Page 547 - Concise Pathology for Exam Preparation ( PDFDrive )

532 SECTION II Diseases of Organ Systems

Size of metastatic deposits and presence of invasion through the capsule indicates
poor prognosis.
• Locally advanced disease: Invasion into the skin and skeletal muscle indicates poor
prognosis.
• Inflammatory carcinoma: Women presenting with a malignant breast mass with
redness, oozing, inflamed appearance and skin thickening have a poor prognosis.
• Tumour size: Second most important independent factor. Five-year survival rate for
tumour of size ,1 cm (node-negative) is nearly 98% and it drops to 77% for tumours
.2 cm.
• Distant metastasis: Presence of distant metastasis indicates poor prognosis.
• Invasive carcinoma versus in situ disease: In situ carcinoma is confined to the
ductal system and does not metastasize whereas at least half the invasive carcinomas
metastasize.
Minor prognostic factors
• Histological subtypes: Special types of invasive carcinoma (tubular, colloid, medullary,
lobular and papillary) have better prognosis than no special type. Tubular and colloid
carcinomas have an exceptionally good prognosis.
• Tumour grade: Most commonly used grading system is the Nottingham Histological Score
or Scarff Bloom Richardson grading based on nuclear grade, tubule formation and mitotic
rate. Ten-year survival for grade I tumours is 85%; grade II is 60% and grade III is 15%.
• Oestrogen and progesterone receptors: Eighty percent of tumours that are both
ER- and PR-positive respond to hormonal therapy. Only 40% of those positive only for
ER or PR receptors respond to the same. Strongly ER-positive tumours do not respond
well to chemotherapy, and tumours that are neither ER- nor PR-positive are more likely
to respond to chemotherapy than hormonal therapy.
• HER2/neu (erb B2): Over-expression is associated with a bad prognosis. Herceptin is
a monoclonal antibody to HER2/neu which targets tumour cells (targeted therapy).
• Lymphovascular invasion: Associated with a poor prognosis.
• Proliferative rate: Tumours with high proliferation rates have a worse prognosis.
• Response to neoadjuvant therapy: The degree to which the tumour responds to
therapy given before surgery is an important prognostic factor. Clinical and radiological
examination can be used to assess this response.
The major prognostic factors are used by the American Joint Committee on Cancer, to
divide breast carcinoma into the following stages:
• Stage 0: DCIS or LCIS (5-year survival rate, 92%)
• Stage 1: Invasive carcinoma 2 cm or less in diameter (including carcinoma in situ with
microinvasion) without nodal involvement (5-year survival, 87%)
• Stage 2: Invasive carcinoma 5 cm or less in diameter with up to three involved axillary
lymph nodes.
Or Invasive carcinoma more than 5 cm without nodal involvement (5-year survival, 75%)
• Stage 3: Invasive carcinoma 5 cm or less with four or more involved axillary lymph
nodes
Or Invasive carcinoma more than 5 cm with nodal involvement
Or Invasive carcinoma with 10 or more involved axillary lymph nodes
Or Invasive carcinoma with involvement of ipsilateral internal mammary lymph nodes
Or Invasive carcinoma with skin involvement (oedema, ulceration or satellite skin
nodules)
Or Chest wall fixation or clinical inflammatory carcinoma (5-year survival, 46%)
• Stage 4: Any breast carcinoma with distant metastasis (5-year survival, 5–13%)

Q. Write briefly on Paget disease of breast.

Ans. Paget disease of breast is a rare form of DCIS with an incidence of 1–4%.
It presents as an erythematous eruption with scaling and crusting and may be mistaken for
eczema.

mebooksfree.com