Cancers are classified by stage. Staging a cancer is the process of finding out how far the cancer has progressed when it is diagnosed. Information collected in staging is used to determine prognosis (outlook for cure versus the chance of cancer coming back or spreading to other organs) and to develop a treatment plan.

The stage of a cancer tells you how far the cancer has spread.
 

Stage 0

Means that the cancer has not spread at all. It composed of cancer cells but is still in situ, i.e. confined to the site [lobule or duct] where it started. 15 to 20 percent of breast cancers are now diagnosed at this very early stage of Carcinoma In-Situ or CIS.

Stage I

Means that the cancer has infiltrated outside the duct into the surrounding fat, but it is less than 2 centimetres across, and has not spread to lymph nodes or anywhere else.

Stage II

Means that either (a) the cancer is more than 2cm across, or (b) it is still less than 2cm but has metastasised to the lymph nodes in the armpit [axilla].

Stage III

Means it has not only jumped to the lymph nodes but is outside the nodes as well, so they are stuck together.

Stage IV

Means the cancer has metastasised [spread] to distant areas, often to lungs, bone or ovaries. This usually happens when invading cancer cells insinuate themselves through the wall of a blood vessel, so they get swept off in the blood stream to anywhere in the body.

The outcome of your cancer, how long you survive, depends partly on how far the tumour has spread when it is first discovered. And this will depend mostly on how vigilant you are at examining your breasts to check for any little lump, and slightly on the size of your breasts, as it will be easier for you to feel a tumour while it is still small in a small breast.

Women with low-stage tumors have a better chance of surviving breast cancer than women with high-stage tumors. Recent findings indicate that 5-year survival rates are 96% for limited, low-stage breast cancers (stage 0, stage I, and some stage II cancers), 75% for breast cancers that have invaded the surrounding tissue (stage II & III cancers), and only 20% for breast cancers that have metastasized (stage IV cancers). Unfortunately, survival rates are lower and breast cancer stages tend to be higher among women from low socioeconomic backgrounds.

Read Inspirational Success Messages from Breast Cancer Warriors and Survivors

The breast also has a lymphatic system, which is an essential part of the immune system in filtering harmful substances and fighting infections or cancers.

The lymphatic system consists of bean-shaped lymph nodes (the main ones are in the neck, armpits and groin) which are linked by vessels that contain lymph. Lymph flows around the body in these vessels in the same way blood flows in the veins and arteries. The lymph nodes filter lymph fluid and trap foreign materials. Any fluid absorbed by the lymphatic system passes through at least one lymph node before it returnsto circulation. Lymph is a clear whitish/yellowish fluid that contains white blood cells (lymphocytes), proteins, and some red blood cells.

The lymph nodes contain lymphocytes which help destroy foreign bacteria or other harmful cells. The lymph nodes may become enlarged or swollen when they fight an infection since they must produce additional white blood cells. Sometimes, the lymphatic vessels will become visible as thin red lines along a limb as the result of an infection (known as lymphangitis). Lymph nodes may also swell from the formation of an abscess (closed pocket filled with pus) in the nodes or if they contain cancer cells.

Whether the lymph nodes contain cancer cells is an important factor when staging breast cancer, determining treatment, and predicting survival. Though breast cancer has the potential to spread to other regions of the body first, it most commonly spreads first to the axillary (underarm) lymph nodes. This is known as regional spread. From there, the breast cancer can (spread) systematically to other areas of the body (such as the bone, liver, lung, or brain).

The importance of lymph nodes in staging breast cancer

Whether the lymph nodes contain cancer cells is an important factor when staging breast cancer, determining treatment, and predicting survival. Though breast cancer has the potential to spread to other regions of the body first, it most commonly spreads first to the axillary (underarm) lymph nodes. This is known as regional spread. From there, the breast cancer can (spread) systematically to other areas of the body (such as the bone, liver, lung, or brain).

If a woman is diagnosed with invasive breast cancer (cancer that has invaded past the wall of the breast duct or lobule and into surrounding breast tissue), it is necessary to examine the axillary lymph nodes to determine whether they contain cancer.

The standard way to examine the lymph nodes is to perform an axillary node dissection. This procedure is often done during the same operation as a lumpectomy or mastectomy and involves removing 10 to 30 lymph nodes for pathological examination under a microscope. The most common side effect of an axillary node dissection is lymphedema (chronic swelling) of the arm, which may affect up to 10% of patients. Lymphedema occurs when the normal process of draining lymph from the arm is disrupted or blocked, causing fluid to build up in the arm.

Another surgical option called a sentinel node biopsy is now being used on select breast cancer patients to determine whether breast cancer is present in the lymph nodes. A sentinel node biopsy involves removing only one to three sentinel lymph nodes (the first nodes in the lymphatic chain).

Studies continue to show that removing fewer lymph nodes may decrease the chance of developing lymphedema, though research on sentinel node biopsy is ongoing. The degree to which sentinel node biopsy is effective in determining whether the lymph nodes contain cancer has been shown in research to be directly related to the experience of the surgeon who is performing the procedure. If the sentinel node(s) is found to be cancerous upon removal, a complete axillary node dissection is usually performed.

Good to know!

It is important to remember that even if your doctor tells you that a biopsy is needed, most women who do it do not have breast cancer. In the US, about 1 in 10 women who have biopsies are diagnosed with cancer.

Lymphedema is a condition in which fluid collects in the arm, causing it to swell. It may affect one arm or leg, but sometimes it can can also involve both arms or both legs. Some 15% to 20% of breast cancer patients develop lymphedema after treatment, usually as a result of treatment to the lymph nodes in the armpit. Lymphedema often develops within a year or two after surgery, though the risk for developing it never disappears.

The swelling occurs when a blockage in your lymphatic system prevents the lymph fluid in your arm or leg from draining. As the fluid accumulates, the swelling continues. Recent studies suggest, however, that the growing use of the less invasive sentinel node biopsy may lead to lower rates of lymphedema after treatment.

Your lymphatic system is crucial to keeping your body healthy. It circulates protein-rich lymph fluid throughout your body, collecting bacteria, viruses and waste products. These substances are carried through your lymph vessels, which lead to lymph nodes. The wastes are then filtered out by lymphocytes — infection-fighting cells that live in your lymph nodes — and ultimately flushed from your body. No cure for lymphedema exists. But lymphedema can be controlled. Controlling lymphedema involves diligent care of your affected limb.

Signs and symptoms:

• Swelling that ranges from mild, hardly noticeable changes in the size of your limb to extreme swelling that can make it impossible to use the affected arm or leg.
• A feeling of heaviness or tightness in your arm or leg.
• Restricted range of motion in your arm or leg.
• Aching or discomfort in your arm or leg.
• Recurring infections in your affected limb.
• Hardening and thickening of the skin on your arm or leg.

Causes of lymphedema

Any condition or procedure that damages the lymph nodes or lymph vessels can cause lymphedema. Causes can include surgery, radiation treatment, cancel cells that block lymphatic vessels, infection and injury.

Treatment options

Lymphedema cannot be cured. Treatment for lymphedema focuses on minimizing the swelling and controlling the pain, including exercises, massage, pneumatic compression, compression garments or surgery.

If you're at risk of developing secondary lymphedema, you can take measures to help prevent it. If you've had or are going to have cancer surgery, ask your doctor whether your particular procedure will involve your lymph nodes or lymph vessels. Ask if your radiation treatment will be aimed at any of your lymph nodes, so you will be aware of the possible risks.

How to lower your risk of lymphedema

• Protect your arm or leg. Avoid any injury to your affected limb. Cuts, scrapes and burns can all invite infection, which can cause lymphedema. If possible, avoid medical procedures, such as blood draws and vaccinations, in your affected limb.
• Rest your arm or leg while recovering. After cancer treatment, avoid heavy activity with that limb. Early exercise and stretching are encouraged, but avoid strenuous activity until you've recovered from surgery or radiation. Here are some ideas on suitable exercises and how to do them.
• Avoid heat on your arm or leg. Don't apply heat, such as with a heating pad, to your affected limb.
• Elevate your arm or leg. When you get a chance, elevate your affected limb.
• Avoid tight clothing. Avoid anything that could constrict your arm or leg, such as tight fitting clothing and, in the case of your arm, blood pressure readings. Ask that your blood pressure be taken in your other arm.
• Keep your arm or leg clean. Make skin care and nail care high priorities. Inspect the skin on your arm or leg every day, keeping watch for changes or breaks in your skin that could lead to infection.

The most common misconception about palliative care is that it is only provided or is available to a person who is dying or is very close to death. In reality, palliative care is the active, holistic care of a patient with an advanced progressive illness, dealing with not just the physical aspects of the disease, but also psychological and social issues.

The main goal of palliative care is to achieve the best quality of life for the patient and the family living with breast cancer. For the patient, this means relieving common symptoms that may be experienced including pain, shortness of breath, lack of appetite, weakness, anxiety and depression.

Palliative care is usually provided by an interdisciplinary team of professionals who work very closely. They may include a nurse, physiotherapist, social worker, occupational therapist, nutritionist, volunteer and physician. They focus on many aspects of continuous care that help alleviate suffering not just at the hospital or clinic, but also at home and for as long as possible.

Palliative care is an integral part of hospice. Hospice is a special type of care meant to provide comfort and support to patients and their families when a life-threatening illness, such as cancer, no longer respond to treatment and a cure no longer the possible objective in treatment.

For more information on hospices in Malaysia, click here.