Breast cancer natural history: Difference between revisions
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==Overview== | ==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. | If left untreated, 22% of patients with breast cancer may regress. Common complications of breast cancer include [[metastasis]]. [[Prognosis]] is generally good with treatment. | ||
Revision as of 15:25, 18 March 2019
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Breast Cancer Microchapters |
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Breast cancer natural history On the Web |
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American Roentgen Ray Society Images of Breast cancer natural history |
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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%
Metastasis
Most people understand breast cancer as something that happens in the breast. However, it can metastasise (spread) via lymphatics to nearby lymph nodes, usually those under the arm. That is why surgery for breast cancer always involves some type of surgery for the glands under the arm — either axillary clearance, sampling, or sentinel node biopsy.
Breast cancer can also spread to other parts of the body via blood vessels. So it can spread to the lungs, pleura (the lining of the lungs), liver, brain, and most commonly, to the bones. Seventy percent of the time that breast cancer spreads to other locations, it spreads to bone, especially the vertebrae and the long bones of the arms, legs, and ribs. Breast cancer cells "set up house" in the bones and form tumors. Usually when breast cancer spreads to bone, it eats away healthy bone, causing weak spots, where the bones can break easily. That is why breast cancer patients are often seen wearing braces or using a wheelchair and why they complain about aching bones.
When breast cancer is found in bones, it has usually spread to more than one site. At this stage, it is treatable, often for many years, but it is not curable. Like normal breast cells, these tumors in the bone often thrive on female hormones, especially estrogen. Therefore, the doctor often treats the patient with medicines that lower estrogen levels.
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