Staging, grading and receptors for breast cancer in men
Your breast specialist needs certain information about the cancer to help plan the most appropriate treatment for you.
This includes the stage of the cancer, its grade and whether it has receptors for hormones, proteins, or both. Your breast specialist and breast care nurse will talk this over with you.
Your surgeon won’t know the exact stage of the cancer until after your operation and when the results of all your tests are ready.
The stage of a cancer is a term used to describe its size and whether it has spread beyond the area of the body where it started.
Breast cancer can be divided into four number stages. This is to measure the size of the cancer (lump), and whether it has spread to the lymph nodes or another part of the body.
This describes non-invasive breast cancers. Ductal carcinoma in situ (DCIS) is sometimes described as stage 0. DCIS can almost always be cured.
The following stages are known as invasive breast cancer:
The cancer (lump) is smaller than, or equal to, 2cm and has not spread to the lymph nodes in the armpit.
This is divided into two stages:
The lump is smaller than 2cm and has spread to lymph nodes in the armpit OR it’s bigger than 2cm (but under 5cm) and hasn’t spread to the lymph nodes OR the cancer can’t be found in the breast but is in the lymph nodes in the armpit.
The lump is smaller than 5cm and has spread to the lymph nodes in the armpit OR it’s bigger than 5cm but hasn’t spread to the lymph nodes in the armpit.
This is divided into three stages:
The cancer can’t be found in the breast or the lump is under 5cm, and the cancer is in the lymph nodes in the armpit, which are stuck together OR the lump is bigger than 5cm and has spread to the lymph nodes.
The cancer has spread to tissue near the breast and may be attached to surrounding skin or muscle. There are usually cancer cells in the lymph nodes in the armpit as well.
The cancer has spread to lymph nodes in the armpit, below the breastbone, near the neck or under the collarbone.
The cancer has spread to other parts of the body such as the bones, liver or lungs. This is called secondary or metastatic breast cancer.
This number stage is then combined with a letter system called TNM, which gives the complete stage of the cancer:
T describes the size of the tumour.
N describes whether the cancer has spread to the lymph nodes and which nodes are involved. For example, N0 is no lymph nodes affected while N1 means there are cancer cells in the lymph nodes.
M describes if the cancer has spread to another part of the body. For example, M0 means the cancer has not spread (metastasised) to other parts of the body.
Other terms used
You may hear other terms used to describe breast cancer:
Early breast cancer is a term often used to describe stage 1 and 2 breast cancer.
Locally advanced breast cancer is a term sometimes used to describe stage 3 breast cancers.
Local recurrence means the cancer has come back in the breast area after treatment.
Secondary, advanced or metastatic breast cancer means it has spread to other parts of the body.
Grading is used to describe how the cancer cells look under the microscope compared with normal cells. The grade helps your doctor to decide if you need further treatment after surgery.
Grade 1 or low-grade or well differentiated
The cancer cells look similar to normal cells and usually grow slowly and are less likely to spread.
Grade 2 or moderate- or intermediate-grade
The cancer cells look more abnormal and are slightly faster growing.
Grade 3 or high-grade or poorly differentiated
The cancer cells look very different from normal cells and may grow more quickly.
Some breast cancer cells have receptors, which allow particular types of hormones or proteins to attach to the cancer cell.
The pathologist will examine the tissue that’s been removed during surgery and test it for hormone or protein receptors. This information helps your doctor to plan the most appropriate treatment for you.
Hormones exist naturally in the body. They help to control how cells grow and what they do in the body. Hormones, particularly oestrogen, can encourage some breast cancer cells to grow.
All men have small amounts of the hormone oestrogen in their bodies. About 20% of this oestrogen is made by the testicles, and the remaining 80% is made from male sex hormones (androgens).
Some breast cancers have receptors for the hormone oestrogen. If there are a significant number of oestrogen receptors, it’s known as oestrogen-receptor positive or ER positive breast cancer. If not, it’s known as oestrogen-receptor negative or ER negative breast cancer. The term ER is used because the American spelling of oestrogen is estrogen.
ER positive breast cancers respond well to hormonal treatments. About 90% of breast cancers in men are ER positive.
Some breast cancers have receptors for the protein HER2 (human epidermal growth factor 2), which can encourage breast cancer cells to grow. Cancers that have high levels of these receptors are called HER2 positive breast cancers. They may be treated with a drug called trastuzumab, which is commonly called Herceptin®.
Cancers that have no hormone or protein receptors are called triple-negative breast cancer.