Understanding Stage 2 Breast Cancer

Diagnosis, Treatments, and Survival Rates

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It is fairly common for people to be diagnosed with stage 2 breast cancer. Stage 2 tumors are usually between 2 cm and 5 cm in diameter (1 inch to 2.5 inches) and may or may not have spread to lymph nodes. Treatment usually includes surgery (either a lobectomy or mastectomy) and adjuvant chemotherapy is often recommended. Radiation therapy is given following a lobectomy, but may or may not be needed after a mastectomy.

If the tumor is estrogen receptor positive, hormonal therapy is usually given for 5 years to 10 years, and for those who are postmenopausal, bisphosphonate therapy may be recommended as well to reduce the risk of recurrence. If it is HER 2 positive, targeted therapy is often used after primary treatment.

Even though stage 2 breast cancer may affect nearby lymph nodes, it is still relatively contained and is not considered metastatic (having spread to distant organs).

Overview

Breast cancer is separated into four (or five) basic stages. Stage 0 breast cancer or ductal carcinoma in situ (DCIS) is not considered invasive breast cancer as it has not spread through something known as the basement membrane.

Stages 1 to 4 of breast cancer is considered "invasive." This does not mean that they have invaded any other tissues or that they have spread. It simply means that they have passed through the basement membrane and have the "potential" to spread. Stage 1 is the earliest stage of invasive breast cancer and stage 4 is the most advanced and is considered metastatic breast cancer.

Stage 2 breast cancer is characterized by tumors that are at least two centimeters (cm) and up to 5 cm in diameter with the possible spread of cancer cells to nearby lymph nodes.

Staging

Cancers are scored and divided into stages by something called the TNM system. In this system:

  • T stands for tumor size. T0 means that a tumor cannot be detected in the breast. T1 includes tumors that have a diameter of 2 cm or less (an inch or less). T2 includes tumors that are between 2 cm and 5 cm in diameter. T3 includes tumors larger than 5 cm in diameter.
  • N stands for lymph node involvement. N0 (N-zero) would mean that cancer has not spread to any lymph nodes. N1mi describes cancers that have spread to lymph nodes but the spread can only be detected under a microscope (micrometastases). N1 is used to describe tumors that have spread to at least one lymph node near the tumor. N2 refers to cancers that have spread farther away from the tumor.
  • M stands for metastasis. M0 means that no metastases are present. M1 means that a breast cancer has spread to other regions of the body such as the bones, brain, liver, or lung.

Using the TNM system, there are several combinations of T and N which are used to classify cancer as either stage 2A or stage 2B. Since by definition stage 2 breast cancers have not metastasized, M is always followed by a zero. Possibilities for stage 2 include:

  • Stage 2A: T0, N1, M0: No tumor has been found in breast tissue, but cancer cells have lodged in lymph nodes near your breast.
  • Stage 2A: T1, N1, M0: You have a tumor of 2 cm or smaller that has spread to at least one lymph node, OR: your tumor has invaded nearby tissue at least 0.1 cm and has spread to at least one lymph node.
  • Stage 2A: T2, N0, M0: Your tumor is over 2 cm or less than 5 cm, but hasn't affected any lymph nodes.
  • Stage 2B: T2, N1, M0: Your tumor is bigger than 2 cm and less than 5 cm, and has involved nearby lymph nodes.
  • Stage 2B: T3, N0, M0: Your tumor is more than 5 cm, but has not reached your chest wall or skin, and has not traveled to any lymph nodes.

Treatment

Your oncologist will compile all the test results on your cancer and give you a comprehensive diagnosis. Treatment options will be very similar to those for stage 1 breast cancer, with some variations for larger tumors or high-grade types of cancer.

  • Local Treatments: Surgical choices will include a lumpectomy or a mastectomy, which may be followed by radiation treatments to the breast or chest wall. If radiation is recommended, that will affect the timing of any breast reconstruction that you may have.
  • Systemic Treatments (Adjuvant Treatments): These therapies will affect cells all over your body and will help prevent a recurrence. Depending on your age, general health, hormone receptor status, lymph node involvement, and HER2/neu results, you may be given chemotherapy, hormonal therapy, Herceptin, or other targeted biological therapies.
  • Neoadjuvant Treatment: You may prefer breast-conserving surgery, but have a tumor that is too large to have a good result after a lumpectomy. In this case, your oncologist may suggest having systemic treatments before surgery, in hopes of shrinking the tumor. When this approach is successful, the smaller tumor can be removed and local treatment may be given if needed. Some tumors don't respond well to pre-treatment and when that happens, a mastectomy will be necessary. You may then consider breast reconstruction.

    You may spend between three to 18 months or longer in the active treatment of stage 2 breast cancer. It may be as simple as surgery and six weeks of radiation or involve the full array of chemo, radiation, and biologic therapies.

    Survival Rates

    At the onset, it is important to understand that survival rates are not a direct indication of how long you will live following the diagnosis and treatment of breast cancer. Rather, it is used to reflect how many people on average will survive for the prescribed period of time at that stage. Clearly, some will live for less than the prescribed time and other for far longer. Each case is individual.

    According to the American Cancer Society, the 5-year survival rate for stage 2 breast cancer is 93 percent for women who have completed treatment. By contrast, women with stage 3 cancer have a 5-year survival rate of 72 percent.

    Treatments have improved greatly over that time, so you may hope for longer-term survival if you are newly diagnosed. You will see your oncologist for five years of follow-up care every three months and then every six months.

    After five years you may only need to see your oncologist once a year, but these visits most often continue throughout your life. These visits are important to make sure that recovery is going smoothly and that treatment for recurrence won't be needed. 

    Follow-Up Care

    Irrespective of the course of treatment you undergo, you will have a 5-year minimum follow-up period of checkups with your oncologist, during which you may need to take hormone therapy if your tumor was hormone sensitive. Some oncologist s are now recommending hormonal therapy which goes beyond five years for those with estrogen receptor-positive tumors.

    If you have a tumor which is estrogen-receptor positive, your oncologist may also recommend that you use bisphosphonate therapy if you are postmenopausal. Bisphosphonates are medications that are used for osteoporosis but all appear to help reduce the chance that breast cancer will spread to bones (the most common site of metastases).

    Unlike some cancers, routine scans are not usually done after primary treatment for stage 2 breast cancer has been completed. The reason for this, even though recurrence is a possibility, is that finding a recurrence early (before symptoms appear) does not improve survival. For those who have finished treatment, it's important to be familiar with the potential signs and symptoms of a recurrence and to contact your doctor with any concerns.

    Coping

    If you've been recently diagnosed with stage 2 breast cancer you may feel overwhelmed with all there is to learn. Check out these tips on where to begin with a new breast cancer diagnosis.

    Thankfully, there is now a multitude of resources through which you can receive support, and learn more about your diagnosis. Ask for help and reach out to your loved ones. Even if you are used to being "the strong one" lean on others for support. Become involved in one of the active breast cancer support groups or support communities available.

    Most importantly, learn how to be your own advocate in your cancer care. Cancer treatments are changing rapidly, and it's important to understand the options available so you can be an active member of your cancer treatment team.

    While it may seem frightening to be diagnosed with stage 2 breast cancer, remember that it is still considered early-stage cancer. Most women diagnosed at this stage do extremely well with treatment and go on to live normal lifespans.

    A Word From Verywell

    If you've been diagnosed with stage 2 breast cancer the outlook is still very good. You are more likely to have chemotherapy and/or radiation therapy than if your tumor was stage 1, but these tumors are still very treatable.

    That said, support is essential. Reach out to friends. Learn as much as you can about your cancer. Consider becoming involved in a local support group or online cancer community. The treatment of breast cancer is improving, and in addition to support, these communities are a great place to stay abreast of the latest research on breast cancer.

    Most importantly, be your own advocate in your care. Make sure you understand your treatment plan and remember that you are the most important person in your cancer care team.

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