A 58-year-old woman with invasive ductal carcinoma of the left breast is found on PET-CT to have uptake in an ipsilateral supraclavicular lymph node. There is no evidence of distant metastasis. According to the AJCC TNM system, what is her clinical stage?

• A Stage IIIA
• B Stage IIIB
• C Stage IV
• D Stage IIIC ✓

Explanation

Ipsilateral supraclavicular nodal involvement is classified as N3c, and any T category with N3 disease and no distant metastasis constitutes stage IIIC. Historically supraclavicular nodes were considered distant metastases, but current staging recognises them as regional nodes amenable to combined modality treatment with curative intent. Stage IV requires distant organ metastasis, so classifying this patient as M1 disease would be incorrect under the present AJCC system.

Reference: AJCC Cancer Staging Manual, 8th ed.

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