Breast Cancer Stage II

Stage 2 breast cancer is an early stage of the disease where cancer cells are either in the breast tissue or nearby lymph nodes, or both. With modern treatments and early detection, many people with stage 2 breast cancer can be successfully treated and go on to live full, healthy lives.

Table of contents

• What is Stage 2 Breast Cancer?
• Understanding Stage 2A and 2B
• The TNM Staging System
• Treatment Options
• Checking the Lymph Nodes

What is Stage 2 Breast Cancer?

Stage 2 breast cancer means that the cancer is either in the breast or in the nearby lymph nodes (small glands that help fight infection) or both^[1]. It is considered an early stage breast cancer^[2]. At this stage, the disease is invasive, meaning that cancer cells have spread from where they started into normal breast tissue^[3].

Stage 2 breast cancer is also known as early breast cancer. It refers to invasive breast cancer that is contained within the breast and may or may not have spread to the lymph nodes in the armpit^[6]. At this stage, some cancer cells may have spread outside the breast and armpit area, but they cannot be detected yet^[6].

The stage of a cancer tells you how big it is and how far it has spread. This information helps your doctor decide the best treatment for you^[2]. The stage of breast cancer is based on the size of the tumor and whether it has spread to other areas^[3]. It is also based on the type of tumor cells, including specific genes and biomarkers (substances in the body that can indicate disease)^[3].

Understanding Stage 2A and 2B

Stage 2 breast cancer can be divided into two groups: 2A and 2B. These divisions help doctors understand the cancer more precisely and plan the right treatment.

Stage 2A means one of the following situations^[2]:

• No cancer is found in the breast, or the breast cancer is 2 centimeters or less, and cancer cells are found in 1 to 3 lymph nodes in the armpit or in the lymph nodes near the breastbone
• The cancer is larger than 2 cm but not larger than 5 cm, and there is no cancer in the lymph nodes

Stage 2B means one of the following^[2]:

• The cancer is larger than 2 cm but not larger than 5 cm, and there are small areas of cancer cells in the lymph nodes
• The cancer is larger than 2 cm but not larger than 5 cm, and the cancer has spread to 1 to 3 lymph nodes in the armpit or to the lymph nodes near the breastbone
• The cancer is larger than 5 cm and has not spread to the lymph nodes

The TNM Staging System

Doctors may also use a system called TNM staging to describe breast cancer. TNM stands for Tumor, Node, and Metastasis^[3]. This system looks at three main factors:

• T describes the size of the tumor (cancer) in centimeters
• N describes whether there are any cancer cells in the nearby lymph nodes
• M describes whether the cancer has spread to parts of the body further away from where the cancer started

The doctor gives each factor a number. The number depends on how far the cancer has grown or spread^[3]. For example, a very small cancer that has not spread to the lymph nodes or elsewhere in the body may be T1 N0 M0. A larger cancer that has spread into the nearby lymph nodes may be T3 N1 M0.

In the TNM staging system, stage 2A breast cancer is the same as T0 N1 M0, T1 N1 M0, or T2 N0 M0. Stage 2B is the same as T2 N1 M0 or T3 N0 M0^[2].

Treatment Options

The stage helps your doctor decide which treatment you need^[2]. Treatment also depends on several other important factors, including the type of cells the cancer started in, whether your cancer cells have receptors for particular cancer drugs, the grade (how abnormal the cancer cells look) of the cancer, whether you have had menopause, and other health conditions you may have^[2]. Your doctor will take many different factors into account when deciding which treatment is best for you.

Surgery is usually one of the main treatments for stage 2 breast cancer^[2]. Your surgeon might remove the cancer and a border of normal breast tissue. This is called breast conserving surgery or a wide local excision (also known as a lumpectomy)^[2]. For smaller tumors, you might get a lumpectomy. For larger tumors, you might need a mastectomy, in which the whole breast is removed^[11]. You can then choose to have a new breast made, which is called breast reconstruction^[2].

Radiation therapy usually follows a lumpectomy. After breast conserving surgery, you might have radiotherapy to the rest of the breast^[2]. It can kill cancer cells that were missed during surgery^[11]. Some women who get a mastectomy will also have radiation, especially if the tumor was large or there were cancer cells in the lymph nodes. You might also have radiotherapy to the chest wall after having a mastectomy^[2].

You may also have drug treatments such as chemotherapy (medicines that kill cancer cells) and hormone therapy as a first treatment. This is called neoadjuvant treatment (treatment given before surgery)^[2]. Chemotherapy after surgery can help destroy remaining cancer cells that were missed^[11]. Some people have chemotherapy before surgery to try to shrink a tumor. If it works, the tumor might then be small enough to remove with a lumpectomy^[11].

Hormone therapy after surgery may help women who have hormone receptor-positive cancer. That means the cancer needs hormones to grow^[11]. Medicines can prevent the tumor from getting the hormones. If hormone receptor-positive cancer is in the lymph nodes, your doctor may recommend a medicine called a CDK4/6 inhibitor in addition to hormonal therapy^[12].

Targeted therapy is a newer approach. In about 25% of women with breast cancer, an excess of a protein known as HER2 makes the cancer spread quickly^[11]. Several medicines are available that treat women with HER2-positive cancer. They stop this protein from making the cancer grow and can make some chemotherapy more effective. It is often used in combination with chemotherapy^[11]. Targeted therapy medicines may be recommended for cancers that have certain characteristics^[12].

Immunotherapy may be recommended for women who have hormone receptor-negative, HER2-negative (also called triple-negative breast cancer)^[11]. If the breast cancer is triple-negative, immunotherapy will likely be recommended before and after surgery^[12].

Checking the Lymph Nodes

Before your surgery, you have an ultrasound scan to check the lymph nodes in the armpit, also called the axilla. This is to see if they contain cancer cells^[2]. If breast cancer spreads, it usually first spreads to the lymph nodes close to the breast.

During surgery, your doctor will also remove some lymph nodes to see if there is cancer in them^[12]. There are two types of lymph node surgery: sentinel lymph node dissection (removing only a few key lymph nodes) and axillary lymph node dissection (removing more lymph nodes from the armpit). The type of lymph node surgery you have depends on the size and other characteristics of the cancer^[12].

Depending on the results of your scan, you might have a sentinel lymph node biopsy during your breast cancer operation, or surgery to remove the lymph nodes under your arm^[2]. In either case, the surgeon will likely remove some of the lymph nodes^[11].