TNM

T (Tumor size), ukuran tumor :

T 0 : tidak ditemukan tumor primer
T 1 : ukuran tumor diameter 2 cm atau kurang
T 2 : ukuran tumor diameter antara 2-5 cm
T 3 : ukuran tumor diameter > 5 cm
T 4 : ukuran tumor berapa saja, tetapi sudah ada penyebaran ke kulit atau dinding dada atau pada
keduanya , dapat berupa borok, edema atau bengkak, kulit payudara kemerahan atau ada
benjolan kecil di kulit di luar tumor utama
N (Node), kelenjar getah bening regional (kgb) :
N 0 : tidak terdapat metastasis pada kgb regional di ketiak / aksilla
N 1 : ada metastasis ke kgb aksilla yang masih dapat digerakkan
N 2 : ada metastasis ke kgb aksilla yang sulit digerakkan
N 3 : ada metastasis ke kgb di atas tulang selangka (supraclavicula) atau pada kgb di mammary
interna di dekat tulang sternum
M (Metastasis) , penyebaran jauh :
M x : metastasis jauh belum dapat dinilai
M 0 : tidak terdapat metastasis jauh
M 1 : terdapat metastasis jauh
STADIUM
Setelah masing-masing faktor T,.N,M didapatkan, ketiga faktor tersebut kemudian digabung dan
didapatkan stadium kanker sebagai berikut :
Stadium 0 : T0 N0 M0
Stadium 1 : T1 N0 M0
Stadium II A : T0 N1 M0 / T1 N1 M0 / T2 N0 M0
Stadium II B : T2 N1 M0 / T3 N0 M0
Stadium III A : T0 N2 M0 / T1 N2 M0 / T2 N2 M0 / T3 N1 M0 / T2 N2 M0
Stadium III B : T4 N0 M0 / T4 N1 M0 / T4 N2 M0
Stadium III C : Tiap T N3 M0
Stadium IV : Tiap T-Tiap N -M1
PROGNOSIS
Stadium klinis dari kanker payudara merupakan indikator terbaik untuk menentukan prognosis
penyakit ini.
Angka kelangsungan hidup 5 tahun pada penderita kanker payudara yang telah menjalani
pengobatan yang sesuai mendekati:
- 95% untuk stadium 0
- 88% untuk stadium I
- 66% untuk stadium II
- 36% untuk stadium III
- 7% untuk stadium IV.
PENANGANAN
Dalam banyak kasus, dokter akan bekerjasama dengan pasien untuk menentukan rencana
pengobatan meskipun pengobatan tiap pasien akan di sesuaikan oleh dokter.
Tapi berikut adalah langkah-langkah umum yang dilakukan dalam pengobatan kanker payudara :
1. Tujuan utama pengobatan kanker stadium awal adalah mengangkat tumor dan membersihkan
jaringan disekitar tumor.
Jadi dokter akan merekomendasikan operasi untuk mengangkat tumor. Umumnya kemudian
akan dilakukan terapi radiasi pada jaringan payudara yang masih ada.
Untuk keadaan tertentu ( misalnya, pasien dengan problem medis yang serius ) radiasi bisa jadi
ditunda.
2. Tahapan berikut dalam menangani kanker stadium awal adalah mengurangi resiko kanker
akan kambuh dan membuang sel kanker yang masih ada.
Bila tumornya lebar atau saluran kelenjar getah bening telah terserang kanker juga, dokter akan
merekomendasikan terapi tambahan, antara lain : Terapi Radiasi, Chemotherapy, dan atau
hormone terapi.
3. Sedang untuk kanker yang kambuh lagi, diperlakukan dengan bermacam-macam cara. Ketika
merencanakan pengobatan, dokter akan mempertimbangkan beberapa faktor :
* Stadium dan grade kanker
* Satus tumor hormone receptor (ER, PR) dan status HER2/neu
* Umur pasien dan kesehatannya secara umum
* Pasien sudah menopause atau belum
* Adanya mutasi dari gen kanker payudara Kondisi biologi kanker payudara memberi efek pada
tingkah laku kankernya dan pengobatannya. Beberapa tumor ukurannya kecil tapi tumbuhnya
cepat atau ukurannya besar tapi tumbuhnya lambat.






Early, locally advanced and secondary breast cancer
Early breast cancer means the cancer has not spread beyond the breast or the lymph nodes in
the armpit on the same side of the body. So, the cancer has not spread to any other part of the
body.
Local recurrence means cancer that has come back in the area of the breast after treatment.
Locally advanced breast cancer means the cancer has not spread to another part of the body but
may be
Bigger than 5 cm across
Growing into the skin or muscle of the chest
Present in the lymph nodes in the armpit, and these lymph nodes are either stuck to each
other, or to other structures
Secondary breast cancer is also called metastatic breast cancer or stage 4 breast cancer. It
means that the cancer has spread to other parts of the body, such as the liver or bones.
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What staging is
The stage of a cancer looks at how big the cancer is and whether it has spread. The tests and
scans you have when diagnosing your cancer give some information about the stage.
The stage is important because it helps your breast cancer specialist to decide on the best
treatment for you. Specialists usually make decisions about treatment for breast cancer according
to the TNM stage and the grade of the cancer.
TMN staging takes into account the size of the tumour (T), whether the cancer has spread to the
lymph glands (lymph nodes) (N), and whether the tumour has spread anywhere else in the body
(M for metastases).
Doctors also sometimes use the number system of staging.
Below is a slightly simplified description of the TNM staging system for breast cancer.
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The T stages (tumour)
TX means that the tumour size cannot be assessed
Tis means DCIS
T1 The tumour is 2 centimetres (cm) across or less

T1 is further divided into 4 groups
T1mi the tumour is 0.1cm across or less
T1a the tumour is more than 0.1 cm but not more than 0.5 cm
T1b the tumour is more than 0.5 cm but not more than 1 cm
T1c the tumour is more than 1 cm but not more than 2 cm
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TNM breast cancer staging

This page tells you about the staging of breast cancer, including TNM staging. You can find
information about
A quick guide to what's on this page
Early, locally advanced and secondary breast cancer
What staging is
The T stages (tumour)
The N stages (nodes)
The M stages (metastases)
How TNM fits together
Using staging to predict outcome
More information about staging


A quick guide to what's on this page
Open box

Early, locally advanced and secondary breast cancer
Early breast cancer means the cancer has not spread beyond the breast or the lymph nodes in
the armpit on the same side of the body. So, the cancer has not spread to any other part of the
body.
Local recurrence means cancer that has come back in the area of the breast after treatment.
Locally advanced breast cancer means the cancer has not spread to another part of the body but
may be
Bigger than 5 cm across
Growing into the skin or muscle of the chest
Present in the lymph nodes in the armpit, and these lymph nodes are either stuck to each other,
or to other structures
Secondary breast cancer is also called metastatic breast cancer or stage 4 breast cancer. It
means that the cancer has spread to other parts of the body, such as the liver or bones.
Back to top

What staging is
The stage of a cancer looks at how big the cancer is and whether it has spread. The tests and
scans you have when diagnosing your cancer give some information about the stage.
The stage is important because it helps your breast cancer specialist to decide on the best
treatment for you. Specialists usually make decisions about treatment for breast cancer according
to the TNM stage and the grade of the cancer.
TMN staging takes into account the size of the tumour (T), whether the cancer has spread to the
lymph glands (lymph nodes) (N), and whether the tumour has spread anywhere else in the body
(M for metastases).
Doctors also sometimes use the number system of staging.
Below is a slightly simplified description of the TNM staging system for breast cancer.
Back to top

The T stages (tumour)
TX means that the tumour size cannot be assessed
Tis means DCIS
T1 The tumour is 2 centimetres (cm) across or less

T1 is further divided into 4 groups
T1mi the tumour is 0.1cm across or less
T1a the tumour is more than 0.1 cm but not more than 0.5 cm
T1b the tumour is more than 0.5 cm but not more than 1 cm
T1c the tumour is more than 1 cm but not more than 2 cm
T2 The tumour is more than 2 centimetres, but no more than 5 centimetres across

T3 The tumour is bigger than 5 centimetres across

T4 is divided into 4 groups
T4a The tumour has spread into the chest wall
T4b The tumour has spread into the skin and the breast may be swollen
T4c The tumour has spread to both the skin and the chest wall
T4d Inflammatory carcinoma this is a cancer in which the overlying skin is red, swollen and
painful to the touch

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The N stages (nodes)
NX means that the lymph nodes cannot be assessed (for example, if they were previously
removed)
N0 No cancer cells found in any nearby nodes
Isolated tumour cells (ITCs) are small clusters of cancer cells less than 0.2 mm across, or a
single tumour cell, or a cluster of fewer than 200 cells in one area of a lymph node. Lymph nodes
containing only isolated tumour cells are not counted as positive lymph nodes
N1 Cancer cells are in the upper levels of lymph nodes in the armpit but the nodes are not stuck
to surrounding tissues
pN1mi One or more lymph nodes contain areas of cancer cells called micrometastases that are
larger than 0.2mm or contain more than 200 cancer cells but are less than 2mm
N2 is divided into 2 groups
N2a there are cancer cells in the lymph nodes in the armpit, which are stuck to each other and
to other structures
N2b there are cancer cells in the lymph nodes behind the breast bone (the internal mammary
nodes), which have either been seen on a scan or felt by the doctor. There is no evidence of
cancer in lymph nodes in the armpit
N3 is divided into 3 groups
N3a there are cancer cells in lymph nodes below the collarbone
N3b there are cancer cells in lymph nodes in the armpit and behind the breast bone
N3c there are cancer cells in lymph nodes above the collarbone

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The M stages (metastases)
M0 means that there is no sign of cancer spread
cMo(i+) means there is no sign of the cancer on physical examination, scans or X-rays but
cancer cells are present in blood, bone marrow, or lymph nodes far away from the breast cancer
the cells are found by laboratory tests
M1 means the cancer has spread to another part of the body

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How TNM fits together
Your doctor puts the TNM results together to give you your overall stage. This is usually what
the doctor writes on your test forms. So, for example, you might see a tumour described as T2
N0 M0. This would be
A single tumour 2.1 to 5 cm across
No evidence of spread to any lymph nodes
No evidence of spread outside the breast
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Using staging to predict outcome
Putting the staging information into a formula called the Nottingham Prognostic Indicator (NPI)
can give some idea of how well treatment may work for an individual person with breast cancer.
The NPI can also give some idea of how long a person may live. You can read more about the
Nottingham Prognostic Index (NPI) in this section.
Doctors often also use computer programs such as Adjuvant! Online, which use staging
information as well as combined results of clinical trials, to help them decide which treatments
may work best for individual people.