Video Transcript:<br /><br />CancerBro, how is the staging of breast cancer done?<br /><br />The staging of breast cancer is called TNM staging. We will discuss this in detail.<br /><br />It is called as T1 when the tumor size is less than or equal to 2 cm.<br /><br />T2 when the tumor is 2 cm to 5 cm. And T3 when the tumor is more than 5 cm.<br /><br />To understand T4 disease, first we have to know the structures.<br /><br />Deep to the breast there is pectoralls fascia and pectoralls major muscle.<br /><br />And here lies the pectoralis minor muscle. Other structures in the chest wall include ribs and intercostal muscles.<br /><br />If we look from the front of the chest, this is the pectoralis major muscle. And this is the serratus anterior muscle.<br /><br />T4a disease is when the tumor inflirates the chest wall, not including only pectoralis muscle adhesion or invasion.<br /><br />And here, the tumor infiltrates into the serratus anterior muscle.<br /><br />T4b disease is involvement of skin by the tumor. It can present as skin ulceration or as satellite tumor nodules.<br /><br />Or as edema of skin looking like an orange peel known as peau de orange. All the skin changes should occupy less than one-third of the surface area of breast to be called as T4b.<br /><br />Infiltration of tumor into both, chest wall and skin, i.e., T4a and T4b both, is called T4c.<br /><br />And when the breast cancer progresses very rapidly to cause diffuse erythema and edema of skin breast, involving more than one-third of the skin, then it is called as inflammatory breast cancer.<br /><br />Now, we move on to the N-staging. To understand the N staging, first you have to know the local structures in that area. In this figure, you can see the humerus, clavicle and sternum bone. This is the pectoralls minor muscle.<br /><br />These nodular structures in the anterior axillary fold, are called as anterior group of lymph nodes.<br /><br />And along the head of the humerus are lateral group of lymp nodes. All these three groups, lateral to pectoralis minor muscle, are level 1 lymph nodes.<br /><br />These present behind the pectoralls minor muscle are central, or level 2 lymph nodes.<br /><br />And these present medial to pectoralls minor muscle, are apical or level 3 lymph nodes.<br /><br />And these, along the sternum are called as internal mammary lymph nodes.<br /><br />For clinical N-staging, we have to palpate level 1 and 2 lymph nodes in axilla. If they are not palpable, it is NO. If palpable, and freely mobile, it is N1.<br /><br />If level 1 or level 2 lymph nodes are palpable, but they are fixed or matted, it is called as N2a.<br /><br />If only internal mammary lymph nodes are seen in CT scan without any level 1 or level 2 nodes, the it is called as N2b.<br /><br />If infraclavicular lymph nodes are involved, it is called as N3a. If internal mammary ans axillary lymph nodes both are involved that is N2a and N2b, then it is N3b.<br /><br />Involvement of supraclavicular lymph nodes are called as N3c.<br /><br />Read the complete transcript here: https://youtu.be/XEBQ0lq67kM
