Stage 2 Breast Cancer

Diagnosis, Treatments and Survival Rates with Stage 2 Breast Cancer

Female scientist looking at breast tumour sample
What do you need to know about stage 2 breast cancer?. Credit: Nicola Tree / Getty Images

It is fairly common for people to be diagnosed with stage 2 breast cancer. Although it can be frightening to hear that you have stage 2 (instead of stage 1 or DCIS), stage 2 is still considered early stage breast cancer and most people do very well with treatment, going on to live a normal lifespan. Even though this stage sometimes involves cancer in nearby lymph nodes, it is not viewed as metastatic.

Let's take a look at the facts about classifying, treating, and surviving stage 2 breast cancer.

Stages of Breast Cancer

Breast cancer is separated into four (or five) basic stages. Stage 0 breast cancer or ductal carcinoma in situ (DCIS) is not considered invasive breast cancer as it has not spread through something known as the basement membrane.

Stages 1 to 4 of breast cancers are considered "invasive" cancer. This does not mean that they have invaded any other tissues or that they have spread. It simply means that they have passed through the basement membrane and have the "potential" to spread. Stage 1 is the earliest stage of invasive breast cancer and stage 4 is the most advanced and is considered metastatic breast cancer.

Stage 2 Breast Cancer

Stage 2 breast cancer includes tumors that are at least 2 cm and up to 5 cm in diameter and may have spread to lymph nodes near the tumor.

Cancers are scored and divided into stages by something called the TNM system.

In this system:

  • T stands for tumor size
  • N stands for lymph node involvement. N0 (N-zero) would mean that cancer has not spread to any lymph nodes. N1 is used to describe tumors that have spread to at least one lymph node near the tumor. N2 refers to cancers that have spread farther away from the tumor.
  • M stands for metastasis. M0 means that no metastases are present. M1 means that a breast cancer has spread to other regions of the body such as the bones, brain, liver, or lung.

Using the TNM system, there are several combinations of T and N which are used to classify a cancer as either stage 2A or stage 2B. Since by definition stage 2 breast cancers have not metastasized, M is always followed by a zero. Possibilities for stage 2 include:

  • Stage 2A: T0, N1, M0: No tumor has been found in breast tissue, but cancer cells have lodged in lymph nodes near your breast.
  • Stage 2A: T1, N1, M0: You have a tumor of 2 cm or smaller that has spread to at least one lymph node, OR: your tumor has invaded nearby tissue at least 0.1 cm and has spread to at least one lymph node.
  • Stage 2A: T2, N0, M0: Your tumor is over 2 cm or less than 5 cm, but hasn't affected any lymph nodes.
  • Stage 2B: T2, N1, M0: Your tumor is bigger than 2 cm and less than 5 cm, and has involved nearby lymph nodes.
  • Stage 2B: T3, N0, M0: Your tumor is more than 5 cm, but has not reached your chest wall or skin, and has not traveled to any lymph nodes.

    Treating Stage 2 Breast Cancer

    Your oncologist will compile all the test results on your cancer and give you a comprehensive diagnosis. Treatment options will be very similar to those for Stage 1 breast cancer, with some variations for larger tumors or high-grade types of cancer.

    • Local Treatments: Surgical choices will include a lumpectomy or a mastectomy, which may be followed by radiation treatments to the breast or chest wall. If radiation is recommended, that will affect the timing of any breast reconstruction that you may have.
    • Systemic Treatments (Adjuvant Treatments): These therapies will affect cells all over your body and will help prevent a recurrence. Depending on your age, general health, hormone receptor status, lymph node involvement and HER2/neu results, you may be given chemotherapy, hormonal therapy, Herceptin, or other targeted biological therapies.
    • Neoadjuvant Treatment: You may prefer breast-conserving surgery, but have a tumor that is too large to have a good result after a lumpectomy. In this case, your oncologist may suggest having systemic treatments before surgery, in hopes of shrinking the tumor. When this approach is successful, the smaller tumor can be removed and local treatment may be given if needed. Some tumors don't respond well to pre-treatment and when that happens, a mastectomy will be necessary. You may then consider breast reconstruction.

    Survival Rates for Stage 2

    The National Cancer Data Base finds that the 5-year survival rate for stage 2A breast cancer is 93 percent for patients who completed treatment. Treatments have improved greatly over that time, so you may hope for longer-term survival if you are newly diagnosed. You will see your oncologist for five years of follow-up care every three months and then every six months. After five years you may only need to see your oncologist once a year, but these visits most often continue throughout your life. These visits are important to make sure that recovery is going smoothly and that treatment for recurrence won't be needed. 

    Follow-up Care After Primary Treatments

    You may spend between three to eighteen months or longer in active treatment for your stage 2 breast cancer. It may be as simple as surgery and six weeks of radiation, or as involved as the full array of chemo, radiation, and additional therapies. Either way, you will have a 5-year follow-up period of checkups with your oncologist, during which you may need to take hormone therapy if your tumor was hormone sensitive. Some oncologist are now recommending hormonal therapy which goes beyond five years for those with estrogen receptor positive tumors. 

    Newly Diagnosed

    If you've been recently diagnosed with stage 2 breast cancer you may feel overwhelmed with all there is to learn. Check out these tips on where to begin with a new breast cancer diagnosis.

    Thankfully, there are now a multitude of resources through which you can receive support, and learn more about your diagnosis. Ask for help and reach out to your loved ones. Even if you are used to being "the strong one" lean on others for support. Become involved in one of the active breast cancer support groups or support communities available.

    Most importantly, learn how to be your own advocate in your cancer care. Cancer treatments are changing rapidly, and it's important to understand the options available so you can be an active member of your cancer treatment team.

    Sources:

    National Cancer Institute. Breast Cancer Treatment (PDQ) – Health Professional Version. Updated 10/21/16. https://www.cancer.gov/types/breast/hp/breast-treatment-pdq

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