Anatomy of a Tumor

Every breast cancer is a little different, but many follow a fairly standard course. How each is treated depends on how early it is discovered, how aggressively it is spreading and how it responds to antihormone treatments and other drugs

PRECANCEROUS

Normal The cells lining the duct are orderly and well differentiated

Hyperplasia A few extra cells accumulate

Atypical ductal hyperplasia The cells start looking more and more abnormal

STAGE 0 DCIS with Microcalcifications

--THE DEFINITION Cells that look like cancer but have not invaded surrounding tissue are called ductal carcinoma in situ (cancer confined to the duct). The lesions may be tiny as pinpoints and may pop up throughout the breast

--THE OPTIONS Patients whose lesions are tightly focused can be treated with lumpectomy and radiation. Some surgeons think surgery alone may be sufficient in certain cases

--THE OUTLOOK Very good. Virtually no one dies of breast cancer within five years of treatment for DCIS. No one knows what percentage of DCIS lesions eventually become invasive

Stage I Invasive Ductal Cancer

--THE DEFINITION Some of the cells from the tumor, which now measures 2 cm or less, spill out of the duct. There is no evidence of cancer in the lymph nodes

--THE OPTIONS Mastectomy or lumpectomy plus radiation. Lymph nodes are biopsied. Chemotherapy or tamoxifen may be recommended for some women

--THE OUTLOOK Anywhere from 95% to 98% of women are doing fine five years after treatment. Most will live much longer

STAGE II

--THE DEFINITION Most tumors in this category measure 2-5 cm but have not spread to the lymph nodes

--THE OPTIONS Mastectomy or lumpectomy plus radiation. Chemotherapy is used for any cancers that have spread to the lymph nodes and may even be indicated for larger node-negative tumors. Tamoxifen is prescribed for those cancers that respond to estrogen

--THE OUTLOOK Depending on tumor size and other characteristics, 76% to 88% of women live at least five years after their diagnosis

STAGE III

--THE DEFINITION The cancer has really taken hold in the lymph nodes. Even a tumor less than 1 cm in size is considered Stage III if several lymph nodes are involved

--THE OPTIONS Mastectomy or lumpectomy plus radiation. Chemotherapy. Tamoxifen for those cancers that respond to estrogen

--THE OUTLOOK Depending on tumor size and other characteristics, 49% to 56% of women live at least five years after diagnosis

STAGE IV

--THE DEFINITION The cancer has spread beyond the breast, leading to secondary tumors in the liver, lungs, brain or elsewhere

--THE OPTIONS Most treatments are aimed at relieving symptoms or prolonging life a few months or years. Surgery or radiation to remove or at least try to shrink any tumors. Chemotherapy. Herceptin for those cancers that express an excess of the Her2 receptor. Tamoxifen or an aromatase inhibitor, if they haven't already been used, for those tumors that respond to estrogen. (Clinical trials of both herceptin and aromatase inhibitors in earlier stages of breast cancer are under way)

--THE OUTLOOK Studies indicate an average survival time of 18 months to 24 months. From 15% to 20% live at least five years after diagnosis

Sources: M. D. Anderson Cancer Center; National Cancer Institute