Stages and Grades and Types and and and...

This is where everything starts to become a little bit confusing.  

You have had a biopsy and have been told you have Breast Cancer.  But then you start to realise those are just two words among many.  There are types and grades and stages and all sorts of other stuff that will determine what will happen to you.

So I will try and explain as simply as I can.  This is not a medical explanation, so please refer to your medical consultants for the proper stuff.  This is just to try and help you get your head around it simply.

I have used my diagnosis as an example.

This may be different for you but the first thing I found out was the Grade.

This tells us basically how fast growing the cancer is.  That means how quickly it could spread.  This all depends on how normal or cancerous the cells look.  It's nothing to do with size, it is possible for a small lump to be more fast growing than a big one.  There are only 3 Grades, number 1 means the cells do not look much different to normal cells, number 2 means the cells are a bit more different and number 3 is quite a bit different.  This kind of works out to say:

    1  = slow growing
    2  = medium growing
    3  = fast growing

My lump was Grade 2.

Which then leads to Primary and Secondary.  Primary means it has not spread beyond your breast or lymph nodes.  Secondary means that secondaries have been found in other parts of your body beyond the breast or lymph nodes or local blood supply.  It is unusual to be diagnosed with Secondary right at the beginning, it usually takes time to progress this far.

At this point my tumour (lump or area) was Primary, meaning it has stayed put in the breast (although only surgery and a biopsy on the Lymph Nodes would be able to confirm this).

My breast cancer was Grade 2 Primary.

Next I found out what Type I had.  This was after my surgery, although your mammograms and scans will have already given your medical team a good idea.  They may say you have:-
  • Patchy looking areas
  • A lump
  • Dodgy looking cells
Cells that look a bit patchy may be non-invasive cancer.  Basically the cells have a chance in the future, to turn into cancer but may not.  It isn't actually cancer, but it has the potential to be.  This can start in either the Ducts or the Lobules. 

You may have felt a lump or one has been detected by mammogram or scan.  A good solid palpable lump may mean that you have cancer cells which started in your Ducts.  (If you haven't been given a diagnosis of cancer, please don't think all lumps are cancerous and just stop reading this now!).

You may have seen or felt dimpling, hardening or thickening or again it may have been detected by mammogram or scan, but there is no palpable lump to feel.  This may mean your cancer has started in the Lobules of your breast.  It is harder to detect and it kind of weaves in and out of the breast tissue.  

The above three types (there are actually more, but I'm only sticking with these three) are known as:
  • DCIS or LCIS  (Ductal or Lobular Carcinoma in Situ)
  • Ductal
  • Lobular
The first are known as non-invasive because the cells have not advanced into any other areas in the breast, hence the "in Situ".  It's still contained in the cells in the Ducts or Lobules. 

The second two are invasive, this means the cancer has spread to the breast tissue outside of those initial cells in the Ducts and Lobules and has the ability to spread further.  Doesn't mean that it has or will, it just has the ability.

Invasive does not mean that the cancer cells have spread all over your body.  It just means should it decide to take a wander, it has the potential to do so.

My lump had spread outside of the Ducts, but still within the breast, so was Grade 2 Primary Ductal Invasive.

After surgery I found out what Stage it was.  Your lump or area of cells (tumour) will have been measured.  I'm just going to stick to this very simply because the Stages will take into consideration whether Lymph Nodes are involved.  Please, please refer to proper medical advice.  I'm just going to talk about lumps and areas.

For DCIS and LCIS because there is no cancer, just "pre-cancer", so they are known as Stage 0 or sometimes as Low, Intermediate or High.  

If your lump or area is less than 2cm, that's Stage 1.  
If its larger than 2cm but less than 5cm, its Stage 2.
If its larger than 5cm its Stage 3.
For Stage 4, the size isn't taken into consideration, it means you have it elsewhere.

Lymph Node involvement makes a different to the Stage, so please ask for proper medical help.  This is just a very simplistic guide. There are further sub-sections to each Stage.

My lump measured 2.5 cm.  This made it a Grade 2 Primary Ductal Invasive Stage 2. 

Keeping up?!!

Then we have things like Hormones and Proteins.

Your tumour can be receptive to hormones, Oestrogen and Progesteron, know as ER and PR.  If it is receptive it will be known as Positive, if it is not receptive it will be known as Negative.  My lump was receptive to both.

My lump is now Grade 2 Primary Ductal Invasive Stage 2 ER+ PR+.

As well as being Hormone receptive, my tumour had added Proteins firing it along from something called HER-2 which made it extra aggressive.  I have a link about HER-2 on another page.  I can also add Aggressive part to the description. Many other things can make it Aggressive, see your medical staff for an explanation.

My lump is now Grade 2 Primary Ductal Invasive Stage 2 ER+ PR+ HER2+ Aggressive.

If your tumour is Aggressive it will respond more to Chemotherapy, as Chemo attacks fast growing cells in your body.

ER, PR and HER2 are in the make up of the cancer cells themselves and not how your whole body responds.

Also there is the Lymph Node situation and whether there was any invasion into the blood supply, called Vascular Invasion.

A couple of my Lymph Nodes were removed and tested and found to be clear (had they not been clear this could have made a difference to my Stage).  But during my surgery some cancer cells were found in the local blood supply, Vascular Invasive.

My diagnosis at this point is Grade 2 Primary Ductal Invasive Stage 2 ER+ PR+ HER2+ Aggressive, Node Negative, Vascular Invasive.

Because of the Vascular Invasion I also had body and bone scans just to check there were not any secondaries. Luckily nothing was spotted, so my diagnosis remained at Primary.

It is possible for your Stage to change as you go through surgeries.  It may be found especially with Lobular, that they didn't get all the cells away in the first surgery, usually a procedure called Wide Local Excision.  It used to be known as a Lumpectomy, but they don't always have just lumps alone to remove.  So you may have been Stage 2 before your first WLE, but then they discovered more dodgy areas, so they either go back in for another WLE, or they decide to do a Mastectomy because they found a bigger lump or area than they expected to find, so your stage may increase.

They may also decide to do a Mastectomy right at the beginning if you have any DCIS or LCIS. This will be done as a precaution to remove the areas that have potential to change to cancer.

Whilst all of this categorising seems a nightmare, it is actually very important for your treatment.  It will dictate what kind of treatment is right for you and it is very individually customised for your needs.  We no longer have a one type fits all treatment.  In this way our bodies can be saved from the rigors of some unnecessary treatments and we can be assured that the treatments we are receiving are specifically for us and therefore much more likely to be effective.

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