【资源】2002年AJCC癌症分期----乳癌(E)

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【TNM Definitions】
        Definitions for classifying the primary tumor (T) are the same for
      clinical and for pathologic classification. If the measurement is made by
      physical examination, the examiner will use the major headings (T1, T2, or
      T3). If other measurements, such as mammographic or pathologic
      measurements, are used, the subsets of T1 can be used. Tumors should be
      measured to the nearest 0.1 cm increment.

      Primary tumor (T)
      TX: Primary tumor cannot be assessed
      T0: No evidence of primary tumor
      Tis: Carcinoma in situ
         Tis (DCIS): Ductal carcinoma in situ
        Tis (LCIS): Lobular carcinoma in situ
         Tis (Pagets): Pagets disease of the nipple with no tumor.

        Note: Pagets disease associated with a tumor is classified according to
      the size of the tumor.

      T1: Tumor ≤2.0 cm in greatest dimension
        T1mic: Microinvasion ≤0.1 cm in greatest dimension
         T1a: Tumor >0.1 cm but ≤0.5 cm in greatest dimension
         T1b: Tumor >0.5 cm but ≤1.0 cm in greatest dimension
        T1c: Tumor >1.0 cm but ≤2.0 cm in greatest dimension

      T2: Tumor >2.0 cm but ≤5.0 cm in greatest dimension

      T3: Tumor >5.0 cm in greatest dimension

      T4: Tumor of any size with direct extension to (a) chest wall or (b) skin,
      only as described below
         T4a: Extension to chest wall, not including pectoralis muscle
         T4b: Edema (including peau d orange) or ulceration of the skin of the
      breast, or satellite skin nodules confined to the same breast
         T4c: Both T4a and T4b
         T4d: Inflammatory carcinoma


      Regional lymph nodes (N)
      NX: Regional lymph nodes cannot be assessed (e.g., previously removed)
      N0: No regional lymph node metastasis
      N1: Metastasis to movable ipsilateral axillary lymph node(s)
      N2: Metastasis to ipsilateral axillary lymph node(s) fixed or matted, or
      in clinically apparent* ipsilateral internal mammary nodes in the absence
      of clinically evident lymph node metastasis
         N2a: Metastasis in ipsilateral axillary lymph nodes fixed to one
      another (matted) or to other structures
        N2b: Metastasis only in clinically apparent* ipsilateral internal
      mammary nodes and in the absence of clinically evident axillary lymph node
      metastasis

      N3: Metastasis in ipsilateral infraclavicular lymph node(s) with or
      without axillary lymph node involvement, or in clinically apparent*
      ipsilateral internal mammary lymph node(s) and in the presence of
      clinically evident axillary lymph node metastasis; or, metastasis in
      ipsilateral supraclavicular lymph node(s) with or without axillary or
      internal mammary lymph node involvement
        N3a: Metastasis in ipsilateral infraclavicular lymph node(s)
        N3b: Metastasis in ipsilateral internal mammary lymph node(s) and
      axillary lymph node(s)
        N3c: Metastasis in ipsilateral supraclavicular lymph node(s)

        * Note: Clinically apparent is defined as detected by imaging studies
      (excluding lymphoscintigraphy) or by clinical examination or grossly
      visible pathologically.

      Pathologic classification (pN)*
      pNX: Regional lymph nodes cannot be assessed (e.g., not removed for
      pathologic study or previously removed)
      pN0: No regional lymph node metastasis histologically, no additional
      examination for isolated tumor cells (ITC)
        Note: ITCs are defined as single tumor cells or small cell clusters ≤0.2
      mm, usually detected only by immunohistochemical (IHC) or molecular
      methods but that may be verified on hematoloxylin & eosin (H&E) stains.
      ITCs do not usually show evidence of malignant activity, e.g.,
      proliferation or stromal reaction.

      pN0(I ): No regional lymph node metastasis histologically, negative IHC

      pN0(I+): No regional lymph node metastasis histologically, positive IHC,
      no IHC cluster >0.2 mm

      pN0(mol ): No regional lymph node metastasis histologically, negative
      molecular findings (RT PCR)**

      pN0(mol+): No regionally lymph node metastasis histologically, positive
      molecular findings (RT PCR)**
        * Note: Classification is based on axillary lymph node dissection with
      or without sentinel lymph node (SLN) dissection. Classification based
      solely on SLN dissection without subsequent axillary lymph node dissection
      is designated (sn) for sentinel node, e.g., pN0(I+) (sn).

        ** Note: RT PCR: reverse transc**tase/polymerase chain reaction.

      pN1: Metastasis in 1 to 3 axillary lymph nodes, and/or in internal mammary
      nodes with microscopic disease detected by SLN dissection but not
      clinically apparent**
        pN1mi: Micrometastasis (>0.2 mm but ≤2.0 mm)
        pN1a: Metastasis in 1 to 3 axillary lymph nodes
         pN1b: Metastasis in internal mammary nodes with microscopic disease
      detected by SLN dissection but not clinically apparent**
        pN1c: Metastasis in 1 to 3 axillary lymph nodes and in internal
      mammary lymph nodes with microscopic disease detected by SLN dissection
      but not clinically apparent.** (If associated with >3 positive axillary
      lymph nodes, the internal mammary nodes are classified as pN3b to reflect
      increased tumor burden.)

      pN2: Metastasis in 4 to 9 axillary lymph nodes, or in clinically apparent
      ** internal mammary lymph nodes in the absence of axillary lymph node
      metastasis to ipsilateral axillary lymph node(s) fixed to each other or to
      other structures
        pN2a: Metastasis in 4 to 9 axillary lymph nodes (at least 1 tumor
      deposit >2.0 mm)
        pN2b: Metastasis in clinically apparent* internal mammary lymph nodes
      in the absence of axillary lymph node metastasis

      pN3: Metastasis in ≥10 axillary lymph nodes, or in infraclavicular lymph
      nodes, or in clinically apparent* ipsilateral internal mammary lymph
      node(s) in the presence of 1 or more positive axillary lymph node(s); or,
      in >3 axillary lymph nodes with clinically negative microscopic metastasis
      in internal mammary lymph nodes; or, in ipsilateral supraclavicular lymph
      nodes
        pN3a: Metastasis in ≥10 axillary lymph nodes (at least 1 tumor deposit
      >2.0 mm); or, metastasis to the infraclavicular lymph nodes
        pN3b: Metastasis in clinically apparent* ipsilateral internal mammary
      lymph nodes in the presence of ≥1 positive axillary lymph node(s); or, in
      >3 axillary lymph nodes and in internal mammary lymph nodes with
      microscopic disease detected by sentinel lymph node dissection but not
      clinically apparent**
         pN3c: Metastasis in ipsilateral supraclavicular lymph nodes

        * Note: Clinically apparent is defined as detected by imaging studies
      (excluding lymphoscintigraphy) or by clinical examination.

        **Note: Not clinically apparent is defined as not detected by imaging
      studies (excluding lymphoscintigraphy) or by clinical examination.


      Distant metastasis (M)
      MX: Presence of distant metastasis cannot be assessed
      M0: No distant metastasis
      M1: Distant metastasis


【Stage Groupings】
      Stage 0
        Tis, N0, M0

      Stage I
        T1*, N0, M0

      Stage IIA
        T0, N1, M0
        T1*, N1, M0
        T2, N0, M0

      Stage IIB
        T2, N1, M0
        T3, N0, M0

      Stage IIIA
        T0, N2, M0
        T1*, N2, M0
        T2, N2, M0
        T3, N1, M0
        T3, N2, M0

      Stage IIIB
        T4, N0, M0
        T4, N1, M0
        T4, N2, M0

      Stage IIIC**
        Any T, N3, M0

      Stage IV
        Any T, Any N, M1
        * Note: T1 includes T1mic
        **Note: Stage IIIC breast cancer includes patients with any T stage who
      have pN3 disease. Patients with pN3a and pN3b disease are considered
      operable and are managed as described in the section on Stage I, II, IIIA,
      and operable IIIC breast cancer. Patients with pN3c disease are considered
      inoperable and are managed as described in the section on Inoperable stage
      IIIB or IIIC or inflammatory breast cancer.

【Stage Notes】
      Stage 0 (carcinoma in situ)
      There are 2 types of breast carcinoma in situ:
         Ductal carcinoma in situ (DCIS) is a noninvasive, precancerous
      condition in which abnormal cells are found in the lining of a breast
      duct. The abnormal cells have not spread outside the duct to other tissues
      in the breast. In some cases, DCIS may become invasive cancer and spread
      to other tissues, although it is not known at this time how to predict
      which lesions will become invasive.
         Lobular carcinoma in situ (LCIS) is a condition in which abnormal
      cells are found in the lobules of the breast. This condition seldom
      becomes invasive cancer; however, having lobular carcinoma in situ in one
      breast increases the risk of developing breast cancer in either breast.

      Pea, peanut, walnut, and lime show tumor sizes.


      Stage I
      In stage I, the tumor is 2 centimeters or smaller and has not spread
      outside the breast.

      Stage IIA
      In stage IIA:
           no tumor is found in the breast, but cancer is found in the axillary
      lymph nodes (the lymph nodes under the arm); or
           the tumor is 2 centimeters or smaller and has spread to the axillary
      lymph nodes; or
           the tumor is larger than 2 centimeters but not larger than 5
      centimeters and has not spread to the axillary lymph nodes.


      Stage IIB
      In stage IIB, the tumor is either:
           larger than 2 centimeters but not larger than 5 centimeters and has
      spread to the axillary lymph nodes; or
           larger than 5 centimeters but has not spread to the axillary lymph
      nodes.


      Stage IIIA
      In stage IIIA:
          no tumor is found in the breast, but cancer is found in axillary lymph
      nodes that are attached to each other or to other structures; or
           the tumor is 5 centimeters or smaller and has spread to axillary lymph
      nodes that are attached to each other or to other structures; or
          the tumor is larger than 5 centimeters and has spread to axillary
      lymph nodes that may be attached to each other or to other structures.


      Stage IIIB
      In stage IIIB, the cancer may be any size and:
          has spread to tissues near the breast (the skin or chest wall,
      including the ribs and muscles in the chest); and
          may have spread to lymph nodes within the breast or under the arm.

      Stage IIIC
      In stage IIIC, the cancer:
         has spread to lymph nodes beneath the collarbone and near the neck;
      and
          may have spread to lymph nodes within the breast or under the arm and
      to tissues near the breast.

      Stage IIIC breast cancer is divided into operable and inoperable stage
      IIIC.

      In operable stage IIIC, the cancer:
        is found in 10 or more of the lymph nodes under the arm; or
         is found in the lymph nodes beneath the collarbone and near the neck
      on the same side of the body as the breast with cancer; or
          is found in lymph nodes within the breast itself and in lymph nodes
      under the arm.

      In inoperable stage IIIC breast cancer, the cancer has spread to the lymph
      nodes above the collarbone and near the neck on the same side of the body
      as the breast with cancer.


      Stage IV
      In stage IV, the cancer has spread to other organs of the body, most often
      the bones, lungs, liver, or brain.