| Most types of cancer, including breast cancer, are | | | | to ask the doctor if there are cancer cells in just one |
| grouped into one of four stages:Stage I The breast | | | | location -- such as a single tumor -- or if cancer cells |
| cancer is in one primary site and has not spread. | | | | have been detected elsewhere, and if so, where. |
| Stage II The cancer has spread to nearby areas, but | | | | The type of cancer you're dealing with, as well as |
| just around the primary site. Stage III The cancer | | | | certain other factors (such as whether breast cancer |
| has spread throughout the nearby area. Stage IV | | | | tests positive for the HER2 protein, which tends to |
| The cancer has spread, or metastasized, to other | | | | lead to more aggressive growth), can also be |
| parts of the body, such as the liver, bones, or brain. | | | | important in understanding the prognosis and |
| - Further distinctions Within these stages, doctors | | | | treatment. Certain cancers, even rare ones, may |
| make even finer distinctions of "A" and "B" -- so a | | | | have a specific type of treatment available that |
| tumor that is stage IIA is less advanced than one | | | | offers a more optimistic prognosis. It was big news a |
| that is stage IIB. The distinction between cancer | | | | few years back, for example, when the |
| stages is often a very fine one, but it can be critical | | | | tumor-suppressing drug Gleevac was found to work |
| to making treatment decisions and knowing what to | | | | very well against certain rare gastrointestinal tumors |
| expect. | | | | and the even rarer chronic myeloid leukemia (CML) |
| - Reading the tests To determine a cancer's stage, | | | | by blocking specific enzymes that fuel cancer |
| doctors employ a series of tests. But once the test | | | | growth.The other thing to keep in mind is that cancer |
| results are in, it becomes a matter of interpretation. | | | | prognosis information and treatment options are |
| This means doctors may disagree about the exact | | | | inextricably intertwined. It might seem like extremely |
| stage of this particular breast cancer and may even | | | | bad news when the doctor tells you that your |
| revise their opinions later as new evidence comes in. | | | | mother's breast cancer is HER2-positive, which |
| It's not uncommon for patients to be told their | | | | studies have shown carries a worse prognosis than |
| cancer is stage IV and fully metastasized, then have | | | | HER2-negative cancers. On the other hand, newly |
| later tests reveal it to be stage IIIB with the | | | | available drugs such as trastuzumab and lapatinib can |
| metastases limited to one area of the body, meaning | | | | be very successful against HER2-positive cancers and |
| that it's more treatable. | | | | have no effect on HER2-negative cancers -- so |
| - Another kind of staging system For many types of | | | | finding out that the cancer is HER2-positive opens |
| breast cancer in which a tumor is present, the doctor | | | | the door to additional treatment options. |
| may use an even more detailed staging system called | | | | The other wild card is that you can't know in |
| the TNM (Tumor, Nodes, and Metastases) system, | | | | advance how well you or the person you're caring |
| created more recently by the American Joint | | | | for will respond to a particular treatment. One of the |
| Committee on Cancer (AJCC). In this system, each | | | | things that makes cancer so mysterious and |
| of the three categories is assigned an individual | | | | frustrating is that doctors can't predict how effective |
| staging number, so a T1N1M0 breast cancer means | | | | a particular treatment will be because patient |
| the tumor that is stage I, with lymph node | | | | response is so individual. For each diagnosis and |
| involvement that is also stage I, and stage zero, or | | | | treatment option, the patient population responds |
| no, metastases. | | | | along a bell curve, with the larger group of patients in |
| - Grading the cancer What can also be confusing is | | | | the middle of the curve responding "typically" and a |
| that, for some types of cancer, doctors use a | | | | small group on either end who respond either much |
| grading system instead of or in addition to staging. | | | | more positively or less well. Many breast cancer |
| Prostate cancer biopsy reports, for example, usually | | | | patients like to set a goal for themselves of "beating |
| use what's called a Gleason scale to grade the | | | | the bell curve," because no matter what the general |
| malignancy of the tumor cells, with grade 1 being the | | | | prognosis for the majority of patients with a |
| least malignant and grade 5 the most malignant. | | | | particular diagnosis, some are going to fall on the side |
| Often they grade two different areas between 1 | | | | that beats the odds. |
| and 5 each, then add the two numbers together for | | | | You or the person you're caring for may well turn |
| a Gleason score that ranges from 2 to 10.At any | | | | out to be one of the patients who is quite |
| point in diagnosis and treatment, when the doctor is | | | | responsive to breast cancer treatment, but |
| giving you this type of grading or staging information, | | | | unfortunately the only way to find out is to give it |
| don't hesitate to ask her to clarify what she's telling | | | | time. If a treatment doesn't work, it's still not reason |
| you. If the doctor says the cancer is stage III, for | | | | to despair -- it's likely the doctor will have another |
| example, it's perfectly okay to ask exactly what that | | | | approach to suggest.Some doctors tell patients to |
| means for this particular type of breast cancer. You | | | | think of their cancer treatment like a bag of tricks. |
| might also ask how the doctor arrived at her | | | | For most types of breast cancer, doctors have a |
| conclusions (which tests were run and what did the | | | | number of different treatment options they can try. |
| results show?), how this particular type of tumor | | | | If one doesn't work, they'll switch to another, and |
| tends to develop from one stage or grade to | | | | that just might be the one that does it. It can be |
| another, and what the cure rate is for this particular | | | | hard to have patience and wait for positive results, |
| breast cancer at each stage. Another way to zero in | | | | but fully understanding the cancer prognosis will help |
| on what the cancer prognosis information means is | | | | you know how much room there is for hope. |