ADVANCES IN BREAST CANCER DIAGNOSIS AND TREATMENT: ESSENTIALS

Advances in breast cancer diagnosis and treatment Essentials_kapak

BREAST CANCER STAGING

Aydın Eray Tufan1 Elif Tufan2

1Şişli Hamidiye Etfal Training and Research Hospital, Department of General Surgery, İstanbul, Türkiye
2Şişli Hamidiye Etfal Training and Research Hospital, Department of General Surgery, İstanbul, Türkiye

Tufan AE, Tufan E. Breast Cancer Staging. In: Citgez B editor. Advances in Breast Cancer Diagnosis and Treatment Essentials. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.43-61.

ABSTRACT

Among women worldwide, breast cancer continues to be a major diagnosis. The way it spreads and the underlying biological features of the tumors are the main factors that vary its presentation. Various staging methods have been adopted by medical profesionals to ensure consistency in diagnosis and treatment. The TNM system is the most commonly used staging method. It was originally proposed by Pierre Denoix and later standardized by organizations including the American Joint Committee on Cancer(AJCC) and the Union for International Cancer Control(UICC). The TNM system assesses tumor size and whether it has invaded nearby tissues, checks for the presence of cancer in the lymph nodes, and evaluates whether the disease has spread to distant parts of the body. These variables help guide treatment choices, provide a sense of prognosis, and allow data to be shared meaningfully across research centers. Given the complex nature of breast cancer, it has become more evident that focusing solely on anatomic features is not enough. The eighth edition of the AJCC guidelines introduced a model that addresses these factors in addition to biological factors. This updated version includes key tumor characteristics such as cancer cell responses to estrogen receptors (ER) and progesterone receptors (PR), human epidermal growth factor receptor 2 (HER2) expression status, tumor aggressiveness under the microscope, and, when available, findings from gene-based risk tests such as Oncotype DX. Taking these parameters into account also allowed for different tumor behaviors to enable more personalized treatment for patients with similar anatomic stages. Modern classifications also take into account different tumor types based on their molecular characteristics. For example, some tumors respond completely to hormonal treatments due to the presence of hormone receptors and tend to grow slowly. Others have a faster growth rate or are overexpressed by the HER2 protein. Tumors that lack hormone receptors or HER2 activity, grow aggressively, and do not respond to current targeted therapies fall into the challenging group. Understanding these biological differences is important to determine the most appropriate treatment and predict long-term outcomes. In conculusion, the staging of breast cancer has evolved to encompass more than just anatomical considerations. By incorporating molecular and pathological features, clinicians are now able to classify disease more precisely and tailor treatments accordingly. This approach reflects a growing emphasis on individualized care in oncology, where therapeutic decisions are guided not only by tumor size and spread but also by biological behavior. The current AJCC staging framework exemplifies this trend toward more refined and personalized strategies in clinical practice.

Keywords: Breast neoplasms; Neoplasm staging; Triple negative breast neoplasms

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