Breast Cancer Staging and Lymph Node Involvement
The stage of breast cancer helps the oncologist choose the best treatments for you. Staging indicates the tumor size and whether lymph nodes are affected. It also refers to whether cancer has spread beyond the breast.
If your breast biopsy came back positive for breast cancer, the Rocky Mountain Breast Specialists (RMBS) team will review the results of the biopsy and any images available to determine the extent, or stage, of the disease as well as a few other important factors. This allows them to establish the best treatment plan. The stage is detected by various factors including the size of the cancer, whether the cancer has invaded nearby lymph nodes, and whether the cancer has spread (metastasized) to other parts of the body.
Additional Tests to Determine Stage
As part of staging breast cancer, we may use other tests to see if the cancer has spread. These aren't always necessary, especially if the cancer is caught early and is very small.
Tests for staging can include:
- CT Scan. CT scans are sometimes used to look for breast cancer that has spread to the liver or lungs. During a CT scan, an x-ray machine linked to a computer takes a series of detailed pictures of your chest or abdomen. To make abnormal areas easier to see, you may receive contrast material by injection into a blood vessel in your arm or hand.
- MRI Scan. Similar to a CT scan, this will look at the soft tissue in your body such as your brain or your spinal cord to look for signs of breast cancer.
- PET Scan. Often combined with a CT, a PET scan can identify areas in the body where cancer cells may be growing, even before a tumor is identified.
- Bone Scan. To perform a bone scan, we will inject a small amount of a radioactive substance into a blood vessel. This substance travels through the bloodstream and collects in the bones. A machine called a scanner will then detect and measure the radiation, as well as take pictures to determine if any cancer has spread to the bones.
- Lymph Node Biopsy. The stage of breast cancer can usually be assessed before this lymph node surgery is performed, however this biopsy will finalize what the scans often show. If the oncologist suspects cancer has spread to the lymph nodes, the breast cancer surgeon will test them to see if they appear to be affected. The most common type of lymph node biopsy is called a Sentinel Node Biopsy. The surgeon uses a dye to see which lymph node is closest to the cancer. A few lymph nodes in this area are then removed for testing to be certain whether cancer has spread outside of the breast.
It’s understandable that you may feel nervous about these tests, however, they are a necessary part of the process. And, rest assured, we will do our best to make you feel comfortable. These tests allow your RMBS oncology team to see whether the cancer has spread and, if so, to what parts of your body. When breast cancer spreads, cancer cells are often found in lymph nodes under the arm (axillary lymph nodes). Breast cancer can also spread to almost any other part of the body, such as the bones, lungs, liver, and brain.
It’s important to understand that when breast cancer spreads from its origin to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. Therefore, the disease is metastatic breast cancer, not bone cancer. For that reason, it is treated as breast cancer, not bone cancer. This new tumor is typically referred to as “distant” or metastatic disease.
Stage IV Breast Cancer
Stage IV is distant metastatic cancer. The cancer has spread to other parts of the body, such as the bones or liver. This includes any T and any N with M1.
Recurrent Breast Cancer
Unfortunately, there are times when a patient’s cancer returns after being seemingly destroyed by treatment. This is called recurrent cancer. Recurrent cancers typically happen because undetected cancer cells remained somewhere in your body after treatment. Your breast cancer may return in the breast or chest wall. Or, it may return in any other part of the body, such as the bones, lungs, liver, or brain.
Side Effects of Lymph Node Surgery
After breast cancer surgery and a lymph node biopsy, the lymph fluid may not move through the arm as well as it should for some patients. This condition is called lymphedema, causing swelling and discomfort in the arm.
