Staging is the process physicians use to assess the size and location of a patient’s cancer.
Identifying the cancer stage is one of the most important factors in selecting treatment options. Several tests may be performed to help stage breast cancer including clinical breast exams, biopsy and certain imaging tests such as

• Chest x – ray.
• Mammogram
• Bone scan
• MRI scan.

Blood tests are used to evaluate a woman's overall health and detect whether the cancer has spread to certain organs often follow imaging tests.

To stage cancer, the “American Joint Committee on Cancer” first places the cancer in a letter category using the TNM classification system.

Cancers are designated with the following letters:-

• T - Tumor size
• N - Palpable nodes
• M - Metastasis

T - Tumor Size

The letter T followed by a number from 0 to 4 describes the tumor's size and whether it has spread to the skin or chest wall under the breast.

Higher T numbers indicate a larger tumor and/or more extensive spread to tissues surrounding the breast.

• TX: Tumor cannot be assessed
• T0: No evidence of a tumor
• Tis: Cancer may be lobular carcinoma in situ ( LCIS),ductal carcinoma in situ (DCIS) or Paget’s disease
• T1: Tumor is 2 cm or less in diameter
• T2: Tumor is between 2 and 5 cm in diameter
• T3: Tumor is more than 5 cm in diameter
• T4: Tumor is any size, has attached itself to the chest wall and spread to the pectoral (chest) lymph nodes

N - Palpable Nodes

The letter N followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, whether the affected nodes are fixed to other structures under the arm.

• NX: Lymph nodes cannot be assessed (lymph nodes were previously removed, etc.)
• N0: Cancer has not spread to lymph nodes
• N1: Cancer has spread to the movable ipsilateral axillary lymph nodes (underarm lymph nodes on same side of breast cancer)
• N2: Cancer has spread to ipsilateral (same side of body as breast cancer) lymph nodes fixed to one another or to other structures under the arm
• N3: Cancer has spread to the ipsilateral mammary lymph nodes or the ipsilateral (same side of body as breast cancer) supraclavicular lymph nodes

M - Metastasis

The letter M followed by a 0 or 1 indicates whether or not the cancer has metastasized (spread) to distant organs (i.e., the lungs or bones) or to lymph nodes that are not next to the breast, such as those above the collarbone.

• MX: Metastasis cannot be assessed
• M0: No distant metastasis to other organs
• M1: Distant metastasis to other organs

Stage 0 cancer is a contained cancer that has not spread beyond the breast ductal system. Fifteen to twenty percent of breast cancers detected by clinical examinations or testing are in Stage 0 (the earliest form of breast cancer).

Two types of Stage 0 cancer are lobular carcinoma in situ (LCIS) and ductal carcinoma in situ ( DCIS)

• LCIS indicates high risk for breast cancer. Many physicians do not classify LCIS as a malignancy and often encounter LCIS serendipitously (by chance) on breast biopsy while investigating another area of concern. While the microscopic features of LCIS are abnormal and are similar to malignancy, LCIS does not behave as a cancer (and therefore is not treated as a cancer).
  
  LCIS is merely a marker for a significantly increased risk of cancer anywhere in the breast. However, bilateral simple mastectomy may be occasionally performed if LCIS patients have a strong family history of breast cancer. More likely, LCIS patients are closely monitored with physician performed clinical breast exams every four months in addition to yearly mammography.
  
  Some patients may be given the drug tamoxifen to help prevent the development of breast cancer.
  
• 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 (such as the lymph nodes).
  
  DCIS may be detected on mammogram as tiny specks of calcium (known as micro calcifications) 80% of the time. Less commonly DCIS can present itself as a mass with calcifications (15% of the time); and even less likely as a mass without calcifications (<5% of the time).Breast biopsy is used to confirm DCIS.
  
  Standard DCIS treatment is breast-conserving therapy (BCT): lumpectomy followed by radiation treatment or mastectomy. DCIS patients have chosen equally among lumpectomy and mastectomy as their treatment option, though specific cases may sometimes favor lumpectomy over mastectomy or vice versa.
  

In this stage cancer has spread from the lobules or ducts to the nearby tissue in the breast. At this stage and beyond, breast cancer is considered to be invasive.

The tumor is 2 cm or less in diameter (approximately 1 inches or less); the lymph nodes are not involved.

Stage – I breast cancer treatment usually consists of:

• Breast conserving therapy (BCT): lumpectomy (removal of cancerous lump and Small margin of surrounding normal tissue) and axillary node dissection (removal of underarm lymph nodes) followed by radiation
• Or modified radical mastectomy (removal of the affected breast) and axillary node dissection.

It is known as locally advanced cancer; tumor may be larger than 5 cm (2 inches) in diameter, Primary breast cancer of any kind that has spread to the axillary (underarm) lymph nodes and to axillary tissues.

Standard Stage IIIA breast cancer treatment is modified radical mastectomy with or without breast reconstruction. Lumpectomy may be performed if the tumor may be cut free with one incision. Radiation and systemic therapy such as chemotherapy or hormonal therapy often follows surgery.

If the tumor is large, neo adjuvant chemotherapy (combination of anticancer drugs administered prior to surgery to shrink the size of a tumor) may be provided, with or without hormonal therapy.

The term "advanced stages of breast cancer" refers to stages of breast cancer labeled III and IV.

The primary breast cancer is any size, has attached itself to the chest wall, and has spread to the pectoral (chest) lymph nodes.

Stage III - B treatment often begins with neo adjuvant chemotherapy to reduce the tumor’s size.

Lumpectomy or modified radical mastectomy followed by chemotherapy, radiation, or chemotherapy plus hormonal therapy are standard treatments.

This stage is known as meta static; cancer has spread from 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.

Systemic treatment (treatment that affects the entire body) such as chemotherapy, hormonal therapy or both is often recommended.

Radical mastectomy or the use of the drug tamoxifen may provide symptom relief in some cases.

Health care professionals are able to be predict a patient’s survival rate based on the determined stage of breast cancer. The following chart is an approximate survival rate for each stage of breast cancer.

Percentages will vary depending on individual medical situations, etc.

• A five-year survival rate refers to the average number of patients who are still alive five years after diagnosis with a specific stage of breast cancer.
• After seven years, the survival rate decreases for each stage.
• The average Stage I breast cancer survival rate is 92%.
• The Stage II survival rate is 71%, Stage III survival rate is 39%, and the Stage IV survival rate is 11%.
• It is important to remember that these survival rates are based on averages.
• Some women with advanced breast cancer live significantly longer than seven years.
• Researchers are constantly developing new treatment alternatives to prolong breast cancer survival.