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TNM Staging, Cancer Stages

What is TNM Staging in Breast Cancer

One day I met, one of my colleague, and I am so surprised, she was so happy. Because she got all answers of her all question and all doubt gets cleared. I remember, that days when she was detected breast cancer. When she heard word cancer, she lost. But cancer is very big for her. She got confused about TNM staging. Her doctor explained her related to cancer and its stages, treatment etc.

Let’s have some knowledge related to cancer it’s staging. Staging a way of describing cancer and where it is located. How much it has grown and spread. Staging of cancer helps doctor to decide treatment. There are the different stage descriptions for different types of cancer.

TNM Staging System

TNM is most common and important staging for description of the cancer.

Tumor (T)

In TNM system, the “T” gives information about tumor size and location. Some groups are divided into smaller group, which helps to more information.

TX – The primary tumor cannot be evaluated

T0 – There is no evidence that cancer in the breast

Tis – Carcinoma in situ. The cancer is confined within the ducts or lobules of the breast tissue and it is not spread into the surrounding tissue of the breast. The carcinoma in situ also divided into three tyeps.

Tis (DCIS) – DCIS is a non-invasive cancer. This means the cancer cells have been found into the breast ducts and have not spread past the layer of tissue from when it began. This cancer should remove immediately otherwise can be developed invasive breast cancer.

Tis (LCIS) – It is not a cancer, but abnormal cells found in the lobules and glands of the breast. If it is not treated within time limit, then there would be chances of developing risk of cancer.

Tis (Paget’s) – Paget’s disease is a nipple disease. Cancer occurs only in the skin cells of the nipple. Sometimes this disease associated with another invasive breast cancer.

T1 – This is invasive tumor. It could be 20 millimeter (mm) or smaller in size at its widest area. This stage again divided into three substages of tumor.

T1a is a tumor which is larger than 1 mm, but 5 mm or smaller

T1b is a tumor which is larger than 5 mm, but 10 mm or smaller

T1c is a tumor which is larger than 10 mm, but 20 mm or smaller.

T2 – The invasive part of the tumor is larger than 20 mm but not larger than 50 mm.

T3 – This is invasive part of the tumor. It is larger than 50 mm.

T4 –This tumor falls into one of the following groups…

T4a means the tumor has grown into the chest wall.

T4b is when the tumor has grown into the skin.

T4c is cancer that has grown into the chest wall and the skin.

T4d is inflammatory breast cancer.

Node (N) 

Here “N” stands for lymph nodes.In this tumor is spread into the lymph nodes. It shows location and number of tumors.

You can find lymph nodes under the arm, above and below the collarbone, and under the breastbone. These are called regional lymph nodes.

Lymph nodes found in other parts of the body are called distant lymph nodes. There are some types of nodes…

NX – The lymph nodes cannot be evaluated.

N0 – There is no cancer found in the lymph nodes.

N0(i+) – When a very small areas of “isolated” tumor cells, which are found in a lymph node under the arm, called the axillary lymph nodes. This nodes usually less than 0.2 mm or less than 200 cells. In this stage, the nodes are still called N0, but an “i+” is also listed.
N1mic – Cancer occur in the axillary lymph nodes is larger than 0.2 mm but less than 2 mm in size and could only be seen through a microscope. This is often called a micrometastasis.

N1 – The cancer has spread to 1-3 axillary lymph nodes under the arm, and is at least 2 mm in size. This is called a macrometastasis. This category can be included positive internal mammary lymph nodes if they are found during a sentinel lymph node procedure and not otherwise clinically detected. The internal mammary lymph nodes are located under the sternum or breastbone.

N2 – The cancer within the lymph nodes falls into one of the following groups:

N2a is, the cancer has spread to 4 to 9 axillary, or underarm, lymph nodes.

N2b is, the cancer has spread to or to internal mammary lymph nodes without spread to the axillary nodes.

N3 – This step of cancer falls within one of the following groups…

N3a is,the cancer has spread to 10 or more lymph nodes under the arm or to those located under the clavicle, or collarbone.

N3b is, the cancer has spread to the internal mammary nodes and the axillary nodes.

N3c is, the cancer has spread to the lymph nodes located above the clavicle, called the supraclavicular lymph nodes.

Metastasis (M)

The “M” indicates in TNM system, whether the cancer has spread to other parts of the body.

MX – The spreading distance can be evaluated

M0 – The disease has not metastasized.

M0 (i+) – Lymph nodes which are no larger than 0.2 mm in a patient without other evidence of metastases.

M1 – There is an evidence of metastasis or spread to another part of the body, meaning there are breast cancer cells growing in other organs.