Treatment Options by Cancer Stage
Different treatment options and sequences are considered for each stage of breast cancer. The links below will give you a general idea of the treatments your doctor may recommend depending on the stage of the breast cancer. These treatment options are not exact — your own treatment plan may be different, depending on your specific situation.
Stage 0
Stage 0 breast cancer describes 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.
total mastectomy (radiation after mastectomy rarely needed) or
lumpectomy alone (with or without internal radiation — only for a limited subset of women)
none required
no chemotherapy required
hormonal therapy usually prescribed; estrogen receptor status is not always known
no current role for targeted therapy medicines
no current role for immunotherapy medicines
does not apply
Stage IA and IB
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.
total mastectomy: radiation after mastectomy is only rarely needed or
lumpectomy plus radiation or
very occasionally, lumpectomy alone, with or without internal radiation — only for a limited subset of women
sentinel lymph node biopsy, also known as sentinel lymph node dissection (preferred approach) or
chemotherapy may be given to reduce the risk of recurrence
hormonal therapy is prescribed for people with hormone-receptor-positive cancer
targeted therapy medicines may be used to treat cancers that have certain characteristics (for example, cancers that are HER2-positive)
immunotherapy may be recommended before and after surgery if the cancer is triple-negative
does not apply
Stage IIA and IIB
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
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
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 cm; 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
it will likely be classified as stage IB.
total mastectomy; radiation after mastectomy may be needed or
lumpectomy plus radiation, in some cases following chemotherapy to shrink a large single cancer
sentinel lymph node biopsy, also known as sentinel lymph node dissection (preferred approach) or
and
possible radiation to supraclavicular and/or internal mammary lymph nodes
chemotherapy is commonly recommended
hormonal therapy is prescribed for people with hormone-receptor-positive cancer
targeted therapy medicines may be used to treat cancers that have certain characteristics (for example, cancers that are HER2-positive)
immunotherapy may be recommended before and after surgery if the cancer is triple-negative
does not apply
Stage IIIA, IIIB, and IIIC
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
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
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
it will likely be classified as stage IIIA.
total mastectomy followed by radiation or
chemotherapy to shrink the cancer tumor and/or treat cancer in the lymph nodes, followed by lumpectomy and radiation or
chemotherapy to shrink the cancer tumor and/or treat cancer in the lymph nodes, followed by total mastectomy and radiation
possible radiation to supraclavicular and/or internal mammary lymph nodes
chemotherapy is almost always recommended
hormonal therapy is prescribed for people with hormone-receptor-positive cancer
targeted therapy medicines may be used to treat cancers that have certain characteristics (for example, cancers that are HER2-positive)
immunotherapy may be recommended before and after surgery if the cancer is triple-negative
does not apply
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.
enlarged lymph nodes may be treated if they are causing discomfort or other symptoms
chemotherapy is almost always recommended
hormonal therapy is almost always prescribed if the cancer is hormone-receptor-positive
targeted therapy will be used to treat cancers that have certain characteristics, for example, cancers that are HER2-positive or cancers that are HER2-negative but have a BRCA1 or BRCA2 mutation; there are a number of targeted therapies that are approved to treat metastatic breast cancer, and new therapies are constantly being studied
immunotherapy may be recommended if the cancer is triple-negative
radiation is most commonly used to relieve specific signs or uncomfortable symptoms; surgery may be used to control specific symptoms
Learn more in Treatment for Metastatic Breast Cancer.
— Last updated on July 27, 2022, 1:48 PM