Breast Incident

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Breast Cancer Staging
T1 T2
>20–50 mm >10–20 mm=T1c

T4a

Direct extension to chest wall not including pectoralis muscle.

>5–10 mm=T1b >1–5 mm=T1a

T3

>50 mm

Primary Tumor (T)
TX T0 Tis Tis (DCIS) Tis (LCIS) Tis (Paget’s)
Primary tumor cannot be assessed No evidence of primary tumorCarcinoma in situ Ductal carcinoma in situ Lobular carcinoma in situ Paget’s disease of the nipple NOT associated with invasive carcinoma and/or carcinoma in situ (DCIS and/or LCIS) in the underlying breast parenchyma. Carcinomas in the breast parenchyma associated with Paget’s disease are categorized based on the size and characteristics of the parenchymal disease, although the presence of Paget’sdisease should still be noted

T1 T1mi T1a T1b T1c T2 T3

Tumor ≤ 20 mm in greatest dimension Tumor ≤ 1 mm in greatest dimension Tumor > 1 mm but ≤ 5 mm in greatest dimension Tumor > 5 mm but ≤ 10 mm in greatest dimension Tumor > 10 mm but ≤ 20 mm in greatest dimension Tumor > 20 mm but ≤ 50 mm in greatest dimension Tumor > 50 mm in greatest dimension

T4 Tumor of any size with directextension to the chest

T4a T4b T4c T4d

wall and/or to the skin (ulceration or skin nodules) Note: Invasion of the dermis alone does not qualify as T4 Extension to the chest wall, not including only pectoralis muscle adherence/invasion Ulceration and/or ipsilateral satellite nodules and/or edema (including peau d’orange) of the skin, which do not meet the criteria for inflammatory carcinoma BothT4a and T4b Inflammatory carcinoma (see “Rules for Classification”)

AN ATO MIC S TAG E / PRO G N O S TIC G RO UP S

Distant Metastases (M)
M0 No clinical or radiographic evidence of distant
metastases

Stage 0 Stage IA Stage IB Stage IIA Stage IIB Stage IIIA

Tis T1* T0 T1* T0 T1* T2 T2 T3 T0 T1* T2 T3 T3 T4 T4 T4 Any T Any T

N0 N0 N1mi N1mi N1** N1** N0 N1 N0 N2 N2 N2 N1 N2 N0 N1 N2N3 Any N

M0 M0 M0 M0 M0 M0 M0 M0 M0 M0 M0 M0 M0 M0 M0 M0 M0 M0 M1

cM0(i+) No clinical or radiographic evidence of distant

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Stage IIIB Stage IIIC Stage IV

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Financial support for AJCC 7th Edition Staging Posters provided by the American Cancer Society

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Copyright 2009 American Joint Committee on Cancer

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Printed with permission from the AJCC.

metastases, butdeposits of molecularly or microscopically detected tumor cells in circulating blood, bone marrow, or other nonregional nodal tissue that are no larger than 0.2 mm in a patient without symptoms or signs of metastases M1 Distant detectable metastases as determined by classic clinical and radiographic means and/or histologically proven larger than 0.2 mm

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Notes
T1 includes T1mi. T0 andT1 tumors with nodal micrometastases only are excluded from Stage IIA and are classified Stage IB. M0 includes M0(i+). The designation pM0 is not valid; any M0 should be clinical. If a patient presents with M1 prior to neoadjuvant systemic therapy, the stage is considered Stage IV and remains Stage IV regardless of response to neoadjuvant therapy. Stage designation may be changed if postsurgicalimaging studies reveal the presence of distant metastases, provided that the studies are carried out within 4 months of diagnosis in the absence of disease progression and provided that the patient has not received neoadjuvant therapy. Postneoadjuvant therapy is designated with “yc” or “yp” prefix. Of note, no stage group is assigned if there is a complete pathologic response (CR) to neoadjuvanttherapy, for example, ypT0ypN0cM0.

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Breast Cancer Staging
Regional Lymph Nodes (N)
CLINICAL PATHOLOGIC (PN)* removed for pathologic study)

pNX Regional lymph nodes cannot be assessed (for example, previously removed, or not pN0 No regional lymph node metastasis identified histologically...