Breast cancer and staging

Question 1

List the different Tumour (T) stages

Answer 1

T-x: Primary tumour cannot be assessed
T-0: No primary tumour
T-is: Carcinoma in situ
T-1: Tumour up to 2cm diamter
T-2: Tumour between 2-5cm
T-3: Tumour greater than 5cm
T-4: Tumour is beyond breast tissue
- T4a: Chest wall
- T4b: Skin (ulcerating, macroscopic nodules, peau d’orange)
- T4c: Both a and b
- T4d: Inflammatory carcinoma

Question 2

List the Nodal (N) stages

Answer 2

N-x: Cannot be assessed
N-0: No involved nodes
N-1: Involved mobile ipsilateral axillary nodes
N-2a: Matted ipsilateral axillary nodes
N-2b: Ipsilateral internal mammary nodes only without axillary nodes
N-3a: Ipsilateral infraclavicular nodes
N-3b: Ipsilateral internal mammary nodes and axillary nodes
N-3c: Ipsilateral supraclavicular lymph nodes

Question 3

List the different metastases (M) stages

Answer 3

M-X: Cannot be assessed
M-0: No metastasis
M-1: Metastasis

Question 4

Where are the common breast cancer metastasis sites

Answer 4

3L’s: Lymphnodes, Liver, Lungs
2B’s: Brain and bones (especially the lower vertabrae)

Question 5

Explain the metastatic staging work-up

List what has to be done

Answer 5

Full blood count
Liver function tests
Calcium: Can be elevated
Chest X-ray
Abdominal ultrasound
CT scan
Nuclear medicine

Question 6

Explain the overall stages of cancer

Answer 6

Stage 1: Early (only T1 lesion)
Stage 2: Large but contained
Stage 3: Locally advanced (T3 or higher, N2 or higher)
Stage 4: Systemic spread (M1)

Question 7

What are the management options for breast cancer

Answer 7

Surgery
- Treatment: Modified radical mastectomy, Breast conserving surgery
- Palliative

Radiation
Chemotherapy: Adjuvent, Neoadjuvent
Hormonal