Breast Cancer Prognosis
Understanding the Prognosis for Breast Cancer
Unlike the diagnosis, which provides information about the type of breast cancer you or the person in your care has and where it originated, the prognosis tells you how far the cancer has advanced and what happens next. You'll probably find yourself wanting hard-and-fast answers, while the doctor strives to give you a clear picture of the various scenarios and how they may play out. It's important to have patience -- with yourself as well as with the doctor -- and realize that learning about and understanding the prognosis will be an ongoing part of cancer treatment.
Understanding the stages of breast cancer
Most types of cancer, including breast cancer, are grouped into one of four stages:
Stage I The breast cancer is in one primary site and has not spread. Stage II The cancer has spread to nearby areas, but just around the primary site. Stage III The cancer has spread throughout the nearby area. Stage IV The cancer has spread, or metastasized, to other parts of the body, such as the liver, bones, or brain.
- Further distinctions Within these stages, doctors make even finer distinctions of "A" and "B" -- so a tumor that is stage IIA is less advanced than one that is stage IIB. The distinction between cancer stages is often a very fine one, but it can be critical to making treatment decisions and knowing what to expect.
- Reading the tests To determine a cancer's stage, doctors employ a series of tests. But once the test results are in, it becomes a matter of interpretation. This means doctors may disagree about the exact stage of this particular breast cancer and may even revise their opinions later as new evidence comes in. It's not uncommon for patients to be told their cancer is stage IV and fully metastasized, then have later tests reveal it to be stage IIIB with the metastases limited to one area of the body, meaning that it's more treatable.
- Another kind of staging system For many types of breast cancer in which a tumor is present, the doctor may use an even more detailed staging system called the TNM (Tumor, Nodes, and Metastases) system, created more recently by the American Joint Committee on Cancer (AJCC). In this system, each of the three categories is assigned an individual staging number, so a T1N1M0 breast cancer means the tumor that is stage I, with lymph node involvement that is also stage I, and stage zero, or no, metastases.
- Grading the cancer What can also be confusing is that, for some types of cancer, doctors use a grading system instead of or in addition to staging. Prostate cancer biopsy reports, for example, usually use what's called a Gleason scale to grade the malignancy of the tumor cells, with grade 1 being the least malignant and grade 5 the most malignant. Often they grade two different areas between 1 and 5 each, then add the two numbers together for a Gleason score that ranges from 2 to 10.