Staging and grading of breast cancer in men

Knowing the extent of the cancer and its grade helps the doctors decide on the most appropriate treatment|.

Staging Back to top

Ductal carcinoma in situ (DCIS) is sometimes described as stage 0. DCIS can almost always be cured.

The following stages of breast cancer are known as invasive breast cancer:

Stage 1 The tumour measures less than 2cm (¾in). There is no cancer in the lymph nodes in the armpit and no sign that the cancer has spread elsewhere in the body.

Stage 2 The tumour measures between 2 and 5cm (¾-2in), or there is cancer in lymph nodes in the armpit, or both. There are no signs that the cancer has spread anywhere else in the body.

Stage 3 The tumour is larger than 5cm (2in) and may be attached to surrounding muscle or skin. There is usually cancer in lymph nodes in the armpit, but there are no signs that the cancer has spread to anywhere else.

Stage 4 The cancer has spread to other parts of the body.

You may hear other terms used to describe breast cancer:

• Early breast cancer means the cancer hasn’t spread outside the breast or the lymph nodes in the armpit. Stages 1 and 2 breast cancer are often described as early breast cancer.
• Locally-advanced breast cancer is a term sometimes used to describe stage 3 breast cancers.
• Local recurrence means that the cancer has come back in the breast area after treatment.
• Advanced breast cancer, secondary breast cancer, metastatic breast cancer These terms describe stage 4 breast cancers, when the cancer has spread beyond the breast and lymph nodes in the armpit to elsewhere in the body.

TNM staging system

Another staging system known as the TNM system is commonly used. This can give more precise information about the extent of the cancer.

T describes the size of the tumour (cancer)

N describes whether the cancer has spread to the lymph nodes (sometimes called nodes)

M describes whether the cancer has spread to another part of the body, such as the bone, liver or the lungs. This is known as metastatic or secondary cancer.

Grading Back to top

Grading refers to the appearance of the cancer cells under the microscope. The pathologist looks at the cancer under a microscope and compares the appearance of the cancer cells to the normal cells nearby. How similar or different the cancer cells are compared to normal cells is the grade of the tumour.

There are three grades:

Grade 1 (low-grade) cancers look similar to normal cells and grow the slowest.

Grade 3 (high-grade) cancers are made up of irregular cells that look very different in appearance from normal cells. They tend to grow quickly and are more likely to spread.

Grade 2 (moderate or intermediate-grade) cancers fall between Grade 1 and Grade 3 in appearance and behaviour.

Receptors Back to top

Some breast cancer cells have receptors that let hormones or proteins attach to the cancer cell and encourage it to grow. Your doctors will test a sample of your breast cancer tissue for these receptors. This will help them to choose the most appropriate treatment for you.

Hormone receptors

More than 9 out of 10 breast cancers in men (90%) have receptors for the hormone oestrogen. Breast cancer that has oestrogen receptors is known as oestrogen-receptor positive (ER+). If a breast cancer doesn’t have oestrogen receptors it is known as oestrogen-receptor negative (ER-). Hormonal treatments, such as tamoxifen, are often used to treat breast cancers that are ER+. Oestrogen-receptors are known as ER because of the American spelling of oestrogen as estrogen.

Protein receptors

Some cancers have receptors for a protein known as HER2 (human epidermal growth factor 2). Cancers with high levels of HER2 receptors are called HER2-positive. Drugs such as trastuzumab (Herceptin®)| may be used to treat people with HER2+ breast cancer. However, the research into using Herceptin has only been carried out in women with breast cancer so it’s not clear how well Herceptin works for men.