When is breast cancer staged?

NayaBean

I had a biopsy last week that came back showing cancer. This happened late in the week, so I do not have a surgeon yet. My primary care doctor will be calling me with a recommendation on Tuesday.

Not knowing anything, really, about breast cancer, I had thought it might be staged right away. I know now that that is not the case, but I still have no real clue as to the timing. So my question: how soon after a biopsy might it be before I know the stage? And who makes that determination -- the surgeon, I assume?

eviec1

Not sure if this is always the case, but this is what happened to me. I had a biopsy a few weeks ago, results came back (IDC). I met first with a surgeon who reviewed the pathology report from the biopsy and gave a preliminary estimate of stage based on presumed size, her guess on likelihood of node involvement, etc. Then I met with the medical oncologist who gave it an official clinical stage (based on the same, which is still largely speculative). However, the FINAL stage will only be known after surgery when they do the pathology report because only then will they really know the size of the invasive portion and node involvement, etc. So the surgeon or oncologist will likely make a guess about the stage, but that won't be final until after surgery.

NayaBean

Thank you, eveic1. That's very helpful.

Beesie

eviec1 is correct, with a couple of provisions.

Some surgeons and MOs provide a clinical (pre-surgery) stage, but many don't and just prefer to wait until after surgery to get the pathological stage.

However in some cases, when chemo is being given prior to surgery, clinical stage is all important, since staging can't accurately be done after surgery since hopefully the chemo has shrunk the tumor and possibly reduced the nodal involvement.

As for who determines the stage, I'd say that falls more with the MO, although you might get the stage from the surgeon at your first post-surgery appointment. Staging is not subjective, so with the information about tumor size and number of nodes affected (if any), and for prognostic staging, the grade, ER, PR and HER2 status, anyone can determine the stage.

And that leads to one more point. Traditional breast cancer staging is TNM staging, referring to tumor, nodes and metastasis. Three years ago breast cancer staging was expanded to include prognostic staging, which is based on TNM with the addition of tumor grade and hormone status (and in some cases, even the Oncotype score). Either staging method can be used but I believe most patients now receive only their prognostic stage.

Melbo

The NCCN guidelines are a great place to get started. They lay out the guidelines for staging and are used by a lot of doctors.

https://www.nccn.org/patients/guidelines/content/PDF/breast-invasive-patient.pdf

ElaineTherese

From my perspective, the most important thing to know about staging is whether you are early stage or Stage IV. Early stage breast cancer is treated with the intent of curing it. With Stage IV, it's all about managing it and keeping it from getting worse.

I will never know my "real" stage because I did chemo first. Ultrasound said my lump was 3.9 centimeters; MRI said it was 5 cm with a lovely satellite growing out of it. A fine needle biopsy showed that one lymph node was compromised. Under the old scheme of staging, I was considered stage IIIA. (Under the new scheme, it would be lower because the treatment for HER2+ cancer has made it very treatable.)

Because chemo wiped out all of the active cancer, I will never know the lump's true size, nor will I know how many lymph nodes were actually involved. And, I don't really care! Prognosis doesn't necessarily depend on stage.

((Hugs))

NayaBean

Thanks, melbo, for the NCCN link. Those guidelines are very informative.

And thanks to everyone for educating me about staging!

B-A-P

This is how it went for me:

I started out with DCIS based on duct excision and mammogram

Then had Breast MRI which was concerning as a node lit up too

then guided biopsy and Node Biopsy

Both positive for IDC- was at the very least stage 2 I believe

Because the node was positive i was sent for a Pet/CT to check for further spread- It was all clear except for 3 nodes and a teeny spot on my liver that never registered on the CT.. but it was invading my pec muscle- So the very least stage 3C i believe

Had MRI of liver - and they could see it, but it didn't behave 100% like a met so we started chemo to shrink everything amd would rescan half way. Repeat mri was inconclusive , so back to the pet scan. Spot no longer lit up and went away at the same rate as everything else. Therefore it was a met and I was stage 4. I was staged about 5 months after initial diagnosis, but we had an idea of what i was earlier.

It's not the same for everyone but this was my experience.

So sorry you are part of the club too. good luck with everything