Stage 2 breast cancer: Definition, treatment, outlook, and more - Medical News Today

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People with stage 2 breast cancer have cancer cells in their breast tissue, nearby lymph nodes, or both.

This article discusses what stage 2 breast cancer is, some treatment options, and the outlook for stage 2 breast cancer.

It also explains how to find support, the next steps, and some questions a person can ask a healthcare professional after receiving a diagnosis.

Stage 2 breast cancer is an early stage of breast cancer in which the cancer has not spread beyond the breast tissue or surrounding lymph nodes.

Cancer stages describe the extent to which the cancer has spread and the size of a tumor.

Knowing the stage of cancer a person has helps healthcare professionals determine which treatment plan may be most effective for them.

Healthcare professionals categorize stage 2 breast cancer into two groups: stage 2A and 2B. These are based on tumor size and whether or not the lymph nodes are involved.

Classifying breast cancer tumors

In addition to using the numerical stage classifications, healthcare professionals also describe tumors using the tumor, node, metastasis (TNM) staging system.

In this system, T describes tumor size, N describes the presence of cancer cells in the lymph nodes, and M describes whether or not the cancer has spread to other areas of the body.

Here are the possible classifications for tumor size (T):

TX: Healthcare professionals cannot measure primary tumor size.
T0: Healthcare professionals cannot find a tumor.
T1: The tumor is smaller than 2 centimeters (cm).
T2: The tumor measures 2–5 cm.
T2: The tumor is larger than 5 cm.
T4: The tumor has spread beyond the breast tissue and lymph nodes or is inflammatory.

Here are the possible classifications for lymph node involvement (N):

NX: Healthcare professionals cannot assess the lymph nodes.
N0: The cancer has not spread to the surrounding nodes.
N1, N2, N3: These indicate the number of nodes involved.

Here are the possible classifications for metastasis (M):

M0: There is no sign that the cancer has spread (all stage 1–3 cancers).
M1: The cancer has spread to another area of the body.
MX: The cancer spread is not measurable.

Since 2018, healthcare professionals have added new cancer characteristics to the TNM staging system that may help guide treatment. These include:

Tumor grade: This measures how similar cancer cells look to normal cells.
- Grade 1: Cancer cells are slower growing, and normal looking cells are less likely to spread.
- Grade 2: Cancer cells look less like normal cells, and the likelihood of spread is somewhere between grades 1 and 2.
- Grade 3: Cancer cells look different from normal cells and are more likely to spread and grow quickly.
Estrogen and progesterone hormone receptor (HR) status: This measures whether or not cancer cells carry receptors for the hormones estrogen and progesterone.
Human epidermal growth factor receptor 2 (HER2) status: This measures whether or not cancer cells are overproducing HER2 proteins, which help breast cells grow, repair themselves, and divide.
Oncotype DX score: This is a genomic profile of the tumor for HR-positive, HER2/neu-negative breast cancer. It helps healthcare professionals learn more about the outlook and whether or not chemotherapy may add benefit beyond anti-estrogen therapy.

Stage 2A

Stage 2A breast cancer typically describes one of the following scenarios:

The tumor in the breast is 2 cm or smaller. Cancer cells occur in one to three lymph nodes near the breastbone or in the armpit.
There is no tumor in the breast, but there are cancer cells in the breast tissue and in one to three lymph nodes.
The tumor in the breast is 2–5 cm. There are no cancer cells in the lymph nodes.

According to the TNM staging system, stage 2A breast cancer equates to one of the following combinations:

T0 N1 M0
T1 N1 M0
T2 N0 M0

Stage 2B

Stage 2B breast cancer typically describes one of the following scenarios:

The tumor in the breast measures 2–5 cm, and a few groups of cancer cells in lymph nodes measure 0.2–2 millimeters.
The tumor is 2–5 cm, and there are cancer cells in one to three lymph nodes near the breastbone or in the armpit.
The tumor is larger than 5 cm, but the cancer has not spread to the surrounding lymph nodes.

According to the TNM staging system, stage 2B breast cancer equates to one of the following combinations: T2 N1 M0 or T3 N0 M0.

Treatment plans for stage 2 breast cancer depend on hormone and HER2/neu receptors, any additional health conditions or risks, and what a person and their healthcare professional feel most comfortable with.

In some cases, people with stage 2 breast cancer undergo the following treatments.

Chemotherapy

Healthcare professionals recommend chemotherapy in some types of stage 2 breast cancer. It is generally a mixture of medications that travel throughout the bloodstream and destroy the cancer cells.

A person may receive chemotherapy after or before surgery. They may receive chemotherapy before surgery to help reduce the size or extent of the cancer.

Surgery

Surgery for stage 2 breast cancer involves the surgical removal of any tumors or lymph nodes that contain cancer cells.

Options may include removing only the breast tissue that is affected while conserving healthy breast tissue (lumpectomy) rather than removing the entire breast (mastectomy).

With either surgery, a specialist will test the lymph nodes to see whether or not they contain cancer cells.

Radiation therapy

Radiation therapy involves using high energy rays to destroy cancer cells in specific areas of the body.

Healthcare professionals frequently use radiation therapy after lumpectomy to destroy cancer cells that may remain after the surgical procedure. They may also use radiation therapy after mastectomy if the person has certain risk factors for local recurrence.

Hormone blocking therapy

Healthcare professionals may use hormone blocking therapy to treat stage 2 breast cancer that is HR-positive.

Hormone blocking therapies consist of medications that either block estrogen and progesterone from binding to cancer cells (tamoxifen) or decrease the amount of estrogen in the body (aromatase inhibitors).

One of the most common medications is tamoxifen. People may take it daily for up to 5 years after undergoing other therapies for cancer. Tamoxifen works in both pre and postmenopausal people but is more common among premenopausal people.

Aromatase inhibitors only work if a person is in menopause or taking medication to imitate menopause (ovarian suppression).

People with HER2-positive cancers may also receive targeted medications, such as Herceptin, Perjeta, Nerlynx, or Kadcycla.

The first three medications prevent cells from receiving signals that stimulate them to grow, while healthcare professionals may give Kadcycla to people with HER2/neu-positive residual cancer after they undergo preoperative treatment.

Triple-negative breast cancer does not benefit from targeted therapies and responds best to chemotherapy.

There are several ways of assessing the outlook for people with breast cancer.

Factors

A person’s outlook or outcome with breast cancer depends largely on:

its stage
the person’s medical history
special characteristics of the cancer, such as its HER2 status and whether or not it has receptors for estrogen and progesterone
treatments the person receives
how the cancer responds to treatments

Outlook by numerical stage

By one estimate, the 5-year relative survival rates for different stages of breast cancer are:

Stage 0: 100%
Stage 1: 100%
Stage 2: 93%
Stage 3: 72%
Stage 4: 22%

Outlook by SEER stage

In the United States, healthcare professionals typically calculate the outlook for people with cancer using the SEER database.

All cases of stage 2 cancer are localized or regional, with cancer that has not spread beyond the breast tissue or nearby lymph nodes.

The relative survival rate for people with cancer compares their likelihood of survival during a given period with that of the general population.

For example, if the 5-year relative survival rate for a stage of cancer is 90%, people with that stage of cancer are 90% as likely as people without cancer to live for a minimum of 5 years after diagnosis, according to the American Cancer Society (ACS).

Outlook by HR and HER2 status

Outlook also varies based on tumor characteristics, such as subtype.

For example, here are the 5-year relative survival rates for different combinations of HR and HER2 status:

92% for HR-positive, HER2-negative cancer
89% for HR-positive, HER2-positive cancer
83% for HR-negative, HER2-positive cancer
77% for HR-negative, HER2-negative cancer

Racial inequity and outlook

Racial inequities may also affect a person’s outlook with breast cancer.

For example, in the U.S., the 5-year relative survival rate is around 92% for white women but 83% for Black women.

Inequities in healthcare are likely one reason behind this difference, according to the ACS.

Breast cancer incidence differs with age. Here are the percentages of people with breast cancer who died in the U.S. in 2019, categorized by age:

under age 40 years: 3%
40–49 years: 8%
50–59 years: 18%
60–69 years: 24%
70–79 years: 21%
over age 80 years: 27%

There is a wide range of educational, emotional, and financial support resources available for people with breast cancer.

Nonprofit organizations and alliances that offer support include:

Receiving a cancer diagnosis can be frightening and overwhelming. However, it is important to get as much information as possible about the cancer itself, the next steps, and the treatment options available.

Questions to ask a healthcare professional

Here are some questions to ask a healthcare professional about a stage 2 breast cancer diagnosis:

Is the cancer stage 2A or 2B? How will this affect the treatment and outlook?
If the cancer has spread, where has it spread to, and what does this mean for my treatment and outlook?
What other tests might I need?
Do I need to talk to more doctors or other healthcare professionals?
Are there any special characteristics about the cancer, such as HR and HER2 status, and what do these mean?
What are my long-term outlook and estimated chances of survival based on what we know now?
How can I obtain a copy of my pathology report?
Are there any ways to help cover the costs of diagnosis and treatment?

Stage 2 breast cancer is an early stage wherein the cancer has not spread beyond the breast and its surrounding lymph nodes.

By some estimates, the average 5-year relative survival rate for stage 2 breast cancer is around 93%. People who receive earlier diagnoses and treatments for cancer tend to have better outcomes.

A person should talk with a healthcare professional as soon as possible if they experience any symptoms of breast cancer.

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