Question: I am confused about my cancer stage as it seems much worse than when I originally had my surgery. Based on the report I asked for, my cancer is an invasive lobular carcinoma and measures 1.3 cm. I had a lumpectomy and sentinel node biopsy; my node was negative. My cancer is ER and PR positive and c-erbB-2 negative (my doctor said that’s the same as Her2). However, after my surgery I was told I am now stage IIIB because my cancer was a T4. I have looked this up and I don’t understand because I didn’t have inflammatory cancer but my doctor said the pathologist saw cancer in my skin and so that means I am T4. Can you explain this?

Answer: I understand your frustration–this is one of the problems in the definitions used for T4 cancers in the current staging system.  The definition says “involvement of the chest wall or skin” but many cancers can extend into the “dermis” of the breast but not involve the epidermis or cause inflammatory breast cancer kinds of symptoms. Cancers that just happen to extend into the dermis should be given a T score based upon their size alone and in your case that would be a T1c.  I would ask your surgeon to contact the pathologist and confirm that there was only involvement of the dermis and not “full thickness” skin involvement or inflammatory type changes. Since your sentinel lymph node was negative and I assume your doctors haven’t found any other disease that could be metastatic, you would be a Stage I cancer, not a Stage IIIB.