Breast Cancer Surgery and Stages

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Breast Cancer Surgery Options

Breast cancer treatment -- including surgery, chemotherapy, radiation, endocrine and targeted/biologic therapies -- is personalized for the individual patient. The course of treatment is based upon how advanced the disease is, the location of the tumor (or tumors), the aggressiveness with which the surgeon and patient want to treat the cancer and the family history of the patient.

There are general guidelines for surgical treatment of breast cancer based upon the stage, or severity, of the disease. The guidelines are not absolute, in consultation with an oncologist and reconstructive plastic surgeon a treatment plan that is geared toward the needs of the patient will be decided upon and altered as needed as treatment continues.

Every case is different and unique, and staging alone cannot determine the course of treatment.  Staging is a guideline, and a treatment plan that is specifically tailored to the individual's needs and personal treatment goals is essential.  

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Stage 0 (Stage Zero) Breast Cancer and Surgery

Stage zero is the term used for breast cancer that is non-invasive, meaning that the cancer is restricted to certain structures within the breast tissue and has not invaded surrounding healthy tissue.

This stage of breast cancer is often referred to as “pre-cancer” or “tumor in situ” because the cancerous cells have not invaded additional structures. Despite the “pre-cancer” label, stage zero is serious and must be treated before the condition becomes worse.

Two Types of Stage 0 Breast Cancer:

Stage 0 Breast Cancer and Surgery

Surgery is the treatment of choice for stage 0 breast cancer. It can treated with a lumpectomy, sometimes followed by radiation or chemotherapy alone. A mastectomy is an option for patients who want to be aggressive in their treatment of the cancer or women who have a significant family history of breast cancer.

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Stage 1 (Stage I) Breast Cancer and Surgery

Stage 1 cancer is only in the breast, and has not spread to lymph nodes, and the tumor is 2cm across or less in size.

Stage I Breast Cancer and Surgery

Surgery is the treatment of choice for Stage 1 breast cancer, followed by chemotherapy or radiation in many cases. The surgery may be a lumpectomy or a mastectomy, depending on the site, the size of the tumor and the desired aggressiveness of the patient and her surgeon. In addition to surgery, patients with Stage 1 cancer may also require radiation therapy if a lumpectomy is chosen. In select cases, chemotherapy, endocrine and targeted/biologic therapies may also be recommended.

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Stage 2 (Stage II) Breast Cancer and Surgery Options

Stage IIA: The cancer is only in the lymph nodes under the arm OR in the breast and lymph nodes under the arm but no other sites OR the tumor is 2-5 cm across but is only found in the breast.

IIBL The cancer in the breast is 2-5 cm across and has spread to lymph nodes under the arm OR the cancer is larger than 5 cm but is isolated to the breast tissue.

Stage II Breast Cancer and Surgery

Stage II breast cancer includes a mastectomy in most cases, although a lumpectomy may be an option. In addition, the surgery usually includes the removal of lymph nodes. In most cases chemotherapy and/or radiation, endocrine therapy or targerted/metabolic therapies will be recommended after surgery.

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Stage 3 (Stage III) Breast Cancer and Surgery Options

IIIA: There is no cancer in the breast but adjoining lymph nodes under the arm are cancerous, OR the cancer in the breast is 5cm or smaller in size and has spread to lymph nodes under the arm that are connected.

IIIB: Inflammatory breast cancer, an aggressive type of cancer, is present OR breast cancer is in breast and adjoining tissue such as skin or muscles around the breast and may also have spread to the lymph nodes under the arm.

IIIC: There is a tumor in the breast which has spread to 10 or more lymph nodes under the arm. Additional lymph nodes around the neck and collar area may be involved.

Stage III Breast Cancer and Surgery

Stage III

breast cancer

involves a

mastectomy

and lymph node removal as a standard of care. A combined approach of both

chemotherapy

and

radiation

is typically recommended after surgery. Endocrine and targeted/biologic therapies may also be options for treatment.

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Stage 4 (Stage IV) Breast Cancer and Surgery Options

Stage IV is cancer that originated in the breast but has spread to organs or tissue in other parts of the body such as the brain, liver or bone.

Stage IV Treatment

Stage IV breast cancer has spread to different areas of the body, so no surgery can effectively treat the disease in the various locations. While a mastectomy may be recommended for the breast cancer, chemotherapy and radiation are considered essential components of treatment as multiple sites can be targeted.

Chemotherapy is especially important as it is a systemic treatment, working on multiple areas of the body, rather than an isolated location as in surgery. Endocrine and targeted/biological therapies may also be used to fight the cancer.

Sources:

American Cancer Society Breast Cancer Treatment By Stage.

Radiation Therapy & You. National Institutes of Health. http://www.cancer.gov/cancertopics/radiation-therapy-and-you/page2

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