It took me a while to get my head round the grades and stages – largely because we were met by a wave of information and it simply took a long time for it to sink in. It will help you zero in on what’s happening to your partner if you know what grade and stage she has so you can focus on the bit that’s pertinent to you. Take your time with this information and don’t jump to conclusions without solid, scientific facts. Don’t fill in blanks with ‘what ifs’. It won’t help.
So, very basically, the grade tells you what the cancer is like, the stage tells you where it is.
The following information is from NHS Online and Cancer Research UK. Specifically, the grade information is from the NHS website and the stage information from Cancer Research UK. Data as at: 27/04/2019 and edited by me in the hope it is more easily digestible. The reason I used two different sources is because the stage system on the NHS page doesn’t reflect that used for breast cancer. Similarly, the Cancer Research UK page detailing grades wasn’t particularly user friendly. I have included references at the foot of the page.
The grade for breast cancer is scored from 1 to 3, with 1 being ‘good’ and 3 being ‘worst’. It essentially boils down to how the tumour cells look under a microscope and how fast they are likely to grow.
Grade 1 cells look like normal cells and don’t grow quickly.
Grade 2 cells don’t look much like normal cells and grow faster than normal.
Grade 3 cells look nothing like normal cells and grow very quickly.
The tumour grade will help your multidisciplinary team decide the best course of treatment. For example, a grade 1 tumour may ‘only’ need local surgery and radiotherapy. In this context, ‘local’ means local to the tumour. A grade 3 tumour may need ‘systemic’ treatment, such as chemotherapy, which affects the whole body.
Any grade may potentially need radiotherapy, hormone therapy and/or targeted therapy either before, during and/or after the main surgical treatment.
There are different stage systems for different cancers which can add to confusion, so we’ll focus solely on breast cancer, which is scored from 1 to 4, with one being ‘good’ and four being ‘worst’. Each of the stages then has additional groups (A, B and so on), so it’s more complex than the grade but does give the added benefit of a clearer picture. And we’re all about the facts here. Beware that the staging system can be confusing, which is why it helps to know the stage so you can focus on the one that relates to you and your partner.
Stage 1 means it’s been caught early.
Stage 1A is a tumour measuring 2 cm or less and has not spread from the breast.
Stage 1B is a tumour measuring 2 cm or less with cancerous cells found in lymph nodes near the breast.
No tumour in the breast, but cancerous cells in lymph nodes near the breast.
Stage 2 also means it’s been caught early.
Stage 2A either the tumour is 2 cm or less or there is no tumour and cancer cells are found in up to three lymph nodes of the armpit or close to the breastbone.
The tumour is between 2-5 cm and there are no cancerous cells in any lymph nodes.
Stage 2B the tumour is between 2 and 5 cm and there are small groups of cancer cells in the lymph nodes.
The tumour is between 2 and 5 cm and the cancer has spread to between one and three lymph nodes of the armpit or near the breastbone.
The tumour is larger than 5 cm and hasn’t spread to any lymph nodes
Stage 3 is known as ‘locally advanced’ and has spread to the lymph nodes near the breast, the skin of the breast or the chest wall.
Stage 3A the tumour can be any size or there is no tumour in the breast and cancerous cells are found in between four and nine lymph nodes of the armpit or near the breastbone.
The tumour is over 5 cm and there are small groups of cancer cells in the lymph nodes.
The tumour is over 5 cm and has spread to three lymph nodes in the armpit or near the breastbone.
Stage 3B the tumour has spread to the breast’s skin or chest wall. The chest wall includes the areas around the lungs and can include ribs, muscle, skin and connective tissues. The cancer has broken the skin or caused swelling and may have spread to up to nine lymph nodes of the armpit or near the breastbone.
Stage 3C the tumour can be any size or there is no tumour but cancer is in the breast’s skin, causing swelling or an ulcer, and has spread to the chest wall. It has also spread to one or more of the following:
Ten or more lymph nodes in the armpit;
Lymph nodes above or below the collar bone;
Lymph nodes in the armpit and near the breastbone;
Stage 3C breast cancer is further divided into operable and inoperable categories.
Stage 4 is also known as advanced, secondary, or metastatic breast cancer. The tumour can be any size, the lymph nodes may or may not contain cancer cells but the cancer has spread to other parts of the body.
Stage 4 does not have subtypes, though it’s worth noting that, while considered largely incurable and, more often than not, inoperable, this doesn’t necessarily mean it’s untreatable, nor does it necessarily mean your partner has been given an instant death sentence. Today’s medicine can often slow or temporarily stop the disease’s progress in its tracks, giving you and your partner precious, precious time together. However, the outlook for survivability with current medicine isn’t good and you need to consider this and discuss it thoroughly with your primary care providers if your partner is diagnosed with stage 4 breast cancer.
Data taken and modified from the following pages as at 27/04/2019
Contains information from NHS Digital, licenced under the current version of the Open Government Licence