Types of TNM staging: (Mnemonic- My CPR
• mTNM- for multiple primary tumors at same site
• yTNM- Staging is done patient has received neoadjuvant chemotherapy
• ypTNM- Pathological staging done after neoadjuvant chemotherapy
• cTNM- for clinical staging
• pTNM- for pathological staging
• rTNM- for recurrent tumors
Stage | Features |
Tis | • DCIS • Paget’s disease of breast |
T1 | ≤2cm (T1a ≤0.5 cm, T1b >0.5-1 cm, T1c >1-2 cm) |
T2 | >2 – ≤5 cm |
T3 | >5 cm |
T4 | Tumor of any size |
T4a (ander) C – Chest wall | Extension to chest wall- (Sir) • Serratus anterior • Intercostal muscles • Ribs Note: Pectoralis major / minor muscle not include. |
T4b (bahar) U – Ulcer | Skin changes (on same breast)- (SURE) • Satellite nodule • Ulcer • Edema, including Peau d’orange (PYQ: INICET May 2025) |
T4c R – Required both | T4a + T4b |
T4d E – Inflammation | Inflammatory breast cancer (Typical ≥1/3rd breast skin involvement) |
Node | Description |
N1 | Metastasis to ipsilateral mobile Axillary LN level I & II |
N2 | N2a: Metastasis to ipsilateral fixed / matted Axillary LN level I & II N2b: Clinically apparent Internal mammary nodes |
N3 | N3a: Metastasis to ipsilateral Infra-clavicular LN N3b = N2a + N2b N3c: Metastasis to ipsilateral Supra-clavicular LN |
Internal mammary LN-
Clinically not palatable
Detect on radiology (USG, Mammography, MRI)
Note- Sentinal node for breast cancer: Anterior LN / Giuliano node (Level I / Lateral to pectoralis minor)
Metastasis | |
M0 | No distant metastasis |
M1 | Distant metastasis: m/c in bones (lumbar or Any nodal metastasis on contralateral |
Stage | Description |
Stage I | T1 N0 |
Stage IIa | T2 N0, T1 N1 |
Stage IIb | T3 N0, T2 N1 |
Stage IIIa | T1 N2*, T3 N2, T2 N2, T3 N1 |
Stage IIIb | T4, N0-2 |
Stage IIIc | any T, N3 |
Stage IV | any T, any N, M1 |
Surgical staging | |
Early breast cancer (EBC) | Stage I Stage IIa Stage IIIb |
Locally advanced breast | Stage IIIa Stage IIIb Stage IIIc |
Metastatic cancers | Stage IV |
