Hair loss Treatment Center

PARTICIPANTS Marisa Weiss, MD Lankenau Hospital, Pennsylvania Lawrence D. Wickherham, MD National Surgical Adjuvant Breast and Bowel Project (NSABP) EDITORIAL CONSULTANT Maura N. Dickler, MD Assistant Attending Physician, Memorial Sloan-Kettering

MARISA WEISS, MD: The staging system is some way of giving the doctor and the patient a sense of what the outlook looks like. What's the nature of the problem? Is it an easily treated problem or is it a more serious problem? And based on the stage of the cancer, that is how treatment plans are determined and designed.

ANNOUNCER: As soon as possible, doctors want to determine how far the cancer has spread.

DEBU TRIPATHY, MD: At the time of diagnosis and initial surgical treatment, we measure the size of the cancer under the microscope and evaluate lymph nodes in the armpit to determine whether or not there are cancer cells present in these lymph nodes. They also often do other tests, X-rays, scans to see if there is any evidence of breast cancer outside of the breast.

MARISA WEISS, MD: The pathology laboratory also looks at other factors. It gives us an idea about the personality or the nature of the cancer problem in terms of: How fast is it growing? Does it have gene abnormalities present? Are there hormone receptors in place? How does it compare under the microscope to a normal set of cells.

ANNOUNCER: After testing, cancers are, in a sense, rated according to a determined system called TNM.

MARISA WEISS, MD: The TNM classification system refers to the "T" being the tumor size, the "N" being what's happening in the lymph nodes and the "M" meaning what's happening in the rest of the body. Is there any evidence of metastases?

ANNOUNCER: Cancers are then grouped into stages to determine prognosis and treatment.

The earliest stages of breast cancer include cancer that stays within the milk pipe or the lobule in which it started. There are no signs of invasion. We call that stage 0 because there are no signs of invasion.

D. LAWRENCE WICKERHAM, MD: Stage I disease for invasive breast cancer means that the cancer is limited to the breast itself. It does not involve lymph nodes in the armpit and has not spread to other areas in the body, at least as we can. Unfortunately, stage I disease is still a life-threatening illness potentially, and for about 20% of the individuals, there is a long-term risk of recurrence and death.

But for people with stage II breast cancer, cancer that involves not only the breast, but the regional lymph nodes, the long-term survival is not as good. It's probably in the range of 40 to 60% long-term survival from the disease.

Stage III disease is larger tumors that involve greater numbers of lymph nodes.

MARISA WEISS, MD: And then there is metastatic breast cancer. That's stage IV breast cancer in which cancer has spread beyond the breast and immediately adjacent lymph nodes.

Her chance of living five years can range. It can be around, probably around 25 to 40% for somebody who has metastatic breast cancer.

ANNOUNCER: Determining the different stage of breast cancer helps tailor the treatment approach.

D. LAWRENCE WICKERHAM, MD: The classification by stage is an important factor in prognosis, how the patient is going to do over the long-term and can be a factor in choices of therapy.

MARISA WEISS, MD: For a woman who has early-stage breast cancer, there are two categories of treatment.

We can treat the whole breast by removal of the whole breast, that's call mastectomy. Or you can treat the whole breast by removal of the lump and radiation to the remainder of the breast tissue.

In terms of the systemic therapy, there are hormonal therapies, where estrogen is either reduced or its effect is blocked from the cancer cell. There is also chemotherapy, and there's complementary medicine that some women are very interested in pursuing. And these are things women hope that will complement what they're doing in the conventional medicine world.

There are nutritional therapies. Herbal medicine. There is traditional Chinese medicine. Acupuncture.

ANNOUNCER: Treatment for later-stage breast cancer usually focuses less on surgery and more on other types of treatments.

MARISA WEISS, MD: If the cancer is hormone receptor positive, it involves hormonal therapies. If it's not, or if the cancer is aggressive, chemotherapy is usually initiated either one agent, one chemotherapy at a time or sometimes in combination.

And then there are local therapies that are pulled in as needed. So let's say someone has metastatic breast cancer to the back. We may use radiation to help with back pain.

ANNOUNCER: Today as we discover more about the nature of breast cancer, the chances of each woman being a cancer survivor improve.

MARISA WEISS, MD: For women with breast cancer today, they have so many more treatment options than they ever had before within each category of surgery, radiation, hormonal therapies, chemotherapies, immune therapies as well as complementary medicine.

But I'm optimistic, but I also know that this is a complicated disease that's going to take a long time to figure out.