Breast cancer stages

Making an educated treatment decision begins with the stage, or progression, of the disease. Using the results from your diagnostic tests, your care team at Cancer Treatment Centers of America^® (CTCA) will develop an appropriate treatment plan for you.

If you have been recently diagnosed, we will review your pathology to confirm you have received the correct diagnosis and staging information, and develop a personalized treatment plan. If you have a recurrence, we will perform comprehensive testing and identify a treatment approach tailored to your needs.

The stage of breast cancer is one of the most important factors in evaluating treatment options. Our cancer doctors use a variety of diagnostic tests to evaluate breast cancer and develop the appropriate treatment plan for you.

What is stage 0 breast cancer?

Also called carcinoma in situ, stage 0 is the earliest breast cancer stage. At stage 0, the breast mass is noninvasive, and there is no indication that the tumor cells have spread to other parts of the breast or other parts of the body. Often, stage 0 is considered a precancerous condition that typically requires close observation, but not treatment.

Stage 0 breast cancer is difficult to detect. There may not be a lump that can be felt during a self-examination, and there may be no other symptoms. However, breast self-exams and routine screening are always important and can often lead to early diagnosis, when the cancer is most treatable. Stage 0 disease is most often found by accident during a breast biopsy for another reason, such as to investigate an unrelated breast lump.

There are two types of stage 0 breast cancer:

Ductal carcinoma in situ (DCIS) occurs when breast cancer cells develop in the breast ducts. Today, stage 0 DCIS is being diagnosed more often because more women are having routine mammogram screenings. DCIS can become invasive, so early treatment can be important.

Lobular carcinoma in situ (LCIS) occurs when abnormal cells develop in the lobules. These cells are not cancerous and this condition rarely becomes invasive cancer. However, women who develop LCIS may be at increased risk for developing breast cancer in the future. For women who develop LCIS, the risk of getting an invasive cancer is 20 percent to 25 percent over 15 years after the initial diagnosis.

What is stage I (stage 1) breast cancer?

This breast cancer is the earliest stage of invasive breast cancer. In stage I, the tumor measures up to 2 cm and no lymph nodes are involved. At this stage, the cancer cells have spread beyond the original location and into the surrounding breast tissue.

Because a stage I tumor is small, it may be difficult to detect. However, breast self-exams and routine screening are always important and can often lead to early diagnosis, when the cancer is most treatable.

Stage I breast cancer is divided into two categories:

Stage IA (Stage1A): The tumor measures 2 cm or smaller (about the size of a pea or shelled peanut) and has not spread outside the breast.

Stage IB (Stage1B): Small clusters of cancer cells measuring no more than 2 mm, are found in the lymph nodes, and either there is no tumor inside the breast, or the tumor is small, measuring 2 cm or less.

The survival rate for stage IA breast cancer may be slightly higher than for stage IB. However, all women with stage I breast cancer are considered to have a good prognosis.

At stage I, TNM designations help describe the extent of the disease. For example, there may or may not be cancer cells in the lymph nodes, and the size of the tumor may range from 1 cm to 2 cm. Most commonly, stage I breast cancer is described as:

• T: T1, T2, T3 or T4, depending on the size and/or extent of the primary tumor
• N0: Usually, cancer has not spread to the lymph nodes.
• M0: The disease has not spread to other sites in the body.

What is stage II (stage 2) breast cancer?

Also known as invasive breast cancer, the tumor in this stage measures between 2 cm to 5 cm, or the cancer has spread to the lymph nodes under the arm on the same side as the breast cancer. Stage II breast cancer indicates a slightly more advanced form of the disease. At this stage, the cancer cells have spread beyond the original location and into the surrounding breast tissue, and the tumor is larger than in stage I disease. However, stage II means the cancer has not spread to a distant part of the body.

At stage II, a tumor may be detected during a breast self-exam as a hard lump within the breast. Breast self-exams and routine screening are always important and can often lead to early diagnosis, when the cancer is most treatable.

Stage II breast cancer is divided into two categories:

Stage IIA (Stage 2A): One of the following is true:

• There is no tumor within the breast, but cancer has spread to the axillary (underarm) lymph nodes, or
• The tumor in the breast is 2 cm or smaller and cancer has spread to the axillary lymph nodes, or
• The tumor in the breast measures 2 cm to 5 cm but cancer has not spread to the axillary lymph nodes.

Stage IIB (Stage 2B): One of the following is true:

• The tumor measures 2 cm to 5 cm and cancer has spread to the axillary lymph nodes, or
• The tumor is larger than 5 cm but cancer has not spread to the axillary lymph nodes.

The survival rate for stage IIA breast cancer may be slightly higher than for stage IIB. However, all women with stage II breast cancer are considered to have a good prognosis.

At stage II, TNM designations help describe the extent of the disease. Most commonly, stage II breast cancer is described as:

• T: T1, T2, T3 or T4, depending on the size and/or extent of the primary tumor
• N1: Cancer has spread to the lymph nodes.
• M0: The disease has not spread to other sites in the body.

What is stage III (stage 3) breast cancer?

Also known as locally advanced breast cancer, the tumor in this stage of breast cancer is more than 2 inches in diameter across and the cancer is extensive in the underarm lymph nodes or has spread to other lymph nodes or tissues near the breast. Stage III breast cancer is a more advanced form of invasive breast cancer. At this stage, the cancer cells have usually not spread to more distant sites in the body, but they are present in several axillary (underarm) lymph nodes. The tumor may also be quite large at this stage, possibly extending to the chest wall or the skin of the breast.

Stage III breast cancer is divided into three categories:

Stage IIIA (Stage 3A): One of the following is true:

• No tumor is found in the breast, but cancer is present in axillary lymph nodes that are attached to either other or other structures, or cancer may be found in the lymph nodes near the breast bone, or
• The tumor is 2 cm or smaller. Cancer has spread to axillary lymph nodes that are attached to each other or other structures, or cancer may have spread to lymph nodes near the breastbone, or
• The tumor is 2 cm to 4 cm in size. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breast bone, or
• The tumor is larger than 5 cm. Cancer has spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.

Stage IIIB (Stage 3B): The tumor may be any size, and the cancer:

• Has spread to the chest wall and/or skin of the breast, and
• May have spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
• Cancer that has spread to the skin of the breast is inflammatory breast cancer.

Stage IIIC (Stage 3C):

• There may be no sign of cancer in the breast or the tumor may be any size and may have spread to the chest wall and/or skin of the breast.
• Cancer cells are present in lymph nodes above or below the collarbone.
• Cancer cells may have spread to axillary lymph nodes or lymph nodes near the breastbone.
• Cancer that has spread to the skin of the breast is inflammatory breast cancer.

Stage IIIC breast cancer may be operable or inoperable:

• Operable stage IIIC: The cancer is found in 10 or more axillary lymph nodes, or is in lymph nodes below the collarbone, or is in axillary lymph nodes and lymph nodes near the breastbone.
• Inoperable stage IIIC: The cancer has spread to the lymph nodes above the collarbone.

The survival rate for stage IIIA breast cancer may be slightly higher than for stage 3B, and the survival rate for stage IIIB may be slightly higher than for stage IIIC. However, all women diagnosed with stage III breast cancer have several promising treatment options.

At stage III, TNM designations help describe the extent of the disease. Higher numbers indicate more extensive disease. Most commonly, stage III breast cancer is described as:

• T: T1, T2, T3 or T4, depending on the size and/or extent of the primary tumor
• N1: Cancer has spread to the lymph nodes.
• M0: The disease has not spread to other sites in the body.

What is stage IV (stage 4) breast cancer?

Also known as metastatic breast cancer, the cancer in this stage has spread beyond the breast, underarm and internal mammary lymph nodes to other parts of the body near to or distant from the breast. The cancer has spread elsewhere in the body. The affected areas may include the bones, brain, lungs or liver and more than one part of the body may be involved.

At stage IV, TNM designations help describe the extent of the disease. Higher numbers indicate more extensive disease. Most commonly, stage IV breast cancer is described as:

• T: T1, T2, T3 or T4, depending on the size and/or extent of the primary tumor.
• N1: Cancer has spread to the lymph nodes
• M1: The disease has spread to other sites in the body

Recurrent breast cancer

Recurrent breast cancer occurs when the disease has returned after initial treatment. Most recurrent cancers appear within the first two or three years after treatment, but, in some cases, the cancer may recur many years later. According to the Susan G. Komen^® organization, women with early breast cancer most often develop local recurrence within the first five years after treatment. On average, 7 percent to 11 percent of women with early breast cancer experience a local recurrence during this time.

For patients with a family history of cancer, or a BRCA1 or BRCA2 gene mutation, the cancer recurrence rate is higher. The risk of finding new cancers, such as ovarian cancer, may also be higher. Cancer recurrence risk is based on many factors, including the cancer type and how it was treated.

Types of recurrent breast cancer

There are three types of recurrent breast cancer:

Local recurrence is when the cancer has returned to the same location as the original cancer.

Regional recurrence is when the cancer has been found in or near the original location.

Distant recurrence is when the breast cancer has spread to other parts of the body. This is also considered metastatic breast cancer.

It is important to report new signs or symptoms of breast cancer to your doctor. Symptoms of recurrent breast cancer vary from person to person.

Learn more about recurrent breast cancer 

Metastatic breast cancer

Metastatic breast cancer, or distant recurrence, occurs when cancer cells have spread to distant organs and/or tissue in the body. Common metastatic areas include the bones, liver and lungs. Even when a metastatic breast tumor spreads to a different part of the body, it contains the same cancerous cells that developed in the breast and is still considered breast cancer.

Signs and symptoms of metastatic breast cancer may include:

• Swelling or lumps in the lymph nodes
• Unexplained pain in other areas of the body, such as the bone
• Difficulty breathing or a persistent cough
• Loss of appetite and/or weight loss
• Intense headaches

Learn more about metastatic breast cancer

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