Stage and grade of breast cancer
When breast cancer is diagnosed, your doctors work out what stage it is. The stage means the size of the cancer and how far it has spread. We use staging information to help us plan the right treatment and understand what the aim of treatment is how well treatment may work.

TNM staging system
The TNM staging system describes breast cancer, providing information about the diagnosis:
T – the size of the tumour
N – whether the cancer has spread to the lymph nodes
M – whether the cancer has spread to other parts of the body

This information is then summarised as a stage

Ductal carcinoma in situ (DCIS) is sometimes described as stage 0. Other stages of breast cancer describe invasive breast cancer and include:

  • stage 1 – the tumour measures less than 2cm and the lymph nodes in the armpit are not affected. There are no signs that the cancer has spread elsewhere in the body
  • stage 2 – the tumour measures 2 to 5cm, the lymph nodes in the armpit are affected, or both. There are no signs that the cancer has spread elsewhere in the body
  • stage 3 – the tumour measures 2 to 5cm and may be attached to structures in the breast, such as skin or surrounding tissues, and the lymph nodes in the armpit are affected. There are no signs that the cancer has spread elsewhere in the body
  • stage 4 – the tumour is of any size and the cancer has spread to other parts of the body (metastasis)

This is a simplified guide. Each stage is divided into further categories: A, B and C. If you're not sure what stage you have, talk to your doctor or cancer nurse specialist.

Grades of breast cancer
The grade describes the appearance of the cancer cells, this often tells us how useful different treatments may be.

  • low grade (G1) – the cells, although abnormal, appear to be growing slowly
  • medium grade (G2) – the cells look more abnormal than low-grade cells
  • high grade (G3) – the cells look even more abnormal and are more likely to grow quickly

Breast Cancer specific tests
Once a diagnosis of Breast cancer is made there are additional tests that are done to the cancer specimen in the laboratory to understand better how your cancer may respond to treatment. The results of these tests can give your doctors a more complete picture of the type of cancer you have and how to treat it.

Hormone receptors
In some cases, breast cancer cells can be encouraged to grow by hormones that occur naturally in your body, such as oestrogen and progesterone. We may say that your Breast cancer is 

  • ER positive – which means your cancer has receptors that are sensitive to oestrogen 
  • ER negative – which means your cancer does not have any of these oestrogen receptors
  • Or mildly ER positive – in that your cancer has receptors and responds to oestrogen to only a small extent.
  • PR positive – which means your cancer has receptors that are sensitive to oestrogen 
  • PR negative – which means your cancer does not have any of these oestrogen receptors
  • Or mildly PR positive – in that your cancer has receptors and responds to oestrogen to only a small extent.

If your Cancer is ER or PR positive, we may talk to you about hormone manipulation treatment. If your cancer is mildly ER / PR positive we may still talk about whether this may be a treatment option for you.

HER2 testing
Another test that is done in the laboratory looks to see if your cancer has HER2 receptors, meaning that your cancer may be encouraged to grow by a protein called human epidermal growth factor receptor 2 (HER2). 

If your cancer is HER2 positive we may recommend a treatment with a medicine that blocks the HER2 receptors so that the HER2 protein is stopped from encouraging your cancer to grow. This is known as targeted therapy.

Click here to read more on diagnostics.

Genetic Testing in Breast Cancer

These links tell you about genetic testing in breast cancer. If you would like further information, please contact the Institute of Genetic Medicine at Centre for Life Telephone 0191 2418600 or email geneticcounsellorenquiries@nhs.net

Breast Cancer Now -Genetic testing for altered breast cancer genes

Macmillan Cancer Support -Family history, genes and cancer risk
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