stage 1a 1b?????

MsKarin

had sent a PM before reguarding this.

A bit confused. When filling in my Diagnosis Information, the pull down box for stage of cancer has a stage 1a and 1b. What are they? Thought stage 1 was only stage 1. Have never heard of them and can't even find reference to them doing a search on your home page. Why are they there?

Thanks, Karin

The reply was:

Karin,

You are correct.  There is no stage 1a and 1b for breast cancer. Thank you for bringing this to our attention. We will make the appropriate changes to the diagnosis information so this issue does not come up again for other new members. 

Best,

Tami, moderator 

Just wanted to bring it to your attention: this has still not been changed. Karin

I

dalycity

Ms. Karin and Tami Moderator:

Actually, I am really a Stage 1c; and was surprised that's not a choice, but Stage 1a and 1b are.

Then on the size of the tumor, mine is really 1.2 cm, but it won'tt allow me to type that in; instead it gives me a choice of a range (1-1.9 cm) and in my signature line, it shows tumor as 1 cm.  I wonder if there's a way for you to change some of the choices so that our biography and diagnose are more clear.  Thank you!

MarieKelly

"There is no stage 1a and 1b for breast cancer."

I think you might be mistaken about that. The AJCC cancer staging manual lists subcategories under T1 as being T1mic, T1a, T1b, T1c.

wishiwere

Yep, same thing here.  I'm considered stage 1c b/c of the tumor (each were over 1cm and one 1.7).  My thoughts is we also need to be able to put on there, the multicentric as I was dx with one ILC/LCIS and the other was IDC/DCIS. 

This is the site I had about staging early BC:  http://www.cancer.gov/cancertopics/pdq/treatment/breast/HealthProfessional/page4

It includes this information.  Is this outdated perhaps, or what?

T1: Tumor not larger than 2.0 cm in greatest dimension

• T1mic: Microinvasion not larger than 0.1 cm in greatest dimension
• T1a: Tumor larger than 0.1 cm but not larger than 0.5 cm in greatest dimension
• T1b: Tumor larger than 0.5 cm but not larger than 1.0 cm in greatest dimension
• T1c: Tumor larger than 1.0 cm but not larger than 2.0 cm in greatest dimension

MsKarin

As far as I understand it the 1a, 1b, 1c is referring to the tumor size and NOT the STAGE of the Cancer.

wishiwere

Well, yes and no.  It's like stage 2a or b.  The a, b, c, refer to the subcatories of each stage.  From what I understand in this AJCC Cancer Staging Manual (new Sixth edition) is that they felt the need was there, b/c they were finding so much smaller tumors and the need for adjuvunct tx were not necessary sometimes for smaller tumors so they wanted to change this to reflect that.  Don't quote me on that, but the site I sent explains it all.

In other words.  The 1 is the stage and the a,b, or c tells the size.  Your stage is based on the tumor size, the N or lymph node involvement and whether there is M, metastasis involved.  If you had more nodes or a larger tumor you might be considered 11b as I read it. 

Does this help?

There is such a big difference between a 3 mm and a 1.9 cm tumor in treatment, you know?  This is why they did, I think.  Or I understand from what I read, anyway.  HOpe it helps.

Beesie

Karin, technically I think you are right.  See page 59 of the NCCN Physician's Guidelines:

http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf

The stages they mention are:

Stage 0: Tis, N0, M0

Stage I: T1*, N0, M0   

Stage IIA: T0, N1, M0   and   T1*, N1, M0   and   T2, N0, M0

Stage IIB: T2, N1, M0   and   T3, N0, M0

Stage IIIA: T0, N2, M0  and   T1*, N2, M0   and   T2, N2, M0   and  T3, N1, M0   and  T3, N2, M0

Stage IIIB:  T4, N0, M0  and  T4, N1, M0   and   T4, N2, M0

Stage IIIC: Any T, N3, M0

Stage IV:  Any T, Any N, M1

* includes T1mic

So they include Stage IIA and IIB but only one Stage I.  The distinctions within the tumor sizes within Stage 1 are subcategories of the "T" (see page 57 of the pdf) but they don't appear to be broken out within the staging itself.  Personally, I think it would be clearer if these tumor size differences were noted within the staging so that there was a Stage Ia, Ib, etc..  But until then, I say that I am Stage I, T1mic.  Similarly, my mother is Stage I, T1b.

Moderators

Thank you for the reminder about this issue.  I am sending your message to our technical support team again.

Best,

Tami, moderator 

Moderators

Update.... We are working on making some changes to the my home page, including your input, and will make a formal annoucement once the changes have been made.Thank you for the great suggestion!  Tami and Melissa, moderators 

stillrusty

Beesie and wishiwere

Thanks for those great web links. I wish I had those earlier! They are very helpful, and answer a lot of the questions I had.

wishiwere

Beesie, if you read page 57 of that same site you posted http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf , it says, that when measurements of mammographic or pathologic are used, that the subsets of T1 may be used. Otherwise, with only physical exam, then the subsets are not used.  Seeing as how each of us basically knows that pathologic report, I would think that would be used.  I know my mast report states pT1c, and thus reflect that when I discuss it. 

Beesie

wishiwere,

The section that you are referring to is specific to "classifying the primary tumor".  I agree that the primary tumor can and should be classified as finely as possible.  The difference between a T1a and a T1c can be quite significant when it comes to treatment.  But tumor classification is only one part of staging; it is not the staging itself.  It's just the "T" within the T, N, M that makes up the stage determination.

When you move on in this report to the actual staging (page 59), you can see that there is no Stage IA or IB or IC.  There is only Stage I.  The extra level of detail from the tumor classification is not carried over into the overall staging.  All the "T"s are included as Stage I.

It's also interesting to note that while Stage II is broken down into Stage IIA and Stage IIB, this does not correlate to the tumor size or "T" classification.  In fact, the tumor classification includes only T2 - there isn't a T2a or a T2b.   The Stage IIA and Stage IIB classifications might include anything from T0 to T3.  So what this means is that it's a bit of an apples and oranges discussion to try to relate the "T" classifications to a specific Stage.  The fact is that someone who is T1b could be Stage I or they could be Stage IIA or Stage IIIA or Stage IIIC or Stage IV.

Personally I think it would be clearer if there were more subclassifications within Stage I.  I'm not arguing with the logic of that however, to the point in the original post, I'm simply confirming that it appears that the Karin and the Moderators are right.  At this time, the 'official' staging classifications do not include a Stage IA or IB.

ChloeZ

Hi,

I just entered my diagnosis info today in my profile, and the choices for stage I tumors still haven't been updated.  (stage I includes Ia and Ib but not Ic).  My doctor told me I was Ic, but that still is not a choice.

Thanks,

Chloe

Beesie

Chloe,

Perhaps your doctor meant that your tumor was T1c, which is an invasive tumor which is more than 1cm but not larger than 2cm in size. 

As per the NCCN treatment guidelines, there is actually no such thing as Stage Ia or Stage Ib.  There is only Stage I.  But within Stage I, there are 4 different tumor sizes - T1mic, T1a, T1b and T1c.

http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf   See pages 57-59

lemont

I just entered my diagnosis and the drop-down list still hasn't been corrected.

MaryNY

Where do you enter your diagnosis? Is it the signature option under "edit my profile." But I don't see any dropdown there.

I'm guessing that people don't enter their diagnosis until they have their final pathology report post-surgery? What is the Dx date -- the date of the first abnormal mammo, date of biopsy or date of path report following biopsy?

SolsticeAshore

I found this page because I had to Google to find out about stage 1a or 1b when the other information on the site just talked about stage 1. It's scary and confusing enough to get the diagnosis without having the confusion added to by the forum. How about fixing it please?

Moderators

SolsticeAshore, thanks for raising this again after so long! We'll check into what happened back in 2009, and look into getting clarification.

The Mods

Moderators

Hi Solstice and all,

We continue to be incredibly grateful for your diligence in your research and experiences. You are correct, the National Cancer Institute has defined these subcategories, and we've included them in the content on our main Breastcancer.org site, with definitions of each Stage Ia and Ib.

Along with the content update, we'll also be including the option to select Stage Ia or Ib as part of your diagnostic signature with the tech upgrade we're looking to accomplish in the next few months.

Thank you for bringing this to our attention (again)!

--The Mods

Beesie

The change of Stage I to include both Stage IA and Stage IB came out in the AJCC Staging Manual in August 2010, and was retroactive to January 1st 2010.  Everyone diagnosed since then who is Stage I is either an "A" or a "B".  Solstice, here's another more recent discussion thread where this was discussed, which might be helpful to you:

Topic: Is there indeed a stage 1a and 1b? 

Mods, since you are planning to update the options so that women can select either Stage IA or IB as part of their diagnostic signature, can you also add DCIS-Mi as a type of breast cancer, for women who have that diagnosis (as I do).  Without that option being available, our diagnosis lines can be confusing since we are Stage I but with such a small amount of invasive cancer, most of us choose to check off "DCIS".  But of course there is no such thing as DCIS Stage I. 

To that point, is there any way to adjust the system so that only "real" diagnoses can show up?  We have a lot of women on this board whose diagnosis lines say DCIS Stage I or II or III, when according to the staging guidelines, pure DCIS is always Stage 0.  Similarly, we have mismatches between the tumor sizes and nodal status and stage.  For example, if the tumor was less than 2cm and there were no positive nodes, then Stage II isn't correct - the stage is Stage IA.  While I'm glad to see the addition of IA and IB, I suspect that a lot of women who have T1b tumors but who are Stage IA will now check off that they are Stage IB.  In the scheme of things these mismatches aren't a big deal, but particularly on the DCIS forum there are often women who get very concerned because they see so many women on this board whose diagnoses lines indicate that have more advanced DCIS diagnoses - which of course isn't really the case. 

Anything that can be done to try to drive more accuracy would be helpful, not just for those reading other people's diagnosis lines, but I'm sure also for those who misunderstand their staging.   

voraciousreader

I was diagnosed Stage 1c in January 2010. I would think that while it is appropriate to update the website to reflect recent changes, I think there needs to be a place where the "old" classifications exist.