Stage 1 to Stage 4: What Cancer Staging Really Means for your Treatment
When you’re first diagnosed with breast cancer, one of the first things you’ll hear is your breast cancer staging—a number between 0 and 4. And if you’re like most people, your heart skips a beat when you hear it. Suddenly, a single number seems to define your entire future.
But here’s the truth: your stage is not your sentence.
As a breast oncologist and founder of myFriendMD, I’ve walked with hundreds of women (and rarely men) through the moment they learned their stage. I want to help you understand what that number really means—because it’s not just about how far the cancer has spread. It’s about helping your medical team create a treatment plan tailored specifically to you.
Let’s break it down.
Stage 0: Ductal Carcinoma in Situ (DCIS)
This is the earliest form of breast cancer—non-invasive. The abnormal cells are confined to the ducts and haven’t spread outside the ducts in the breast to nearby tissue.
Treatment: often includes surgery (lumpectomy or mastectomy) and possibly radiation. Hormone therapy (estrogen blocking pills) may follow if the DCIS is estrogen receptor positive.
The good news: cure rates are excellent. Chemotherapy is not recommended
Stage 1: Early-Stage Invasive Cancer
The tumor is small (usually under 2 cm) and may or may not have reached a nearby lymph node.
Treatment: surgery, radiation, and sometimes chemotherapy or hormone therapy (estrogen blocking pills if estrogen positive), or Herceptin (if HER2 positive) depending on the tumor type
What matters most: at this stage, we often focus on preventing recurrence and tailoring therapy to the specific features of your cancer (like hormone receptors or HER2 status)
Stage 2: Larger or Node-Positive Cancer
The tumor may be slightly larger (>2 cm), or it may have spread to a few nearby lymph nodes.
Treatment: typically includes surgery, possibly chemotherapy, radiation, hormone therapy (estrogen blocking pills if estrogen receptor positive), HER2 targeted therapy if HER2 positive (Herceptin or perjeta), sometimes cdk4/6 inhibitors (like abemaciclib or ribociclib), immunotherapy (like Keytruda) if triple negative
Why staging matters here: stage 2 is still highly treatable, but your doctors are thinking ahead—about both curing the cancer and protecting you from future spread.
Stage 3: Locally Advanced Breast Cancer
This means the cancer is larger or has spread to the lymph nodes, but not to distant organs
Treatment: usually a combination of chemotherapy, surgery, radiation, and possibly targeted therapy (hormone blocking therapy if estrogen positive, her2 targeted therapy if HER2 positive, immunotherapy if triple negative, cdk4/6 inhibitors if hormone receptor positive). Treatment often starts before surgery to shrink the tumor (this is called neoadjuvant therapy). Imaging (like CT/bone scan or PET scans) may be recommended to ensure disease is localized to the breast and lymph nodes.
Important perspective: even though stage 3 sounds scary, many people are cured at this stage with the right combination of treatments.
Stage 4: Metastatic Breast Cancer
This means the cancer has spread to distant organs like the bones, lungs, liver, or brain.
Treatment: while stage 4 is not considered curable, it is absolutely treatable. Many people live for years –sometimes even decades—with metastatic breast cancer. Estrogen positive disease is treated with pills. HER2 positive and triple negative disease is treated with chemotherapy, possibly in combination with targeted therapy (such as HER2 targeted therapy if HER2 positive or immunotherapy if triple negative)
The focus: treatment aims to control the cancer, relieve symptoms, and protect quality of life. This is where personalized care and expert guidance matter most.
So What Does Your Stage Really Mean?
It tells your team:
- How aggressive treatment should be
- Whether cure is the goal or if the focus is long-term control
- What kind of support—physical, emotional, and logistical—you might need
But it doesn’t tell you who you are. It doesn’t measure your strength. And it certainly doesn’t determine your hope. Remember there are long term survivors who outlive the statistics.
At myFriendMD, we’re here to walk beside you—whether you’re navigating early-stage treatment decisions or managing life with metastatic disease. You deserve more than a treatment plan. You deserve clarity, confidence, and compassionate guidance.
If you’re unsure what your stage means or what’s next, book a session. Let’s make space for your questions—and make sure you feel heard.
Check out our article: Do Doctors Tell You Right Away if You Have Cancer? to learn how the process works—and how Dr. Friend supports patients through it.
