The prognosis of breast cancer

By | May 2, 2012

Prognosis of breast cancer is affected by many factors such as age, menstruation, fertility, disease course, the primary tumor size, clinical stage, treatment, pathological type, local infiltration, lymph node metastasis, estrogen receptor status, cancer DNA ploidy status and cell gene expression in cancer cells. In which the decisive factors are the following.
1. Lymph node metastasis, lymph node metastasis is a breast cancer one of the factors influenced, lymph node metastasis, the number of metastatic lymph nodes, and axillary lymph node metastatic sites is a measure of the level of the important prognostic factors in breast cancer. Per lymph node metastasis in patients 10 years up to 75% cure rate, while patients leaching Pat-node metastasis was only 10 years, 30% cure rate, the absolute number of involved lymph nodes and the degree of involvement is also closely related to the survival time of patients . Most scholars advocate should be checked at least after 10 or more lymph nodes. Rosen reported that the primary lesion less than 2cm lymph node-negative cases, 18 year mortality was 19%, 1-3 for 28% of node-negative, 4 or 4 more than 51%. Tianjin Cancer Hospital Statistics radical mastectomy 30 years, 3452 cases of breast cancer without lymph node metastasis in 10-year survival rate was 61%, and 23.3% had metastasis. Shanghai Medical University Cancer Institute data show: survival rate when lymph node metastasis, metastasis in more than a few low survival rate in 7. At the same time with axillary lymph node and internal mammary lymph node metastasis prognosis than a single case of metastasis at the poor survival rate, which subclavian lymph node metastasis the worst prognosis.
2. Pathologic type and differentiation of the pathological type, differentiation, tumor invasion and host immunity against tumors is the impact of breast cancer prognostic factors. Highly malignant tumors (histological grade as H, level III) treatment was significantly lower than the cancer recur, the score of the tumor differentiation degree of difference between a good prognosis good. Specific breast cancer compared with non-special type of good prognosis, non-special type of invasive breast cancer good prognosis Africa. In addition, the adenocarcinoma interstitial fluid in a large number of end there, or medullary carcinoma with lymphocytic infiltration of a large number of good prognosis. Severe internal necrosis of the tumor shows rapid tumor growth, invasion intensity and poor prognosis. Tianjin Cancer Institute statistics of domestic radical mastectomy 10 hospitals pathological data of 2594 cases and 10 years of follow-up observations, including non-invasive cancer. Early invasive carcinoma, invasive carcinoma and invasive non-special special cancer lymph node metastasis rates were 9.8%, 23%, 43.5% and 60.8%; of which more than 10 years survival rates were 83.8%, 78.0%, 62.8% and 39.5 %, showing a worse tumor differentiation, metastasis more, the trend of lower survival rates by a statistically significant difference in handling.
3. The primary tumor size and local infiltration in the absence of regional lymph nodes and distant metastasis, primary tumor larger, more serious local infiltration, the worse the prognosis, on the contrary, the smaller the tumor the better the prognosis. In the absence of axillary lymph node metastases, the tumors smaller than 2cm in diameter was better than the prognosis of patients the tumor more than 5cm in 2_5cm and patients. Clinical data show that the Shanghai Medical University. In Tl, Tz, T3, T4 breast cancer 20 year survival rates were 87.8%, 62.6%, 46%, 19.7%. In addition, tumor invasion and invasion of deep tissue skin that has excess breast cancer range of poor prognosis.
4. Cell proliferation rate and DNA content of cells the size of the mitotic capacity of a relationship with the prognosis, split faster, the worse the prognosis, the prognosis is good to split slow. Tumor cells by flow cytometry cell cycle DNA content and the proportion of cells. Most benign tumors and normal breast tissues of diploid DNA content Wong, and malignant tumors in 50% _60% of aneuploid DNA content, S phase cell percentage of aneuploid tumors and increased the percentage of S phase cells are often an early recurrence.
5. Age and elderly patients vibrating baby slow tumor growth, lymph node metastasis later, the prognosis is good, the rapid development of the young cancer patients, lymph node metastasis early, the prognosis is poor. Vibration and breast-feeding baby breast cancer with poor prognosis.
6. Overexpression of oncogene amplification, allele combination, loss or rearrangement of genetic alterations and tumors, and prognosis. Shanghai Medical University Cancer Hospital immunohistochemistry method in 19 of the 38 cases of breast cancer patients with p53 gene locus loss, loss rate was positively associated with the disease, and her-2 over-expression can be used as indicators of early recurrence, and other cancer genes as hst-1 and iut-2 amplification and high expression of rasp21, often suggest the prognosis poor.
7. hormone receptors estrogen receptor CER) and progesterone receptor CPR) Determination of hormone treatment not only can be used as a reference, can be used as indicators of prognosis, compared with negative receptor-positive patients with good prognosis. The patient's state of ER and PR in the comprehensive influence the prognosis of breast cancer, ER and PR were positive in the best prognosis, while ER and PR were negative in the worst prognosis. There is a receptor-positive patients in between. ER-positive PR-negative patients with ER-negative PR than the prognosis of positive patients. In the hormone receptor on breast cancer prognosis, the judgments of the value of pre-menopausal patients than in postmenopausal patients, and in patients with advanced than early to judge the value of the patient.
8. Social and psychological factors in breast cancer with poor prognosis, patients a long period of psychological anger and grief, the patient often can not afford a reality. At first, the performance of temperament and more brutal, outrageous, pessimism is particularly serious. Most patients will appear weary of the idea of future disappointment. Patients after surgery because the body changes, so that they have an inferiority complex, and some patients on the sexual attitudes have changed. This requires social and family to give them the full understanding, give them encouragement and support, to encourage patients to establish the confidence to overcome the disease. However, the society for many reasons, such as medical costs rise, forcing the work environment, lack of awareness of the disease and so on, so many patients the illness can not be timely medical treatment, the results of losing the early diagnosis and early treatment of the best period . Patients with poor quality of some other mental illness or lack of social and people around after the care and understanding, improper care, so patients lose confidence in the fight against the disease, negative thoughts, low self-esteem, poor prognosis breast cancer.

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