FAQs about Staging

This content has been reviewed and approved by

William J. Gradishar, MD FACP
Director, Breast Medical Oncology, Professor of Medicine
Robert H. Lurie Comprehensive Cancer Center
Northwestern University Feinberg School of Medicine

I have just been diagnosed with breast cancer, but I don't know my "stage." How many stages are there and what does it mean?

Stage is the extent of the spread of a cancer. Breast cancer is divided into four stages. The stage depends on how large the cancer is, how many lymph nodes are involved, and whether the cancer has spread outside the breast and/or chest wall. The stage of your cancer helps your doctor determine the appropriate treatment. Talk to your doctor about the stage of your cancer and what it means for your treatment and prognosis.

Stage IV breast cancer means that it has already spread to other parts of the body beyond the confines of the breast, such as the lungs, liver, bone, brain, skin, etc. Although stage IV disease is highly treatable, it is generally not considered curable.

There have been, however, occasional cases of long-term survival—particularly when breast cancer spreads only to one other part of the body and is removed from both sites (breast and the distant site), rendering the patient disease free. It should be kept in mind that stage IV breast cancer does not necessarily mean imminently terminal disease. Twenty percent of those with stage IV disease are alive at 5 years, 5 percent to 10 percent may be alive at 10 years, and 1 percent to 2 percent may be alive at 20 years. Treatment for stage IV disease should be sought aggressively and proper management can make a difference in prolonging life.

Staging is a process of determining the extent of spread of any given cancer. This determines the seriousness of the disease and contributes to decision making, estimating survival probability, and determining the approach to therapy. In the case of breast cancer, one is interested in looking at all of the common areas where this cancer can spread, such as bone, liver, and lungs.

Multiple tests can be performed to examine where the cancer has spread. It is important to bear in mind that very early-stage breast cancer is quite unlikely to have spread beyond the breast tissue, so you usually only need a physical exam and routine blood tests unless you're having specific symptoms.

Depending on the tumor size, involvement of lymph nodes in the armpit, and microscopic features of the tumor, the likelihood of spread may increase. For a more thorough search, several tests may be performed, including CT scans of the chest, abdomen, and pelvis to look at internal organs, and a bone scan to look at the skeleton. This series of tests is not applicable to everyone, and your treating physician is best able to determine which tests are right for you. Depending on the results of the tests, additional tests may be ordered. After completion of this exercise, you will be categorized as having stage I, II, III, or IV breast cancer.

Breast cancer is a group of diseases that all share two common features: location in the breast and uncontrollable growth or abnormal accumulation of cells. Beyond that, there is tremendous variation in its behavior and natural history. Every patient is different, and no one should extrapolate their prognosis from the experience of another patient.

Your doctor is correct in pointing out that your disease is not expected to behave as your neighbor's. For example, women who have a long interval from primary diagnosis to recurrence of the cancer or have disease only in bones or soft tissue as opposed to the lungs and liver, have a longer survival time. There are many other such factors that may put you in a good risk or poor risk category for survival. Only your doctor can try to put these factors together and give you a rough guess. It is important to realize that after this exercise, this guess remains a very rough estimate, and no one can pinpoint your expected length of survival.

I'm assuming you had early-stage breast cancer (stage I-III) and underwent curative surgery. Most patients do not and should not have scans before chemotherapy in early-stage breast cancer in the absence of symptoms. The scans done before your chemotherapy tell us about the extent of the spread of disease, so that the physician can determine your stage properly and pick the right therapy. Once your therapy is completed for early breast cancer, there is no rationale for scanning again in the absence of symptoms because all of the visible disease was removed with surgery.

It has been shown that diagnosing a relapse early versus late does not have any real impact on survival time. Therefore, it would be a waste of your time and resources to have those scans. However, patients who have a known spread of cancer (stage IV) and are being treated to limit the effects of the disease, do undergo periodic scans. For example, CAT scans may be done every 3 to 4 months and bone scans every 3 to 6 months to see whether the treatment is still working.

We stage cancer by examination and imaging (clinically) before starting the treatment. The stage does not change at the end of treatment. This may differ if your staging was done by physical examination and imaging only and then you received chemotherapy to shrink the tumor in your breast before surgery. In this case, your stage may be revised after surgery, based on what was found during the operation and under the microscope.