Breast Cancer Stages

Our personalized breast cancer care program in Framingham and nearby cities meets the physical and emotional needs of patients at various breast cancer stages.

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How Do Doctors Determine Different Stages of Breast Cancer?

Cancer doctors or oncologists determine the stage of a breast cancer based on several factors including the following:

1. The spread of cancer to lymph nodes and/or other body parts

Once a patient has been diagnosed with breast cancer, her doctor may request several tests or screenings to determine if cancer cells have spread into other parts of the breast and/or other parts of the body. These may include blood tests, X-rays, mammograms, ultrasounds, magnetic resonance imaging (MRI), computerized tomography (CT) scans and/or positron emission tomography (PET) scans.

2. Location and size of the primary tumor

Cancer doctors use a staging system called the TNM, (tumor, node and metastasis), when trying to find out the location and size of the primary tumor and the size and location of lymph nodes where cancer cells are present. It uses numbers from 0-4 to assign a value to the cancer.

3. The tumor grade

Cancer doctors follow a grading system that helps determine how fast a primary tumor can grow and spread within the breast or in other parts of the body.

4. Whether specific biomarkers are present in the tumor

Cancer doctors also use biomarker testing to determine whether breast cancer cells have specific receptors. The biomarker status is combined with the TNM system and the grading system to diagnose the breast cancer stage.

What Are the Stages of Breast Cancer?

There are five breast cancer stages: 0-4. Every stage has various signs and symptoms. Cancer doctors offer various treatment options for each.

Stage 0 Breast Cancer

This stage of breast cancer is noninvasive. Therefore, cancer cells are still within the area where they started growing and the cancer hasn’t spread to other parts of the breast or the body. Stage 0 breast cancer is also called ducta carcinoma in situ (DCIS) which means cancer cells remain in the lining of milk ducts. Patients who have been diagnosed with stage 0 breast cancer are recommended to get treatment as early as possible to prevent the cancer from turning into an invasive type.

Treatment Options

Cancer doctors may recommend any of the following treatment options for stage 0 breast cancer:

• Lumpectomy – a type of surgery that aims to remove cancer cells from the breast.
• Mastectomy – the removal of the affected breast.
• Radiation therapy – uses radiation to help kill and prevent remaining cancer cells from spreading after breast surgery.
• Hormone treatment – may be recommended in addition to surgery if a patient has progesterone receptor-positive (PR+) or estrogen receptor-positive (ER+) breast cancer.

Stage 1 Breast Cancer

As the earliest stage of invasive breast cancer, this is when cancer cells have already started spreading in the surrounding breast tissue from where it started. Stage 1 breast cancer has two subcategories: stages 1A and 1B.

Stage 1A

Patients with stage 1A breast cancer have a tumor no larger than 2 cm in diameter that remains within the breast.

Stage 1B

Stage 1B breast cancer can present in two ways:

• The patient may have no tumor in the breast, but cancer cells have developed between 0.2 to 2 mm in diameter. These cancer cells may also be present in the lymph nodes.
• The patient has a growing tumor no larger than 2 cm in the breast and also has small groups of cancer cells between 0.2 to 2 mm in diameter growing in the lymph nodes.

Treatment Options

Cancer doctors may recommend any of the following treatment options for stage 1 breast cancer:

• Chemotherapy – uses certain drugs to kill cancer cells throughout the body. These drugs are often given orally or intravenously but may also be administered into the spinal fluid surrounding the spinal cord. Chemotherapy is usually recommended before breast cancer patients undergo surgery to minimize a tumor or after surgery to kill any remaining cancer cells.
• Lumpectomy
• Mastectomy
• Radiation therapy
• Hormone therapy

Stage 2 Breast Cancer

This breast cancer stage also has two subcategories: 2A and 2B.

Stage 2A

A patient may be diagnosed with stage 2A breast cancer if:

• There is no tumor in the breast, but cancerous masses that are greater than 2 mm in diameter are growing in lymph nodes near the breastbone and in up to three lymph nodes (in and surrounding the armpit).
• The breast has a tumor under 2 cm in diameter and has also reached the axillary lymph nodes.
• The breast has a tumor that measures 2 to 5 cm in diameter that has not reached the axillary lymph nodes.

Stage 2B

A patient may be diagnosed with stage 2B breast cancer if:

• There is a tumor, measuring 2 to 5 cm in diameter, that is growing in the lymph nodes together with groups of cancer cells between 0.2 to 2 mm in diameter.
• The breast has a tumor, 2 to 5 cm in diameter. Cancer cells have also spread in the lymph nodes near the breastbone and/or in up to three axillary lymph nodes.
• The breast has a tumor over 5 cm in size. Cancer cells have not reached the axillary lymph nodes.

Treatment Options

Cancer doctors may recommend a combination of chemotherapy, surgery, hormone therapy and radiation therapy to treat stage 2B breast cancer.

Stage 3 Breast Cancer

This cancer stage has three subcategories: 3A, 3B and 3C.

Stage 3A

A patient may be diagnosed with stage 3A breast cancer if:

• There is no tumor within the breast, but a tumor is growing together with cancer cells in the lymph nodes near the breastbone or in four to nine axillary lymph nodes.
• The breast has a tumor, over 5 cm in diameter. Groups of cancer cells in 0.2 to 2 mm in diameter are also present in the lymph nodes.
• The breast has a tumor over 5 cm in size and cancer cells have reached the lymph nodes near the breastbone or one to three axillary lymph nodes.

Stage 3B

A patient may be diagnosed with stage 3B breast cancer if a tumor, regardless of size, has spread into the skin of the breast or the chest wall. This usually leads to swelling or to the development of an ulcer. The cancer may also spread to the lymph nodes near the breastbone or to up to nine axillary lymph nodes. It’s good to note that the doctor may diagnose an inflammatory breast cancer if the cancer has spread to the skin of the breast. 

Stage 3C

A patient may be diagnosed with stage 3C breast cancer if:

• There is no tumor within the breast, but a tumor of any size is already in the skin of the breast or the wall of the chest. Cancer cells may also be present in at least 10 axillary lymph nodes.
• Cancer has reached a patient’s lymph nodes below or above the collarbones, the lymph nodes near the breastbone or the axillary lymph nodes.

Treatment Options

Just like the earlier stages of breast cancer, stage 3 breast treatment care may also involve surgery, hormone therapy, chemotherapy and radiation therapy, depending on what the doctor thinks is best for the patient.

Stage 4 Breast Cancer

As the most advanced stage of breast cancer, this is when cancer has already spread not only to lymph nodes near the breast, but also to other organs and other lymph nodes in the body. Stage 4 breast cancer may be a recurrent condition.

Treatment Options

Treating stage 4 breast cancer may also include chemotherapy, surgery, radiation therapy and hormone therapy, if appropriate. A cancer doctor may also prescribe certain medications to help treat stage 4 breast cancer symptoms such as pain, neurologic conditions or mood concerns.

A Supportive Environment for Breast Cancer Care

If you’ve been diagnosed with breast cancer, getting care and treatment in a supportive community and environment is crucial to your journey. At MetroWest Medical Center, we have warm and compassionate doctors, nurses and staff who provide the best possible care and assistance to patients with breast cancer.

Our cancer center in Framingham is accredited by the American College of Surgeons’ Commission on Cancer, meaning that we meet the highest standards of care to help ensure an encouraging care experience for our patients.

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