What Kind Of Cancer Do I Have?

One of the most important things I learned during my journey is that everyone’s breast cancer is different. Doctors stage them and grade them. They test them for hormones. In the end, the resulting “TNM” formula suggests the best way to manage the cancer in question. So let’s take a look at the letters and numbers.

Tumors (“T”) removed during surgery are checked for several things: Have the cancer cells spread beyond the site from which they originated? What is the size of the tumor? How does the skin over the tumor area look? Has the nipple retracted into the breast? Is the tumor attached to the chest wall or pectoral muscle? Tumor classifications range from Tis to T4d, with the last one being the most serious form.

The removed lymph nodes (“N”) will undergo biopsy and be classified as follows: NX means that the involvement of lymph nodes can’t be determined; N0 means no cancer is present; N1 tells us there is cancer in the nodes, but the nodes are movable; N2 means the nodes are attached to one another or to blood vessels nearby; N3 indicates the cancer has spread to the nodes near the collarbone or behind the sternum.

Doctors also look for metastasis, which is the “M” in the formula. Has the cancer spread from the breast to the lymph nodes under the arm, for example? A designation of M1 means there is metastasis to other parts of the body.

When these three items, the tumor, lymph nodes, and metastasis (TNM) are known, doctors can arrive at a “stage” for the cancer. Cancer is staged from 0 to IV. In Stage 0 no nodes are involved, and there is no metastasis. At this level, the cancer is in situ (a tumor that has not invaded neighboring tissue) and no normal tissue has been invaded. Stage I cancer is less than two centimeters in size, has no nodal involvement, and is believed to have no metastasis. Stages II and III fall between the least aggressive to the most aggressive category, which is Stage IV. This last stage means cancer has likely spread to a distant site in the body.

Another part of a tumor’s pathology is whether it expresses the estrogen or progesterone hormones. If the hormone receptors are there, a tumor will be classified as estrogen receptor-positive or progesterone receptor-positive. Tumors can also be receptor-negative. A tumor with receptor-positive cells is more likely to respond to hormone-suppressing therapy which is, at the time of this writing, a five-year drug program that usually comes after chemotherapy and radiation treatments.

There is yet another component to the classification of a tumor. This is the HER-2/neu test performed during biopsy of the suspicious area in the breast. When the HER-2 gene is amplified, or “overexpressed,” the cancer is very aggressive. According to Breast Cancer - The Complete Guide by doctors Yashar Hirshaut and Peter I. Pressman, “About 25 percent of breast cancer cells have a greatly increased number of HER-2 receptors. Such tumors have a greater tendency to recur.”