The staging system of breast cancer in men depends upon the size of the tumor, its metastasis to lymph nodes and other body parts, and its biomarkers. The location or suspect area of cancer growth is evaluated by assessing the stage of the disease. The TNM staging system is used for determining the stages of breast cancer in men. There are five stages involving stages 0, which is noninvasive ductal carcinoma in situ (DCIS), and stages I through IV (1 through 4) for invasive breast cancer.
Stages of Breast Cancer in Men
Staging is the procedure of determining where the tumor is located, whether it has spread or not, and how it grows. While assessing the cancer stage, many factors are taken into account.
Doctors use diagnostic tests to discover cancer’s stage, so staging may not be complete until all tests are finished.
TNM staging system
The TNM system is the tool doctors use to describe the stage of Bladder cancer.
- T is for tumour – How large the tumour is and where is its location
- N is for nodes – Has cancer spread to lymph nodes, and if so, where and how many?
- M is for metastasis – Whether cancer has metastasized to other parts of the body.
There are five stages – stage 0, which is noninvasive ductal carcinoma in situ (DCIS), and stages I through IV (1 through 4), used for invasive breast cancer. The stage provides a standard method of describing cancer, so doctors can work together to plan the best treatments.
A stage may also be divided into smaller groups that help describe the tumour in even more detail.
TX- The primary tumour cannot be evaluated.
T0 (T plus zero)- There is no evidence of cancer in the breast.
Tis- This refers to carcinoma in situ. The cancer is confined within the ducts of breast tissue and hasn’t spread into the nearby breast tissue.
- Tis (DCIS)- DCIS is noninvasive cancer, but if not removed, it can develop into an invasive breast cancer later. DCIS means that cancer cells are found in breast ducts and have not spread past the layer of tissue where they began.
T1- The tumour in the breast is 20 mm or smaller in size at its widest area. This stage is then broken into four substages depending on the size of the tumour –
- T1mi – Tumour that is 1 mm or smaller.
- T1a – Tumour larger than 1 mm but 5 mm or smaller.
- T1b – Tumour larger than 5 mm but 10 mm or smaller.
- T1c – Tumour larger than 10 mm but 20 mm or smaller.
T2- The tumour is larger than 20 mm but not larger than 50 mm.
T3-The tumour is larger than 50 mm.
T4- The tumour falls into 1 of the following groups:
- T4a means the tumour has grown into the chest wall.
- T4b is when the tumour has grown into the skin.
- T4c is a cancer that has grown into the chest wall and the skin.
- T4d is inflammatory breast cancer.
Lymph nodes near where cancer started are called regional lymph nodes. Regional lymph nodes for breast cancer include:
- Lymph nodes located under the arm are called the axillary lymph nodes
- Lymph nodes above and below the collarbone
- Lymph nodes under the breastbone are called the internal mammary lymph nodes
Lymph nodes in other body parts are called distant lymph nodes.
NX- The lymph nodes were not evaluated.
N0- Either of the following-
- No cancer was discovered in the lymph nodes.
- Only areas of tumour 0.2 mm or smaller are in the lymph nodes.
N1- Cancer has spread to 1 to 3 axillary lymph nodes or the internal mammary lymph nodes. If cancer in the lymph node is larger than 0.2 mm but 2 mm or smaller, is it called “micrometastatic” (N1mi).
N2- Cancer has spread to around 4 to 9 axillary lymph nodes. Or has spread to the internal mammary lymph nodes but not to the axillary lymph nodes.
N3 – Cancer has spread to ten or more axillary lymph nodes. Or, it has spread to the lymph nodes located under the clavicle or collarbone. It may have spread to the internal mammary lymph nodes. Cancer spreads to the lymph nodes above the clavicle, the supraclavicular lymph nodes, described as N3.
If there is cancer present in the lymph nodes, knowing how many lymph nodes are involved help doctors plan treatment. The pathologist can determine the number of axillary lymph nodes containing cancer after being removed during surgery. It is uncommon to remove the supraclavicular or internal mammary lymph nodes during surgery. If there is cancer in these lymph nodes, treatments other than surgery, like chemotherapy, radiation therapy, and hormonal therapy, are used first.
The ‘M’ in the TNM system describes whether cancer has spread to other body parts, called distant metastasis. This is no longer considered as early-stage or locally advanced cancer.
MX- Distant spread cannot be evaluated.
M0- The disease has not metastasized.
- M0 (i+) – There is no clinical or radiographic evidence of distant metastases. Microscopic evidence of tumour cells is found in the bone marrow, blood, or other lymph nodes that are no larger than 0.2 millimetres.
M1 – There is evidence of metastasis to another part of the body, meaning breast cancer cells are growing in other organs.
Breast Cancer in men stages grouping
Doctors assign the cancer stage by combining the T, N, and M classifications, the tumour grade, and ER or PR and HER2 testing results.
The doctor will generally confirm the stage of cancer when the testing post-surgery is finalized, usually about 5 to 7 days after surgery 1. The cancer stage is primarily determined clinically when systemic or whole-body treatment is given before surgery, called neoadjuvant therapy. Doctors may refer stage I to stage IIA cancer as early-stages and stage IIB to stage III as locally advanced 2.
Stage 0 – Stage zero (0) describes a disease that is only in the ducts of the breast tissue and has not spread to the nearby breast tissue. It is also known as noninvasive cancer (Tis, N0, M0).
Stage IA- The small, invasive tumour has not spread to the lymph nodes (T1, N0, M0).
Stage IB – Cancer has spread to the lymph nodes, and cancer in the lymph node is larger than 0.2 millimetres but less than 2 millimetres in size. There is either no evidence of a tumour in the breast or the tumour in the breast is 20 millimetres or smaller (T0 or T1, N1mi, M0).
Stage IIA – Any 1 of these conditions-
- There is no evidence of a tumour in the breast, but cancer has spread to 1 to 3 axillary lymph nodes. It has not spread to distant body parts (T0, N1, M0).
- The tumour is 20 millimetres or smaller and has spread to 1 to 3 axillary lymph nodes (T1, N1, M0).
- The tumour is larger than 20 millimetres but not larger than 50 millimetres and hasn’t spread to the axillary lymph nodes (T2, N0, M0).
Stage IIB – Either of these conditions-
- The tumour is larger than 20 millimetres but not larger than 50 millimetres and has spread to 1 to 3 axillary lymph nodes (T2, N1, M0).
- The tumour is larger than 50 millimetres but has not spread to the axillary lymph nodes (T3, N0, M0).
Stage IIIA- The cancer of any size has spread to 4 to 9 axillary lymph nodes or internal mammary lymph nodes. It has not spread to other body parts (T, N2, M0). Stage IIIA may also be a tumour larger than 50 mm spread to 1 to 3 axillary lymph nodes (T3, N1, M0).
Stage IIIB- The tumour has spread to the chest wall or is diagnosed as inflammatory breast cancer, or has caused swelling or ulceration of the breast. It may or may not have spread to up to nine axillary or internal mammary lymph nodes. It has not spread to other body parts (T4; N0, N1, or N2; M0).
Stage IIIC- A tumour of any size spread to 10 or more axillary lymph nodes, the internal mammary lymph nodes, or the lymph nodes under the collarbone. It hasn’t spread to other body parts (T, N3, M0).
Stage IV (metastatic)- The tumor can be of any size and has spread to other organs, like the bones, brain, lungs, liver, distant lymph nodes, or the chest wall (any T, any N, M1). Metastatic cancer found when the cancer is first diagnosed occurs about 5% to 6% of the time. This can be called de novo metastatic breast cancer. Most of the time, metastatic breast cancer is found after a previous early breast cancer diagnosis. Recurrent- Recurrent cancer is cancer that has come back after treatment. The disease can be found in the colon, rectum, or another body part. If cancer returns, there will be another round of tests to know the extent of the recurrence. These tests and scans are usually similar to those at the original diagnosis. this is basic Breast Cancer in men stages grouping
- 1.Fentiman IS, Fourquet A, Hortobagyi GN. Male breast cancer. The Lancet. Published online February 2006:595-604. doi:10.1016/s0140-6736(06)68226-3
- 2.Giordano SH, Buzdar AU, Hortobagyi GN. Breast Cancer in Men. Ann Intern Med. Published online October 15, 2002:678. doi:10.7326/0003-4819-137-8-200210150-00013