Breastcancer staging

In order to plan your treatment, your doctor will determine what stage of cancer you have, and what parts of your body are affected.

Staging of breast cancer can seem complicated, and if your head is still spinning from the diagnosis, it can be hard to take in everything you’re told.

Breast cancer is described in terms of stages and grades. There are also features of the breast cancer cells (e.g. positive and negative receptor status) that affect how they react to certain hormones and growth factors.

Using tissue from your biopsy and/or surgery, your doctor will order a pathology report. Your report will contain information about these stages, grades and features.

The results can help you and your doctor to plan the most appropriate treatment. It can also help your doctor to give you an idea of the prognosis (your chance of achieving a good outcome). Here are some of the questions you need to ask about your pathology report:

What stage of breast cancer do I have?

The stage of your breast cancer is a way of describing how much cancer is in your body.

Stage 0 breast cancer

  • Ductal carcinoma in situ (DCIS) consists of cancerous cells found inside the lining of your breast ducts. They haven’t yet spread outside the ducts and cannot spread to lymph glands or around the body.
  • Lobular carcinoma in situ (LCIS) features cancerous cells in both the ducts and lobules of the breast. It doesn’t spread but it’s a warning of increased breast cancer risk.

Stage I and II breast cancer

  • Invasive breast cancer (early breast cancer). This type of cancer has spread into your breast tissue and possibly, the nearby lymph nodes in your armpit. You may be able to feel a lump in your breast.

Stage III and IV breast cancer

  • Locally advanced or metastatic breast cancer.

What grade of breast cancer do I have?

The grade of breast cancer is a way of measuring how different to normal tissue the cancer cells look under the microscope. It helps to measure how fast the cancer is growing.

Grade 1. The cells look similar to normal cells and they’re slow growing

Grade 2. The cells look different to normal cells and are growing faster than Grade 1 cells

Grade 3. The cells look very different to normal cells and they’re growing fast.

A higher grade means it’s more likely your doctor will recommend chemotherapy, hormonal therapies and targeted therapies in addition to surgery.

What do the positives and negatives mean?

The biopsy is positive: You have breast cancer.

Positive lymph nodes: There are cancer cells in one or more lymph nodes in your armpit.

Oestrogen receptor positive: The hormone oestrogen affects the growth of your breast cancer.

Progesterone receptor positive: The hormone progesterone affects the growth of your breast cancer.

HER2 positive: The cells have high levels of a protein called HER2 that affects how quickly cells divide. This type of breast cancer may respond to certain targeted therapies.

Triple negative: There are no oestrogen, progesterone or HER2 receptors in your cancer.

Negative margins: after your surgery, there were no cancer cells found at the edge of the tissue that was removed. It means that you don’t need further surgery.

About genomic assays

A genomic assay is a test that you can have to predict the likelihood of your breast cancer recurring after surgery. You doctor may recommend a genomic assay if your cancer is oestrogen or progesterone-receptor positive and/or if you have less than 4 positive lymph nodes. If the assay shows a high likelihood that the cancer will recur, then you’ll probably benefit from chemotherapy after your surgery.

Genomic assays are complex, expensive (up to $4,500) and not covered by Medicare or your health insurance. If you want to have a genomic assay, ask your doctor to refer you to a medical oncologist.

Ask for a copy of your pathology report, so you can take it home and read it in your own time.