Breast cancer natural history: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
| Line 153: | Line 153: | ||
|- | |- | ||
| rowspan="4" | - | | rowspan="4" | - | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IA | |IA | ||
|- | |- | ||
| Line 161: | Line 161: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IB | |IB | ||
|- | |- | ||
| Line 173: | Line 173: | ||
T2 N0 M0 | T2 N0 M0 | ||
| rowspan="8" |G1 | | rowspan="8" |G1 | ||
| rowspan="4" | | | rowspan="4" | + | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IB | |IB | ||
|- | |- | ||
| Line 182: | Line 182: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIA | |IIA | ||
|- | |- | ||
| Line 189: | Line 189: | ||
|- | |- | ||
| rowspan="4" | - | | rowspan="4" | - | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IB | |IB | ||
|- | |- | ||
| Line 197: | Line 197: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIA | |IIA | ||
|- | |- | ||
| Line 208: | Line 208: | ||
T2 N0 M0 | T2 N0 M0 | ||
| rowspan="8" |G2 | | rowspan="8" |G2 | ||
| rowspan="4" | | | rowspan="4" | + | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IB | |IB | ||
|- | |- | ||
| Line 217: | Line 217: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIA | |IIA | ||
|- | |- | ||
| Line 224: | Line 224: | ||
|- | |- | ||
| rowspan="4" | - | | rowspan="4" | - | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IB | |IB | ||
|- | |- | ||
| Line 232: | Line 232: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIA | |IIA | ||
|- | |- | ||
| Line 243: | Line 243: | ||
T2 N0 M0 | T2 N0 M0 | ||
| rowspan="8" |G3 | | rowspan="8" |G3 | ||
| rowspan="4" | | | rowspan="4" | + | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IB | |IB | ||
|- | |- | ||
| Line 252: | Line 252: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIA | |IIA | ||
|- | |- | ||
| Line 259: | Line 259: | ||
|- | |- | ||
| rowspan="4" | - | | rowspan="4" | - | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IIA | |IIA | ||
|- | |- | ||
| Line 267: | Line 267: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIB | |IIB | ||
|- | |- | ||
| Line 277: | Line 277: | ||
T3 N0 M0 | T3 N0 M0 | ||
| rowspan="8" |G1 | | rowspan="8" |G1 | ||
| rowspan="4" | | | rowspan="4" | + | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IB | |IB | ||
|- | |- | ||
| Line 286: | Line 286: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIA | |IIA | ||
|- | |- | ||
| Line 293: | Line 293: | ||
|- | |- | ||
| rowspan="4" | - | | rowspan="4" | - | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IIA | |IIA | ||
|- | |- | ||
| Line 301: | Line 301: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIB | |IIB | ||
|- | |- | ||
| Line 310: | Line 310: | ||
T3 N0 M0 | T3 N0 M0 | ||
| rowspan="8" |G2 | | rowspan="8" |G2 | ||
| rowspan="4" | | | rowspan="4" | + | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IB | |IB | ||
|- | |- | ||
| Line 319: | Line 319: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIA | |IIA | ||
|- | |- | ||
| Line 326: | Line 326: | ||
|- | |- | ||
| rowspan="4" | - | | rowspan="4" | - | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IIA | |IIA | ||
|- | |- | ||
| Line 334: | Line 334: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIB | |IIB | ||
|- | |- | ||
| Line 343: | Line 343: | ||
T3 N0 M0 | T3 N0 M0 | ||
| rowspan="8" |G3 | | rowspan="8" |G3 | ||
| rowspan="4" | | | rowspan="4" | + | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IB | |IB | ||
|- | |- | ||
| Line 352: | Line 352: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIB | |IIB | ||
|- | |- | ||
| Line 359: | Line 359: | ||
|- | |- | ||
| rowspan="4" | - | | rowspan="4" | - | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IIB | |IIB | ||
|- | |- | ||
| Line 367: | Line 367: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIIA | |IIIA | ||
|- | |- | ||
| Line 383: | Line 383: | ||
T3 N2 M0 | T3 N2 M0 | ||
| rowspan="8" |G1 | | rowspan="8" |G1 | ||
| rowspan="4" | | | rowspan="4" | + | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IIA | |IIA | ||
|- | |- | ||
| Line 392: | Line 392: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIIA | |IIIA | ||
|- | |- | ||
| Line 399: | Line 399: | ||
|- | |- | ||
| rowspan="4" | - | | rowspan="4" | - | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IIA | |IIA | ||
|- | |- | ||
| Line 407: | Line 407: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIIA | |IIIA | ||
|- | |- | ||
| Line 422: | Line 422: | ||
T3 N2 M0 | T3 N2 M0 | ||
| rowspan="8" |G2 | | rowspan="8" |G2 | ||
| rowspan="4" | | | rowspan="4" | + | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IIA | |IIA | ||
|- | |- | ||
| Line 431: | Line 431: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIIA | |IIIA | ||
|- | |- | ||
| Line 438: | Line 438: | ||
|- | |- | ||
| rowspan="4" | - | | rowspan="4" | - | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IIA | |IIA | ||
|- | |- | ||
| Line 446: | Line 446: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIIA | |IIIA | ||
|- | |- | ||
| Line 461: | Line 461: | ||
T3 N2 M0 | T3 N2 M0 | ||
| rowspan="8" |G3 | | rowspan="8" |G3 | ||
| rowspan="4" | | | rowspan="4" | + | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IIB | |IIB | ||
|- | |- | ||
| Line 470: | Line 470: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIIA | |IIIA | ||
|- | |- | ||
| Line 477: | Line 477: | ||
|- | |- | ||
| rowspan="4" | - | | rowspan="4" | - | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IIIA | |IIIA | ||
|- | |- | ||
| Line 485: | Line 485: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIIB | |IIIB | ||
|- | |- | ||
| Line 499: | Line 499: | ||
Any T N3 M0 | Any T N3 M0 | ||
| rowspan="8" |G1 | | rowspan="8" |G1 | ||
| rowspan="4" | | | rowspan="4" | + | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IIIA | |IIIA | ||
|- | |- | ||
| Line 508: | Line 508: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIIB | |IIIB | ||
|- | |- | ||
| Line 515: | Line 515: | ||
|- | |- | ||
| rowspan="4" | - | | rowspan="4" | - | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IIIB | |IIIB | ||
|- | |- | ||
| Line 523: | Line 523: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIIB | |IIIB | ||
|- | |- | ||
| Line 536: | Line 536: | ||
Any T N3 M0 | Any T N3 M0 | ||
| rowspan="8" |G2 | | rowspan="8" |G2 | ||
| rowspan="4" | | | rowspan="4" | + | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IIIA | |IIIA | ||
|- | |- | ||
| Line 545: | Line 545: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIIB | |IIIB | ||
|- | |- | ||
| Line 552: | Line 552: | ||
|- | |- | ||
| rowspan="4" | - | | rowspan="4" | - | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IIIB | |IIIB | ||
|- | |- | ||
| Line 560: | Line 560: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIIB | |IIIB | ||
|- | |- | ||
| Line 573: | Line 573: | ||
Any T N3 M0 | Any T N3 M0 | ||
| rowspan="8" |G3 | | rowspan="8" |G3 | ||
| rowspan="4" | | | rowspan="4" | + | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IIIB | |IIIB | ||
|- | |- | ||
| Line 582: | Line 582: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIIB | |IIIB | ||
|- | |- | ||
| Line 589: | Line 589: | ||
|- | |- | ||
| rowspan="4" | - | | rowspan="4" | - | ||
| rowspan="2" | | | rowspan="2" | + | ||
| | | + | ||
|IIIB | |IIIB | ||
|- | |- | ||
| Line 597: | Line 597: | ||
|- | |- | ||
| rowspan="2" | - | | rowspan="2" | - | ||
| | | + | ||
|IIIC | |IIIC | ||
|- | |- | ||
Revision as of 19:16, 1 April 2019
|
Breast Cancer Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Breast cancer natural history On the Web |
|
American Roentgen Ray Society Images of Breast cancer natural history |
|
Risk calculators and risk factors for Breast cancer natural history |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2] Mirdula Sharma, MBBS [3]
Overview
If left untreated, 22% of patients with breast cancer may regress. Common complications of breast cancer include metastasis. Prognosis is generally good with treatment.
Natural History
- There is a theory that up to 22% of small (radiographically detected) breast tumors regress, based on an analysis in a large population.[1] The study is supported by NCI's SEER data.[2]
- The natural history of breast cancer is extremely variable ranging from indolent cancers to aggressive cancers that can metastasize with fatal consequences.[3]
Prognosis
The prognosis and treatment options depend on the following:
- The stage of the cancer (the size of the tumor and whether it is in the breast only or has spread to lymph nodes or other places in the body)
- The type of breast cancer
- Estrogen receptor and progesterone receptor levels in the tumor tissue
- Human epidermal growth factor type 2 receptor (HER2/neu) levels in the tumor tissue
- Whether the tumor tissue is triple negative (cells that do not have estrogen receptors, progesterone receptors, or high levels of HER2/neu)
- How fast the tumor is growing
- How likely the tumor is to recur (come back)
- A woman’s age, general health, and menopausal status (whether a woman is still having menstrual periods)
- Whether the cancer has just been diagnosed or has recurred (come back)
Nottingham Prognostic Index
The Nottingham prognostic index (NPI) is used to determine prognosis following surgery for breast cancer. Its value is calculated using three pathological criteria: the size of the lesion; the number of involved lymph nodes; and the grade of the tumor.[4]
Calculation
The index is calculated using the formula:
- NPI = [0.2 x S] + N + G
Where:
- S is the size of the index lesion in centimetres
- N is the node status: 0 nodes = 1, 1-4 nodes = 2, >4 nodes = 3
- G is the grade of tumour: Grade I =1, Grade II =2, Grade III =3
Interpretation
| Score | 5-year survival |
|---|---|
| 2.0 to 2.4 | 93% |
| 2.5 to 3.4 | 85% |
| 3.5 to 5.4 | 70% |
| > 5.4 | 50% |
Estimated five year survival rates:[5]
- stage I: ~87%
- stage II: ~75%
- stage III: ~46%
- stage IV: ~13%
AJCC clinical prognosis categorization
- The 8th revision of AJCC staging system for breast cancer has been extensively modified.
- Rather than classic TNM system, other characteristics of tumors such as pathologic grade, the presence of ER, PR, hormone receptors as well as presence of certain genetic mutations such as HER2 has been integrated into the latest revision.
- Patients has been assigned to clinical prognosis stages with respect to the above-mentioned criteria.
Approach to determine the clinical prognostic stage group of the patients according to the AJCC staging recommendations for breast cancer (8th edition)
| TNM | Histopathologic Grade | HER2 | ER | PR | Clinical prognostic stage group |
| Tis N0 M0 | Any | Any | Any | Any | 0 |
| T1* N0 M0
T0 N1mi M0 T1*N1mi M0 |
G1 | Any | Any | Any | IA |
| IA | |||||
| IA | |||||
| IA | |||||
| IA | |||||
| IA | |||||
| IA | |||||
| - | - | IB | |||
| - | |||||
| T1* N0 M0
T0 N1mi M0 T1* N1mi M0 |
G2 | Any | Any | Any | IA |
| IA | |||||
| IA | |||||
| IA | |||||
| IA | |||||
| IA | |||||
| IA | |||||
| - | IB | ||||
| - | - | ||||
| T1* N0 M0
T0 N1mi M0 T1* N1mi M0 |
G3 | + | Any | Any | IA |
| IA | |||||
| IA | |||||
| IA | |||||
| - | + | + | IA | ||
| - | IB | ||||
| - | + | IB | |||
| - | IB | ||||
| T0 N1¶ M0
T1* N1¶ M0 T2 N0 M0 |
G1 | + | + | + | IB |
| - | IIA | ||||
| - | + | IIA | |||
| - | IIA | ||||
| - | + | + | IB | ||
| - | IIA | ||||
| - | + | IIA | |||
| - | IIA | ||||
| T0 N1¶ M0
T1* N1¶ M0 T2 N0 M0 |
G2 | + | + | + | IB |
| - | IIA | ||||
| - | + | IIA | |||
| - | IIA | ||||
| - | + | + | IB | ||
| - | IIA | ||||
| - | + | IIA | |||
| - | IIB | ||||
| T0 N1¶ M0
T1* N1¶ M0 T2 N0 M0 |
G3 | + | + | + | IB |
| - | IIA | ||||
| - | + | IIA | |||
| - | IIA | ||||
| - | + | + | IIA | ||
| - | IIB | ||||
| - | + | IIB | |||
| - | IIB | ||||
| T2 N1Δ M0
T3 N0 M0 |
G1 | + | + | + | IB |
| - | IIA | ||||
| - | + | IIA | |||
| - | IIB | ||||
| - | + | + | IIA | ||
| - | IIB | ||||
| - | + | IIB | |||
| - | IIB | ||||
| T2 N1Δ M0
T3 N0 M0 |
G2 | + | + | + | IB |
| - | IIA | ||||
| - | + | IIA | |||
| - | IIB | ||||
| - | + | + | IIA | ||
| - | IIB | ||||
| - | + | IIB | |||
| - | IIIB | ||||
| T2 N1Δ M0
T3 N0 M0 |
G3 | + | + | + | IB |
| - | IIB | ||||
| - | + | IIB | |||
| - | IIB | ||||
| - | + | + | IIB | ||
| - | IIIA | ||||
| - | + | IIIA | |||
| - | IIIB | ||||
| T0 N2 M0
T1* N2 M0 T2 N2 M0 T3 N1Δ M0 T3 N2 M0 |
G1 | + | + | + | IIA |
| - | IIIA | ||||
| - | + | IIIA | |||
| - | IIIA | ||||
| - | + | + | IIA | ||
| - | IIIA | ||||
| - | + | IIIA | |||
| - | IIIB | ||||
| T0 N2 M0
T1* N2 M0 T2 N2 M0 T3 N1Δ M0 T3 N2 M0 |
G2 | + | + | + | IIA |
| - | IIIA | ||||
| - | + | IIIA | |||
| - | IIIA | ||||
| - | + | + | IIA | ||
| - | IIIA | ||||
| - | + | IIIA | |||
| - | IIIB | ||||
| T0 N2 M0
T1* N2 M0 T2 N2 M0 T3 N1Δ M0 T3 N2 M0 |
G3 | + | + | + | IIB |
| - | IIIA | ||||
| - | + | IIIA | |||
| - | IIIA | ||||
| - | + | + | IIIA | ||
| - | IIIB | ||||
| - | + | IIIB | |||
| - | IIIC | ||||
| T4 N0 M0
T4 N1Δ M0 T4 N2 M0 Any T N3 M0 |
G1 | + | + | + | IIIA |
| - | IIIB | ||||
| - | + | IIIB | |||
| - | IIIB | ||||
| - | + | + | IIIB | ||
| - | IIIB | ||||
| - | + | IIIB | |||
| - | IIIC | ||||
| T4 N0 M0
T4 N1Δ M0 T4 N2 M0 Any T N3 M0 |
G2 | + | + | + | IIIA |
| - | IIIB | ||||
| - | + | IIIB | |||
| - | IIIB | ||||
| - | + | + | IIIB | ||
| - | IIIB | ||||
| - | + | IIIB | |||
| - | IIIC | ||||
| T4 N0 M0
T4 N1Δ M0 T4 N2 M0 Any T N3 M0 |
G3 | + | + | + | IIIB |
| - | IIIB | ||||
| - | + | IIIB | |||
| - | IIIB | ||||
| - | + | + | IIIB | ||
| - | IIIC | ||||
| - | + | IIIC | |||
| - | IIIC | ||||
| Any T Any N M1 | Any | Any | Any | Any | IV |
References
- ↑ Zahl PH, Maehlen J, Welch HG (2008). "The natural history of invasive breast cancers detected by screening mammography". Arch Intern Med. 168 (21): 2311–6. doi:10.1001/archinte.168.21.2311. PMID 19029493.
- ↑ Jatoi I, Anderson WF (2009). "Breast cancer overdiagnosis with screening mammography". Arch Intern Med. 169 (10): 999–1000, author reply 1000-1. doi:10.1001/archinternmed.2009.95. PMC 2768420. PMID 19468099.
- ↑ Breast Cancer. Cleveland Clinic (2015) http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hematology-oncology/breast-cancer/ Accessed on January 18 2016
- ↑ Nottingham Prognostic Index. Wikipedia(2016) https://en.wikipedia.org/wiki/Nottingham_Prognostic_Index Accessed on january 16, 2016
- ↑ Breast Cancer. RadioPedia (2015) http://radiopaedia.org/articles/breast-cancer-staging Accessed on January 16, 2016