Groundhog Day - 12 months to live or not!?

Groundhog Day – 12 months to live or not?

On this day in 2017, I was told, in the worst way (if that is even possible) my breast cancer had metastasized to my liver. While I had a pet scan that morning and we knew that we could hear that my cancer had returned, I just had thought recurrence not metastatic. I really did not understand.

Unfortunately, my oncologist was off that day, so when we returned to receive the results of the Pet Scan, we were met with a Fellow, who we had never met before. Admittedly, that meeting is a blur, but I do recall that English was not his first language and we had difficulty understanding him. What I heard – the cancer has metastasized to my liver, this was really bad, and would have 6 to 12 months to live. What he actually said, who knows, but this is what I heard. He had no plan or next steps to offer, just that our oncologist would follow up with us. Of course, it was a Friday.

In July 2014, I was diagnosed with Stage 2B, ER/PR positive – Her2 Negative Breast Cancer. During my treatment, I found out that I was positive for the BRCA1 gene.  I did chemotherapy, bilateral mastectomy and 35 radiation treatments. After this, I was declared “Cancer Free” in March 2015. However, there were no more scans, apparently this is standard protocol to not confirm this. Just 90 days checkups with my oncologist and an aromatase inhibitor daily to keep the cancer away. These checks up consisted of a physical exam and blood work. Thank goodness my oncologist believes in monitoring tumor markers in the blood work too, many do not.

I wish I knew about my BRCA1 status before I started my treatment, I have so many regrets about the decisions I made during this time. But I learned a lot and did not make those same mistakes this time around. Biggest lesson learned was RESEARCH and get several opinions and options, do not accept the status quo AND advocate and educate myself on what is the best plan for me.

When I was finally able to meet with my oncologist the following week, we did a biopsy and determined that my cancer had not only metastasized, but the characteristics changed. The cancer was now Triple Negative, the most aggressive form of breast cancer along with now being Stage IV Metastatic, the only breast cancer that KILLS.

There were 4 presented options for my cancer now, approved by the FDA, which all came with horrible percentage of success rates and quality of life. Kent and I just did not could not decide which path to go on, they all seemed bad with limited guarantees of giving me more time to live, while offering me possible limited quality of life.

We decided to seek out a second opinion. This was the best decision of my life so far. The oncologist at Dana Farber, Dr. Erica. Mayer presented us with the same 4 options previously offered PLUS 11 possible clinical trials that were open or opening that I would qualify for. Clinical Trials are not only competitive as there are only so many spots available, but very targeted not just your type of cancer, stage but also how many lines of treatment you have had.

Triple Negative Breast Cancer has a lot of trials available now as the “standard of care” options had such bleak outlooks and other cancers had already found better options for metastatic due to clinical trials, like Herceptin for Triple Positive Cancers.

We thoroughly went through all the trials available, possible side effects and quality of life. We picked the one we thought would have the best results. BUT it was not available to me in Jacksonville, my hometown, but it was open at Dana Farber. To join this trial, I would need to travel, every 3 weeks to Boston, for 2 nights, and receive treatment there. Lucy, our daughter, was 5, and we had no family that lived locally. We decided to make this commitment to try and add more time to my life. Our family, friends, nanny and even strangers, stepped up and helped us with our daughter to allow us to do this. Without this amazing support, we could not have done this. Yes, there were people in our lives, who let us down and were not there for what we needed. We know though, everyone deals with this in their own way, and everyone has something they are facing, we try not to judge, be disappointed and expect nothing more.

In August of 2018, the trial actually opened up at my local hospital, Mayo Clinic, in Jacksonville and I was allowed to move my trial, eliminated our need to travel for treatment, a game changer.

The trial, TOPACIO, is the best decision I made, no regrets. It is saving my life. I am still on trial and will be for the rest of my life, unless it stops working, but I refuse to consider this. I would rather say, until science catches up and there is a CURE. The drugs I am on are brand names, Zejula, made by Tesarso (Now owned by GSK) and Keytruda, made by Merck. Zejula is a PARP inhibitor and I take it daily. Keytruda is immunotherapy and I receive an infusion, every 3 weeks. I have a CT Scan with contrast, every 9 weeks, to confirm it continues to work.

In March of 2019, the trial is working so well, that I am considered NEAD (No Evidence of Active Disease), this means that my tumor has shrunk so much that it is impossible to find on the scans. It does NOT mean that the tumor is gone, it does NOT mean that I cured from Stage IV Metastatic Breast Cancer. It is important to know that there is NO CURE. I will never hear those words or even “Cancer Free” but that does not mean I won’t have a long life to live. I believe I will.

The drugs I am on, while FDA approved for other cancers, are not approved for Breast Cancer. I do not know the status or plans by Merck to get Keytruda approved for certain Breast Cancers by FDA, but based on how generous Merck is by providing access to many breast cancer patients through compassionate use, outside FDA approval and free to the patients aa insurance cannot approve the use of non-FDA approved drugs and pay for it.  I do know that while GSK has obtained approval for Zejula for Ovarian Cancer, they will not be moving forward and get it approved for Breast Cancer. Triple Negative breast cancer characteristics closely align with Ovarian cancer, so the treatments that work are similar. I cannot tell you why they will not try for FDA approval but there other 2 similar drugs on the market that have already been approved for Triple Negative by the FDA, so PARPs are available.

For me, while they will close my trial, Tesaro has guaranteed me access to Zejula for as long as it continues to work for me. I am grateful for that. Merck is providing me Keytruda through compassionate use now and I have no expectations that they will end this program until/if it becomes available through FDA approval.

Where am I on Groundhog Day, 3 years after being told that I had 12 months to live?  I am raising my beautiful 7-year-old daughter with my incredible supportive husband, Kent. I am so lucky! Yes, I said LUCKY, many, many women are not having the success in their treatment that I am especially in the first line of treatment, and many do not have supportive husbands or even families.  I work full time, have not ever had to take a break from work. I build an amazing career and am passionate about what I do. Without the support of my friend, mentor, boss and partner in my business, this would not be possible. Is it as important to me as it once was before cancer, no. At one time in my life, my career, had little work/life balance by my own choice. This is not the case today. I am not sure how I feel about this, as my career is a big part of my life and very important to me. I work with many people who remind me every day why I dedicated my career to this path, and I am grateful for them too.

I am passionate now about correcting wrongs about Breast Cancer Awareness. There is so much misinformation out there. I am dedicated to advocate for a cure. I will do this with by dedicating my time, my money (my friends and supporters’ money  by fundraising) and staying vocal and LOUD about the truth.

Here is what you need to know about Stage IV Metastatic Breast Cancer. This is cancer that has moved out of the breast and into other areas of the body – liver, brain, lungs, skin and bones are the most common areas it will metastasize to. It IS breast cancer in these areas, not a new cancer.

Metastatic breast cancer is the ONLY breast cancer that KILLS. 42,000 women and men in 2019 died from this disease and in 1989, the SAME NUMBER died from this disease. This is so unacceptable. We need to save all these lives. I do not want to be a part of this statistic in the future nor do I want anyone with this disease to be a part of it either.

The only path to a cure is RESEARCH! And research costs money. Research has to include Clinical Trials so that they FDA can approve these drugs to make them available for “standard of care” What does not lead to a cure… PINK RIBBONS; BS messaging that women are being cured from this disease. Yes, Stage 0 to Stage 3 diagnosed women are told they are CURED, and this is amazing BUT 1 in 5 of those women will later hear that their cancer has metastasized to somewhere else in their body and their outlook will change.

Thank you for staying with me, if you are still reading  - remember:
#PINKisaCOLORNOTACURE #StageIVneedsmore BRCA needs more publicity so more understand their risk and can test if they want #RESEARCHNOTRIBBONS

 Follow more of my story on Facebook at LUCYSMOMFIGHTSCANCER

Stacy Hanson AKA Lucy’s Mom Stacy Hanson

Event Chair- Making Strides Against Breast Cancer

Unfortunately with my amazing personal news comes the unfortunate stark reality of Metastatic Breast Cancer #MBC aka Stage IV.

7 people, 1 of whom I consider a personal inspiration and part of my inner support group of friends (on Facebook, across the world) that communicate and share the good, bad and ugly of living with Stage IV breast cancer on a daily basis, have died from this horrible disease in the past 48 hours.

I am devastated and back to reality, and why my advocacy will never stop! Approximately 40,000 women DIE everyday from #mbc in just the United States alone, that is 110 women EVERY DAY!!

We need to change this. I will again post the graph from the CDC that shows that with all the strides made with Breast Cancer research, the number of BC deaths has not changed annually in over 25+ years! This is unacceptable. As Beth Fairchild (the founder of METAvivor) started 5 years ago #stageivneedsmore

This is so unfair, my friend who passed was under 40 years old and had 3 young sons, deserved so much more. Through it all she blogged about her journey, educated, raised awareness and funds for research and finding a cure, advocated for change and her story was even told by People Magazine less than a year ago.

Please continue to support the charities you KNOW make a change, there are many out there, but a limited number, who really fight to find a cure for Stage IV breast cancer.

While the official announcement has not been made yet, I have agreed to come back at the event chair of the Making Strides Against Breast Cancer event on October 19, 2019 in Jacksonville, FL. Any doubts I had about signing up again for this commitment are now gone and we will make this the best fundraising year this event has ever seen Making Strides Against Breast Cancer of Jacksonville. I know the Amercian Cancer Society will use the funds raised in last years event (over $570K) and this years event, make a difference in finding a cure by funding grants and clinical trials dedicated to #mbc

Only we can make a difference, our voices needs to be heard. This is not about pink ribbons or runs, or even walks, this is about saving lives, I will not sit on the sidelines and allow Breast Cancer “awareness” be about partial truths and fundraising directed at these efforts.

The truth is there is NO CURE for Stage IV breast cancer, any kind, and to quote Beth again from her appearance on the today show “no one dies from a lump in their breast” but 110 women die a day in the U.S.

#tnbc #mbc #brca1 #allforlucyStacy Hanson, Chief Client Officer of CoventBridge Group, to serve as 2019 Making Strides Against Breast Cancer event chair for the second consecutive year.

Guest Blog on the BRCA Gene written by Stacy Hanson

Blindsided By Stage IV Breast Cancer

Update from Boston

We had a great and informative trip to Boston. 

Here are the highlights:

Dr. Mayer reviewed my Feb 11th scans with her radiologist and the radiologist said to her that there is NO signs of cancer! 😳 

Dr. Mayer then asked her to look at my Feb 2017 scans, from original diagnosis, and compare to these scans, at that point they were able to see the same small something in the area where we know the tumor was. She said it is most likely scar tissue but there is no way to know if there is any cancer cells in there without an MRI or PET but not worth doing.

She puts me at NED and considers me at complete response on the trial to date! 💕💕💕💕💕*Note, my Mayo oncologist takes a much more conservative approach to this diagnosis, while the radiologist report at Mayo also states No Definitive Evidence of Metastatic Disease, Dr. Colon currently officially does not call it NED as while he agrees it is probably scar tissue, wants to be exact as I am in trial and would not want to risk my participation in the trial and reports accurately that we can still see this TINY spot on the scans where the known tumor was located.

Still lots of unknown about going off Keytruda at the 2 year mark. Overall, if I can find a way to get Merck to give me the drug off trial, I will but most likely I won’t have success in those efforts. 

Bottom line, we are just data blind in Keytruda or any immunotherapy regarding length of time to be on it longer than 2 years especially for breast cancer and the FDA has only approved the drug for other cancers with the 2 year limit.

With all that said, I am thrilled and beyond amazed at my progress on these drugs and will stay on trial and continue to pray and trust in my doctors at Mayo Clinic and Dana-Farber Cancer Institute, as well as Tesaro. These drugs have given me much more than I could have hoped for with Stage IV Metastatic Breast Cancer with the BRCA1 gene. 

Thank you for following my journey and all your love and prayers! 💕💕💕

#tnbc #brca1 #stageivneedsmore #allforlucy

My Story with Dana Farber

https://blog.dana-farber.org/insight/2018/12/living-with-metastatic-breast-cancer-one-moms-story/

Where is the OUTRAGE???

In 1995, if there was a terriorst attack in the United States, that slowly began to kill approximately 40,000 women annually and disabled approximately 150,000 women, who may die from this disability. AND this continued year after year for the next 23 years to today with no end in sight, no way to stop it. You can be sure everyone would be motivated to find a way to stop it immediately, before more women die and more are affected. Politians, celebrities, major corporations, Charities, and the public, would join together to find a way to stop it.  These are huge numbers of people per year and is unacceptable in the United States to not do everything to stop it. 

However, this scenario exists, with these exact tragic number of deaths annually (approximately 40,000) and another 150,000 living with Stage IV Metastatic Breast Cancer, dying for a cure in just the United States. The CDC has tracked and reported the cause of deaths since 1995 to date, and as you can see in the graph attached, these numbers have remained unchanged for breast cancer deaths for more than 2 decades.

Where is the outrage?  Where are the politicians, corporations, celebrities and just the citizens of the United States coming together to fund, research, and find a cure for those already effected and researching to create a vaccine to completely eradicate this horrible disease.

I have sat in meetings and telephone calls with various “activists” over the past few weeks and am so discouraged and disappointed but also MOTIVATED even more to be a part of the change.

I will be posting over the next few days, my thoughts on what needs to be done. I have struggled with  my platform for my personal advocacy and I think I have some more clairty now.

Know this, there are a lot of Breast cancer charities out there, many do great things for research and to help patients financially and emotionally while fighting this disease at all stages. However, the field is littered with charities all focused on the same features and getting on the “Breast Cancer Awareness” band wagon, accepting that what they are all doing today, as a group and individually, is making an impact. We have made huge strides in early detection but are leaving behind the Stage IV Metastatic women fighting, losing their lives and/or accepting a quality of life less than what they deserve. It seems to me that it has been decided that the numbers of people in this group of MBC, is not large enough to dedicate much more to. Only 5% of all the donations raised across all breast cancer charities are donated to Stage IV Metastatic research and a cure.

Change is needed- who will be the first National Breast Cancer charity to step out of the pack, and focus on finding a cure and saving women! And take their research to the next step, Find a CURE  AND develop a vaccine that can eradicate breast cancer, like we have done with other horrible diseases in the past.  A cure and finding a way to eradicate the disease do not have to be mutually exclusive, we can and should be focused on both!

How does Breast Cancer Staging Work?

Do you know what each staging of Breast Cancer means? How is it determined?

How does Breast Cancer Staging Work?

he stage of a breast cancer is determined by the cancer’s characteristics, such as how large it is and whether or not it has hormone receptors. The stage of the cancer helps you and your doctor:

• figure out your prognosis, the likely outcome of the disease
• decide on the best treatment options for you
• determine if certain clinical trials may be a good option for you

Breast cancer stage is usually expressed as a number on a scale of 0 through IV — with stage 0 describing non-invasive cancers that remain within their original location and stage IV describing invasive cancers that have spread outside the breast to other parts of the body.

How a breast cancer’s stage is determined

Your pathology report will include information that is used to calculate the stage of the breast cancer — that is, whether it is limited to one area in the breast, or it has spread to healthy tissues inside the breast or to other parts of the body. Your doctor will begin to determine this during surgery to remove the cancer and look at one or more of the underarm lymph nodes, which is where breast cancer tends to travel first. He or she also may order additional blood tests or imaging tests if there is reason to believe the cancer might have spread beyond the breast.

The breast cancer staging system, called the TNM system, is overseen by the American Joint Committee on Cancer (AJCC). The AJCC is a group of cancer experts who oversee how cancer is classified and communicated. This is to ensure that all doctors and treatment facilities are describing cancer in a uniform way so that the treatment results of all people can be compared and understood.

In the past, stage number was calculated based on just three clinical characteristics, T, N, and M:

• the size of the cancer tumor and whether or not it has grown into nearby tissue (T)
• whether cancer is in the lymph nodes (N)
• whether the cancer has spread to other parts of the body beyond the breast (M)

Numbers or letters after T, N, and M give more details about each characteristic. Higher numbers mean the cancer is more advanced. Jump to more detailed information about the TNM system.

In 2018, the AJCC updated the breast cancer staging guidelines to add other cancer characteristics to the T, N, M system to determine a cancer’s stage:

• tumor grade: a measurement of how much the cancer cells look like normal cells
• estrogen- and progesterone-receptor status: do the cancer cells have receptors for the hormones estrogen and progesterone?
• HER2 status: are the cancer cells making too much of the HER2 protein?
• Oncotype DX score, if the cancer is estrogen-receptor-positive, HER2-negative, and there is no cancer in the lymph nodes

Adding information about tumor grade, hormone-receptor status, HER2 status, and possibly Oncotype DX test results has made determining the stage of a breast cancer more complex, but also more accurate.

“The updated guidelines mean that staging is now catching up to how people are actually treated,” explained Elizabeth Mittendorf, M.D., Ph.D., Rob and Karen Hale Distinguished Chair in Surgical Oncology and director of the Breast Immuno-Oncology Program at the Dana-Farber Cancer Institute, who served on the expert panel that wrote the updated guidelines. “When developing a treatment plan, doctors always consider tumor grade, hormone-receptor status, HER2 status, and the Oncotype DX score, if applicable. So, a woman diagnosed with stage II disease that is triple-negative [estrogen-receptor-negative, progesterone-receptor-negative, and HER2-negative] will have a very different treatment plan than a woman diagnosed with stage II disease that is estrogen-receptor-positive. The staging guidelines now take into account what doctors have been doing all along.”

In general, according to experts, the new staging system classifies triple-negative breast cancer (estrogen-receptor-negative, progesterone-receptor-negative, and HER2-negative) at a higher stage and classifies most hormone-receptor-positive breast cancer at a lower stage.

You also may see or hear certain words used to describe the stage of the breast cancer:

• Local: The cancer is confined within the breast.
• Regional: The lymph nodes, primarily those in the armpit, are involved.
• Distant: The cancer is found in other parts of the body as well.

Sometimes doctors use the term “locally advanced” or “regionally advanced” to refer to large tumors that involve the breast skin, underlying chest structures, changes to the breast's shape, and lymph node enlargement that is visible or that your doctor can feel during an exam.

Jump to a specific breast cancer stage to learn more:

• Stage 0
• Stage I
• Stage II
• Stage III
• Stage IV

The updated AJCC breast cancer staging guidelines have made determining the stage of a cancer a more complicated but accurate process. So, the characteristics of each stage below are somewhat generalized. To see all the possible characteristics of each stage, you can review the AJCC Breast Cancer Staging Guidelines (PDF) online.

Stage 0

Stage 0 is used to describe non-invasive breast cancers, such as DCIS (ductal carcinoma in situ). In stage 0, there is no evidence of cancer cells or non-cancerous abnormal cells breaking out of the part of the breast in which they started, or getting through to or invading neighboring normal tissue.

Learn about what treatments you can generally expect for stage 0 in the Options by Cancer Stage: Stage 0 page in Planning Your Treatment.

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Stage I

Stage I describes invasive breast cancer (cancer cells are breaking through to or invading normal surrounding breast tissue) Stage I is divided into subcategories known as IA and IB.

In general, stage IA describes invasive breast cancer in which:

• the tumor measures up to 2 centimeters (cm) and
• the cancer has not spread outside the breast; no lymph nodes are involved

In general, stage IB describes invasive breast cancer in which:

• there is no tumor in the breast; instead, small groups of cancer cells — larger than 0.2 millimeter (mm) but not larger than 2 mm — are found in the lymph nodes or
• there is a tumor in the breast that is no larger than 2 cm, and there are small groups of cancer cells — larger than 0.2 mm but not larger than 2 mm — in the lymph nodes

Still, if the cancer is estrogen-receptor-positive or progesterone-receptor-positive, it is likely to be classified as stage IA.

Microscopic invasion is possible in stage I breast cancer. In microscopic invasion, the cancer cells have just started to invade the tissue outside the lining of the duct or lobule, but the invading cancer cells can't measure more than 1 mm.

Learn about what treatments you can generally expect for stage IA and IB in the Options by Cancer Stage: Stage IA and IB page in Planning Your Treatment.

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Stage II

Stage II is divided into subcategories known as IIA and IIB.

In general, stage IIA describes invasive breast cancer in which:

• no tumor can be found in the breast, but cancer (larger than 2 millimeters [mm]) is found in 1 to 3 axillary lymph nodes (the lymph nodes under the arm) or in the lymph nodes near the breast bone (found during a sentinel node biopsy) or
• the tumor measures 2 centimeters (cm) or smaller and has spread to the axillary lymph nodes or
• the tumor is larger than 2 cm but not larger than 5 cm and has not spread to the axillary lymph nodes

Still, if the cancer tumor measures between 2 and 5 cm and:

• has not spread to the lymph nodes or parts of the body away from the breast
• is HER2-negative
• is hormone-receptor-positive

it will likely be classified as stage IB.

Similarly, if the cancer tumor measures between 2 and 5 cm and:

• has not spread to the lymph nodes
• is HER2-negative
• is estrogen-receptor-positive
• is progesterone-receptor-negative
• has an Oncotype DX Recurrence Score of 9

it will likely be classified as stage IA.

In general, stage IIB describes invasive breast cancer in which:

• the tumor is larger than 2 cm but no larger than 5 centimeters; small groups of breast cancer cells — larger than 0.2 mm but not larger than 2 mm — are found in the lymph nodes or
• the tumor is larger than 2 cm but no larger than 5 cm; cancer has spread to 1 to 3 axillary lymph nodes or to lymph nodes near the breastbone (found during a sentinel node biopsy) or
• the tumor is larger than 5 cm but has not spread to the axillary lymph nodes

Still, if the cancer tumor measures between 2 and 5 cm and:

• cancer is found in 1 to 3 axillary lymph nodes
• is HER2-positive
• estrogen-receptor-positive
• progesterone-receptor-positive

it will likely be classified as stage IB.

Learn about what treatments you can generally expect for stage IIA and IIB in the Options by Cancer Stage: Stage IIA and IIB page in Planning Your Treatment.

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Stage III

Stage III is divided into subcategories known as IIIA, IIIB, and IIIC.

In general, stage IIIA describes invasive breast cancer in which either:

• no tumor is found in the breast or the tumor may be any size; cancer is found in 4 to 9 axillary lymph nodes or in the lymph nodes near the breastbone (found during imaging tests or a physical exam) or
• the tumor is larger than 5 centimeters (cm); small groups of breast cancer cells (larger than 0.2 millimeter [mm] but not larger than 2 mm) are found in the lymph nodes or
• the tumor is larger than 5 cm; cancer has spread to 1 to 3 axillary lymph nodes or to the lymph nodes near the breastbone (found during a sentinel lymph node biopsy)

Still, if the cancer tumor measures more than 5 cm across and:

• is grade 2
• cancer is found in 4 to 9 axillary lymph nodes
• is estrogen-receptor-positive
• is progesterone-receptor-positive
• is HER2-positive

it will likely be classified as stage IB.

In general, stage IIIB describes invasive breast cancer in which:

• the tumor may be any size and has spread to the chest wall and/or skin of the breast and caused swelling or an ulcer and
• may have spread to up to 9 axillary lymph nodes or
• may have spread to lymph nodes near the breastbone

Still, if the cancer tumor measures more than 5 cm across and:

• is grade 3
• cancer is found in 4 to 9 axillary lymph nodes
• is estrogen-receptor-positive
• is progesterone-receptor-positive
• is HER2-positive

it will likely be classified as stage IIA.

Inflammatory breast cancer is considered at least stage IIIB. Typical features of inflammatory breast cancer include:

• reddening of a large portion of the breast skin
• the breast feels warm and may be swollen
• cancer cells have spread to the lymph nodes and may be found in the skin

In general, stage IIIC describes invasive breast cancer in which:

• there may be no sign of cancer in the breast or, if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast and
• the cancer has spread to 10 or more axillary lymph nodes or
• the cancer has spread to lymph nodes above or below the collarbone or
• the cancer has spread to axillary lymph nodes or to lymph nodes near the breastbone

Still, if the cancer tumor measures any size and:

• is grade 2
• is estrogen-receptor-positive
• is progesterone-receptor-positive
• is HER2-positive or negative

it will likely be classified as stage IIIA.

Learn about what treatments you can generally expect for stage IIIA, IIIB, and IIIC in the Options by Cancer Stage: Stage IIIA, IIIB, and IIIC page in Planning Your Treatment.

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Stage IV

Stage IV describes invasive breast cancer that has spread beyond the breast and nearby lymph nodes to other organs of the body, such as the lungs, distant lymph nodes, skin, bones, liver, or brain.

You may hear the words “advanced” and “metastatic” used to describe stage IV breast cancer. Cancer may be stage IV at first diagnosis, called “de novo” by doctors, or it can be a recurrence of a previous breast cancer that has spread to other parts of the body.

Learn about what treatments you can generally expect for stage IV in the Options by Cancer Stage: Stage IV page in Planning Your Treatment.

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More information about the TNM staging system

The T (size) category describes the original (primary) tumor:

• TX means the tumor can't be assessed.
• T0 means there isn't any evidence of the primary tumor.
• Tis means the cancer is "in situ" (the tumor has not started growing into healthy breast tissue).
• T1, T2, T3, T4: These numbers are based on the size of the tumor and the extent to which it has grown into neighboring breast tissue. The higher the T number, the larger the tumor and/or the more it may have grown into the breast tissue.

The N (lymph node involvement) category describes whether or not the cancer has reached nearby lymph nodes:

• NX means the nearby lymph nodes can't be assessed, for example, if they were previously removed.
• N0 means nearby lymph nodes do not contain cancer.
• N1, N2, N3: These numbers are based on the number of lymph nodes involved and how much cancer is found in them. The higher the N number, the greater the extent of the lymph node involvement.

The M (metastasis) category tells whether or not there is evidence that the cancer has traveled to other parts of the body:

• MX means metastasis can't be assessed.
• M0 means there is no distant metastasis.
• M1 means that distant metastasis is present.