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What is breast cancer staging?

Staging seeks to assess the extent of the cancer to help define its prognosis. For this, doctors perform local exams on patients to check the extent of the cancer, as well as exams in other organs, to assess the presence or absence of distant metastases. Internationally, the TNM convention of the International Union Against Cancer – UICC is used.

Knowing the stage of the tumor helps to define the type of treatment and predict the patient's prognosis.

How is the TNM Staging System?

The staging system used for breast cancer is the TNM system of the American Joint Committee on Cancer. The TNM system uses three criteria to assess the stage of the cancer: the tumor itself, the regional lymph nodes around the tumor, and whether the tumor has spread to other parts of the body.

TNM is an abbreviation for tumor (T), lymph node (N) and metastasis (M):

T. Indicates the size of the primary tumor and has spread to other areas.

N. Describe if there is spread of disease to regional lymph nodes, or if there is evidence of in-transit metastases.

M. Indicates whether there is metastasis in other parts of the body.

Tumor. By the TNM system, the T followed by a number (0 to 4) is used to describe the primary tumor, particularly its size.

Lymph node. The N in the TNM system represents the regional lymph nodes, and is assigned a number (0 to 3), which indicates whether the disease has spread to the lymph nodes.

Metastasis. OM in the TNM system indicates whether the disease has spread to other parts of the body.

How is the clinical staging?

Breast cancer is divided into four stages (or stages), depending on the extent of the disease:

Stage 0: Cancer cells are still contained in the ducts or lobules (in situ).

Stage I: tumor with less than 2 cm, without involvement of the axillary lymph nodes.

Stage II: tumor between 2 and 5 cm, with involvement of the axillary lymph nodes.

Stage III: nodule larger than 5 cm that can reach neighboring structures, such as muscle and skin, as well as the axillary lymph nodes. There is still no evidence that the cancer has spread throughout the body.

Stage IV: tumors of any size with metastases, lymph nodes are usually compromised.

How is the pathological evaluation?

The anatomopathological exam informs us of the tumor size, histological type, degree of differentiation and allows immunohistochemical evaluation.

What is the degree of differentiation?

Grade is assessed by three criteria: nuclear grade, number of mitoses, and tubule formation.

Grade 1: Tumor cells are well differentiated, that is, these cells are very similar to normal cells and are not growing rapidly.

Grade 2: Tumor cells are moderately differentiated from normal cells (they have an intermediate degree of aggressiveness).

Grade 3: Tumor cells are poorly differentiated, that is, they do not have the same characteristics as normal cells and tend to grow and spread more aggressively.

What is tumor immunohistochemical analysis?

Protein expression reflects the genetic activity of cells. In the examination of immunohistochemistry, cell proteins are analyzed, as well as their quantity and characteristics. This is essential in determining the treatment strategy for fighting breast cancer. The exam determines Hormonal Receptors, Her-2 and Ki 67.

What are hormone receptors?

Receptors are proteins located in cells and, when activated, trigger some biological action. Normal cells, and some breast cancer cells, have receptors that bind to estrogen and progesterone and depend on these hormones to grow. Breast cancer cells may have only one, both receptors, or neither.

Positive Estrogen Receptor. Estrogen receptor breast cancers are called ER+.

Positive Progesterone Receptor. Breast cancers with progesterone receptors are called PR+.

How important is the Hormone Receptor?

Certain medications are used to treat breast cancers that have one or both hormone receptors. Most types of hormone therapy for breast cancer reduce estrogen levels or stop estrogen from working on cancer cells. This type of treatment is useful for hormone receptor positive breast cancer, but it does not work for hormone receptor negative (ER- and PR-) tumors.

All invasive breast cancers must be evaluated for both hormone receptors, either in the needle biopsy specimen or when the tumor is surgically removed. About 67% of breast cancers have at least one of these receptors. This percentage is higher in older women than in younger women.

Positive Hormone Receptor Breast Cancer. Hormone receptor positive breast cancer cells have ER+ or PR+. These cancers can be treated with hormonal therapy that reduce estrogen levels or block estrogen receptors. This includes cancers that are ER-mas PR+. Women with hormone receptor-positive cancers tend to have a better short-term prognosis, but these cancers can sometimes relapse many years after treatment. Hormone receptor positive cancers are more common after menopause.

Hormone Receptor Negative Breast Cancer. Hormone receptor negative breast cancers do not have either estrogen or progesterone receptors. Treatment with hormone therapy is not helpful for these cancers. These cancers tend to grow faster than hormone receptor positive cancers. Hormone receptor negative cancers are more common in women who have not yet reached menopause.

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Sorocaba Medical Center


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Americas Medical City

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