Breast Cancer Stages
Doctors diagnose and classify breast cancer, including hormone receptor-positive, according to stages (stages 0 through 4). To determine the stage of breast cancer, your doctor will consider three important factors: tumor size, nodal status, and metastasis.
The size of the primary tumor is one of the main distinguishing characteristics of the cancer stage.
Nodal status indicates the presence or absence of cancer cells in glands or lymph nodes—small, bean-shaped organs that make and store cells that fight infection. The lymph nodes are found in many places in the body, including under the arms, behind the ears, and in the groin. Nodal status helps to define the stage of breast cancer.
Metastasis describes cancer that has spread from the affected breast to other areas of the body such as soft tissue (tissue of the opposite breast, distant lymph nodes, or skin), organs (the liver or lungs), or bone.
Stages 0, 1, and 2 are considered early stage breast cancer.
Stage 0
Ductal or lobular carcinoma in situ is very early breast cancer that has not spread beyond the duct or lobule.
Stage 1
A stage 1 tumor is 2 cm or smaller and has not spread outside the breast.
Stage 2A
In stage 2A breast cancer, no tumor is found in the breast but cancer is found in the axillary lymph nodes, the tumor is 2 cm or smaller and has spread to the axillary lymph nodes, or the tumor is 2 to 5 cm but has not spread to the axillary lymph nodes.
Stage 2B
In stage 2B breast cancer, the tumor is 2 to 5 cm and has spread to the axillary lymph nodes, or the tumor is larger than 5 cm but still confined to the breast.
Stage 3A
In stage 3A breast cancer, no tumor is found in the breast but cancer cells have spread to the axillary lymph nodes that are attached to each other or other structures, the tumor is 5 cm or smaller and has spread to the axillary lymph nodes that are attached to each other or other structures, or the tumor is larger than 5 cm and has spread to the axillary lymph nodes that may or may not be attached to each other or other structures.
Stage 3B
A stage 3B tumor has spread to tissue near the breast (the skin or chest wall, including the ribs and chest muscles) and may have spread to lymph nodes within the breast area or under the arm.
Stage 3C
In stage 3C, the tumor has spread to the lymph nodes beneath the collarbone and near the neck and may have spread to the lymph nodes within the breast area or under the arm and to the tissues near the breast.
Stage 4
In stage 4, the tumor has spread to other organs of the body such as the bones, lungs, liver, or brain.
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Indication Femara is also approved for the extended adjuvant treatment of early stage breast cancer in postmenopausal women who are within three months of completion of five years of tamoxifen therapy. The benefits of Femara in clinical trials are based on 24 months of treatment. Further follow-up will be needed to determine long-term results, including side effects. In addition, Femara is approved for the treatment of postmenopausal women with estrogen receptor-positive or estrogen receptor-unknown breast cancer that has spread to another part of the body (metastatic cancer). Femara is also indicated for the treatment of advanced breast cancer in postmenopausal women with disease progression following antiestrogen therapy. Important Safety Information You should not take Femara if you are premenopausal. Your doctor should discuss the need for adequate birth control if you have the potential to become pregnant, if you are not sure of your postmenopausal status, or if you recently became postmenopausal. Femara is only indicated in postmenopausal women. Talk to your doctor if you're allergic to Femara or any of its ingredients. You should not take Femara if you are pregnant as it may cause harm to an unborn child. Some women reported fatigue and dizziness with Femara. Until you know how it affects you, use caution before driving or operating machinery. Some patients taking Femara had an increase in cholesterol. Additional follow-up is needed to determine the risk of bone fracture associated with long-term use of Femara. In the adjuvant setting, commonly reported side effects are generally mild to moderate. The most common side effects seen with Femara include hot flashes, joint pain, night sweats, weight gain, nausea, tiredness, other heart-related events, and bone fractures. Other less commonly reported side effects include vaginal bleeding, blood clots, other cancers, osteoporosis, stroke, heart attack, and endometrial cancer. In the extended adjuvant setting, commonly reported side effects are generally mild to moderate. Commonly reported side effects for Femara include hot flashes, fatigue, joint pain, headache, increase in sweating, swelling due to fluid retention, increase in cholesterol, dizziness, constipation, nausea, heart-related problems, muscle pain, osteoporosis, arthritis, and bone fracture. In the metastatic cancer setting, commonly reported side effects are generally mild to moderate and may include bone pain, hot flashes, back pain, nausea, joint pain, shortness of breath, tiredness, coughing, constipation, limb pain, chest pain, and headache. Femara is a once-daily convenient prescription tablet. For additional safety information, please see the prescribing information. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 
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