Nottingham Score is a prognostic scoring tool.
Breast cancer is usually staged based on TNM staging chart.
Any biopsy report should mention the size of the tumour, cut section appearance of the specimen. The specimen should be carefully examined forthe clearance of the margins, the differentiation of the cells, the mitotic index of the cancer cells. In addition to this, hormonal markers analysis is also done.
When you say breast cancer of stage 4 it means advanced stage of breast cancer.
I had a score of 9 with a 5cm tumor removed, 1 node involved....stage 3. Stage 4 is metastatic cancer involved in the system, not just a tumor and a node. But to make sure, check out a book on breast cancer that has the EXACT defintitions. Sorry, I've already given mine away, otherwise I'd give more specifics.
See other post on radiation. Please consider it.