm across and:

it will likely be classified as stage IIA.

Inflammatory breast cancer is considered at least stage IIIB. Typical features of inflammatory breast cancer include:

  • reddening of a large portion of the breast skin

  • the breast feels warm and may be swollen

  • cancer cells have spread to the lymph nodes and may be found in the skin

In general, stage IIIC describes invasive breast cancer in which:

  • there may be no sign of cancer in the breast or, if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast

and

  • the cancer has spread to 10 or more axillary lymph nodes or

  • the cancer has spread to lymph nodes above or below the collarbone or

  • the cancer has spread to axillary lymph nodes or to lymph nodes near the breastbone

Still, if the cancer tumor measures any size and:

it will likely be classified as stage IIIA.

Treatment to the breast
  • total mastectomy followed by radiation or

  • chemotherapy to shrink the cancer tumor and/or treat cancer in the lymph nodes, followed by lumpectomy and radiation or

  • chemotherapy to shrink the cancer tumor and/or treat cancer in the lymph nodes, followed by total mastectomy and radiation

Treatment to the lymph nodes
Chemotherapy
Hormonal therapy
  • hormonal therapy is prescribed for people with hormone-receptor-positive cancer

Targeted therapy
  • targeted therapy medicines may be used to treat cancers that have certain characteristics (for example, cancers that are HER2-positive)

Immunotherapy
  • immunotherapy may be recommended before and after surgery if the cancer is triple-negative

Treatment to other parts of the body
  • does not apply

 

Stage IV

Stage IV describes invasive breast cancer that has spread beyond the breast and nearby lymph nodes to other organs of the body, such as the lungs, distant lymph nodes, skin, bones, liver, or brain.

You may hear the words “advanced” and “metastatic” used to describe stage IV breast cancer. Cancer may be stage IV at first diagnosis, called “de novo” by doctors, or it can be a recurrence of a previous breast cancer that has spread to other parts of the body.

Treatment to the breast
  • surgery, radiation, or both may be used, depending on many individual factors

Treatment to the lymph nodes
  • enlarged lymph nodes may be treated if they are causing discomfort or other symptoms

Chemotherapy
Hormonal therapy
  • hormonal therapy is almost always prescribed if the cancer is hormone-receptor-positive

Targeted therapy
  • targeted therapy will be used to treat cancers that have certain characteristics, for example, cancers that are HER2-positive or cancers that are HER2-negative but have a BRCA1 or BRCA2 mutation; there are a number of targeted therapies that are approved to treat metastatic breast cancer, and new therapies are constantly being studied

Immunotherapy
  • immunotherapy may be recommended if the cancer is triple-negative

Treatment to other parts of the body
  • radiation is most commonly used to relieve specific signs or uncomfortable symptoms; surgery may be used to control specific symptoms

Learn more in Treatment for Metastatic Breast Cancer.


— Last updated on July 27, 2022, 1:48 PM

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