American Board of Internal Medicine (ABIM) Certification Practice Exam

In breast cancer stages, what does Stage IV represent?

1. Local lymph node involvement

2. Distant metastasis

3. Tumor size of 2-5 cm

4. Minimal lymph node involvement

The correct answer is: Distant metastasis

Stage IV breast cancer is characterized by distant metastasis, which means that the cancer has spread beyond the breast and nearby lymph nodes to other parts of the body. This could include spread to vital organs such as bones, liver, lungs, or brain. The identification of Stage IV indicates a more advanced disease state, emphasizing the need for comprehensive treatment strategies that address not only the primary tumor but also the metastasized sites. Understanding this stage is crucial for determining prognosis and treatment options, as management often shifts to systemic therapies such as chemotherapy, hormonal therapy, or targeted therapies, rather than just localized treatment methods. The other options represent different stages or characteristics of breast cancer. Local lymph node involvement typically corresponds to Stage III, while tumor sizes of 2-5 cm relate to specific characteristics of earlier stages, specifically Stage II, where the cancer may not yet have spread to distant sites. Minimal lymph node involvement also pertains to earlier stages of the disease. Thus, Stage IV is distinct in that it explicitly references the critical aspect of distant metastasis.