Staging of breast cancer
-
Anatomic: tumor size, chest wall invasion, axillary LN mets (strongest prognostic factor)
-
Histopathologic: type (little prognostic relevance) & grade; lymphatic/vascular invasion In situ carcinoma: no invasion of surrounding stroma Ductal (DCIS): ↑ risk of invasive cancer in ipsilateral breast (~30%/10 y) Lobular (LCIS): benign entity; marker of ↑ risk of inv. cancer in either breast (~1%/y) Invasive carcinoma: infiltrating ductal (70–80%); invasive lobular (5–10%); tubular, medullary and mucinous (10%, better prognosis); papillary (1–2%); other (1–2%) Inflammatory breast cancer (see above): not a histologic type but a clinical reflection of tumor invasion of dermal lymphatics; very poor prognosis Paget disease (see above): ductal cancer invading nipple epidermis ± associated mass
-
Tissue biomarkers: estrogen and progesterone receptor (ER/PR), HER2
-
Oncotype DX 21-gene expression recurrence score predicts which ER ⊕, HER2 ⊖ will have minimal benefit from adjuvant chemo in LN ⊖ (NEJM 2018;379:111) and LN ⊕ (1–3) disease (NEJM 2021;385:2336)
Simplified Staging & 5-y Dis. Specific Survival (CA Cancer J Clin 2017;67:290; SEER 2017)
| Stage | Characteristics | Description | 5-y DSS | | | | | | | I | Tumor ≤2 cm | Operable locoregional | 99% | | IIA | Tumor >2 cm or mobile axillary nodes | = | 98% | | IIB | Tumor >5 cm or 2–5 cm w/ mobile nodes | = | 96% | | IIIA | Internal mammary or fixed axillary nodes | Locally advanced | 95% | | IIIB/C | Chest wall, skin, infra or supraclavic. nodes | Inoperable 80–85% | 完了 | | IV | Distant metastases | Metastatic | 27% |
Clinical Stage I ☝️
- T1N0M0 只有T1是stage I
Clinical Stage II ✌️
- T0N1M0
- T1N1M0
- T2N0M0
- T2N1M0 (T2N1以上是Stage III)
Clinical Stage III 🤟
- T0N2M0
- T1N2M0
- T2N2M0
- T0N3M0
- T1N3M0
- T2N3M0