RadOnc Resident Wiki/Breast/Staging

Staging Discussion

Current staging
AJCC 7th Edition (2009) Primary Tumor:
 * T0 - no primary tumor found
 * Tis
 * T1                  20mm]
 * T1mi                1]
 * T1a                  5]
 * T1b                10]
 * T1c                20]
 * T2                        50]
 * T3                       (50
 * T4 Chest wall /skin
 * T4a Chest wall (X pecs)
 * T4b Edema | ulceration
 * T4c a+b
 * T4d Inflammatory

Abbreviations: Axillary = A, Internal Mammary = IM Infraclavicular nodes = ICN, Supraclavicular nodes = SCN Mnemonics:

"A" Nodes are "A"xillary, "B" Nodes are internal "B"reast (eg IMNs), "C" Nodes are supra"C"lavicular - excludes N1 subgroups

N2b and N3b are the same for p and c No clinically + nodes in pN1 cN3b is cN1 + cN2b (clinical pN1c "upgraded")

N2b-N3c is the same for both, except pN3a also includes &ge;10

N1b and N3b are "A"+"IM"

Stage Grouping:
 * 0: Tis
 * 1A = T1
 * 1B if N1mi
 * 2A = Adds to 2
 * 2b: Adds to 3              (N1/N0)
 * 3A: N2 or adds to 4     (T3N1)
 * 3B: T4
 * 3C: N3
 * 4: M1

New Classifications

 * For additional information, see Tissue microarrays (Breast/Breast overview)

Gene expression profiling is the basis for additional classification schemes.
 * Luminal ER|PR (+)
 * A type low grade
 * B type more aggressive
 * HER2
 * Basal type - Trip (-) |cytokeratin 5/6 positive | HER1+