Enhancing Healthcare Team Outcomes
After the treatment of breast cancer, long-term follow-up is necessary. There is a risk of local and distant relapse, and hence an interprofessional team approach is necessary. The women need regular mammograms and a pelvic exam. Also, women with risk factors for osteoporosis need a bone density exam and monitoring for tumor markers for metastatic disease. For those who are about to undergo radiation therapy, a baseline echo and cardiac evaluation are necessary. Even though many types of integrative therapies have been developed to help women with breast cancer, evidence for the majority of these treatments is weak or lacking.
Over the past four decades, the survival rates of most breast cancer patients have improved. Of note is that the presence of breast cancer has gradually slowed down over the past decade, which may be due to earlier detection and improved treatments. The prognosis for patients with breast cancer is highly dependent on the status of axillary lymph nodes. The higher the number of positive lymph nodes, the worse the outcome. In general, hormone-responsive tumors tend to have a better outcome. In breast cancer survivors, adverse cardiac events are common this is partly due to the cardiotoxic drugs to treat cancer and the presence of traditional risk factors for heart disease. The onus is on the healthcare provider to reduce the modifiable risk factors and lower the risk of adverse cardiac events. [Level 5)
What Are The Symptoms Of Metastatic Cancer
The symptoms produced by metastatic breast cancer vary depending on the location of the metastases.
For example, metastatic disease to the bone causes severe, progressive pain, and less commonly, pathological fracture, erythema over the affected bone and swelling.
Breast cancer cells that have spread to the brain cause persistent, progressively worsening headache, visual changes, seizures, nausea, vomiting, vertigo, behavioral and personality changes and increased intracranial pressure.
Metastatic disease to the liver causes jaundice, elevated liver enzymes, abdominal pain, loss of appetite, nausea, and vomiting.
Metastatic breast cancer to the lung or pleura causes chronic cough, dyspnea, abnormal chest x-ray, and chest pain.
In addition, general, non-specific systemic symptoms of metastatic breast cancer include fatigue, malaise, weight loss and poor appetite.
Tnm System For Breast Cancer
Doctors also group cancers by the letters T, N, or M. Each of those letters tells you something about your cancer.
âTâ stands for tumor, or the lump of cancer found in the breast itself. The higher the number assigned after it, the bigger or wider the mass.
âNâ stands for nodes, as in lymph nodes. These small filters are found throughout the body, and they’re especially dense in and around the breast. They’re meant to catch cancer cells before they travel to other parts of the body. Here, too, a number tells you whether the cancer has spread to lymph nodes near the breast and, if so, how many.
âMâ stands for metastasis. The cancer has spread beyond the breast and lymph nodes.
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What Happens After The Local Breast Cancer Treatment
Following local breast cancer treatment, the treatment team will determine the likelihood that the cancer will recur outside the breast. This team usually includes a medical oncologist, a specialist trained in using medicines to treat breast cancer. The medical oncologist, who works with the surgeon, may advise the use of the drugs like tamoxifen or anastrozole or possibly chemotherapy. These treatments are used in addition to, but not in place of, local breast cancer treatment with surgery and/or radiation therapy.
After treatment for breast cancer, it is especially important for a woman to continue to do a monthly breast examination. Regular examinations will help you detect local recurrences. Early signs of recurrence can be noted in the incision area itself, the opposite breast, the axilla , or supraclavicular region .
Maintaining your follow-up schedule with your physician is also necessary so problems can be detected when treatment can be most effective. Your health care provider will also be able to answer any questions you may have about breast self-examination after the following procedures.
What Is The Tnm Staging System For Cancer
Doctors use the TNM staging system for most types of cancer. The TNM system uses letters and numbers to describe the tumor , lymph nodes , whether or not the cancer has spread or metastases . Each letter and number tell you something about the cancer. The specific definitions for each category are different for each type of cancer that is staged using this system. Learn more specific staging information for each type of cancer.
Tumor : The letter T and the number after it describe the tumor by answering these questions:
How large is the primary tumor?
Does it go into other tissues or organs in the same area?
Where is it located?
The letter T is followed by a letter, number, or combination of letters after it. This gives additional information about the tumor. The different letters and numbers that may see include:
TX means that there is no information about the tumor or it cannot be measured.
T0 means that there is no evidence of a tumor.
Tis refers to a tumor “in situ.” This means that the tumor is only found in the cells where it started. It has not spread to any surrounding tissue.
T1-T4 describe the size and location of the tumor, on a scale of 1 to 4. A larger tumor or a tumor that has grown deeper into nearby tissue will get a higher number.
Has the tumor spread to the lymph nodes?
If so, which lymph nodes and how many?
Metastasis : The letter M and the number after it describes if the cancer has spread. It answers these questions:
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More Information About The Tnm Staging System
The T category describes the original tumor:
- TX means the tumor can’t be assessed.
- T0 means there isn’t any evidence of the primary tumor.
- Tis means the cancer is “in situ” .
- T1, T2, T3, T4: These numbers are based on the size of the tumor and the extent to which it has grown into neighboring breast tissue. The higher the T number, the larger the tumor and/or the more it may have grown into the breast tissue.
The N category describes whether or not the cancer has reached nearby lymph nodes:
- NX means the nearby lymph nodes can’t be assessed, for example, if they were previously removed.
- N0 means nearby lymph nodes do not contain cancer.
- N1, N2, N3: These numbers are based on the number of lymph nodes involved and how much cancer is found in them. The higher the N number, the greater the extent of the lymph node involvement.
The M category tells whether or not there is evidence that the cancer has traveled to other parts of the body:
- MX means metastasis can’t be assessed.
- M0 means there is no distant metastasis.
- M1 means that distant metastasis is present.
The Tnm System For Staging Breast Cancer
The AJCCs addition of the letters T, N, and M for anatomic breast cancer staging adds more information to a breast cancer diagnosis. Heres what they mean:
- T : The tumor grade shows a higher number for a larger size or density.
- N : Nodes refers to lymph nodes and uses the numerals 0 to 3 to give information about how many lymph nodes are involved in the cancer.
- M : This refers to how the cancer has spread beyond the breast and lymph nodes.
The AJCC also added clarifications in staging for ER, PR, and HER2 expression and also genetic information.
Ultimately, this means someone diagnosed with stage 3 breast cancer can receive more information from their breast cancer staging than ever before.
No matter the stage, the best source of information about your individual outlook is your own oncology team.
Getting the right treatment and the support you need can help you navigate the challenges of being diagnosed with stage 3 breast cancer.
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Mechanisms Of Breast Cancer Metastasis
No one really knows what factors will make a certain patient more or less susceptible to breast cancer metastasis.
There is growing awareness that part of that susceptibility is due to host factors. The host factors are the characteristics of the non-malignant cells and the general biological environment surrounding the malignant breast tumor.
Sometimes the host factors are referred to as the pre-metastatic niche and it is thought that bone-marrow-derived progenitor cells may directly influence the dissemination of malignant cells to distant areas.
Non-neoplastichost cells within the tumor may also play a key role in the regulation of breast cancer metastasis.
How Grade Affects Treatment Options
Your treatment team will consider the grade of your cancer when deciding which treatment to offer you.
If you have grade 3 breast cancer, youre more likely to be offered chemotherapy. This is to help destroy any cancer cells that may have spread as a result of the cancer being faster growing.
Chemotherapy is less likely for grade 1 and grade 2 cancers.
The grade of your cancer alone will not determine what treatment youre offered. Your treatment team will consider the grade alongside all other information about your cancer when deciding on the best treatment options for you.
Find out more about breast cancer and prognosis.
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T Categories For Breast Cancer
T followed by a number from 0 to 4 describes the main tumor’s size and if it has spread to the skin or to the chest wall under the breast. Higher T numbers mean a larger tumor and/or wider spread to tissues near the breast.
TX: Primary tumor cannot be assessed.
T0: No evidence of primary tumor.
Tis: Carcinoma in situ
T1 : Tumor is 2 cm or less across.
T2: Tumor is more than 2 cm but not more than 5 cm across.
T3: Tumor is more than 5 cm across.
T4 : Tumor of any size growing into the chest wall or skin. This includes inflammatory breast cancer.
What Other Staging Systems Are There
The TNM staging is mainly used to describe cancers that form solid tumors, such as breast, colon, and lung cancers. Doctors use other staging systems to classify other types of cancer, such as:
Central nervous system tumors . Cancerous brain tumors do not normally spread outside the brain and spinal cord. Therefore, only the “T” description of the TNM system applies. No single staging system exists for central nervous system tumors. Learn more about brain tumor staging and prognostic factors.
Childhood cancers. The TNM system does not include childhood cancers. Doctors stage most childhood cancers using systems that are specific to that cancer.
Blood cancers. The TNM system does not describe blood cancers, such as leukemia, lymphoma, or multiple myeloma. That is because they usually do not form solid tumors. Each blood cancer has its own staging system.
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How Is Invasive Ductal Carcinoma Diagnosed
Same Day Results
At the Johns Hopkins Breast Center, we know how quickly patients want results from a biopsy or scan if there is a suspicion of breast cancer. We follow strict guidelines for biopsies and pathology reports. Most of our patients will receive the probability of cancer immediately following their biopsy procedure and a pathology confirmation within 24 hours.
Learn more about the steps of diagnosis, including:
- Digital mammography
- Biologic targeted therapy
What Are The Risk Factors For Breast Cancer
Like many conditions, risk factors for breast cancer fall into the categories of things you can control and things that you cannot control. Risk factors affect your chances of getting a disease, but having a risk factor does not mean that you are guaranteed to get a certain disease.
Controllable risk factors for breast cancer
- Alcohol consumption. The risk of breast cancer increases with the amount of alcohol consumed. For instance, women who consume two or three alcoholic beverages daily have an approximately 20% higher risk of getting breast cancer than women who do not drink at all.
- Body weight. Being obese is a risk factor for breast cancer. It is important to eat a healthy diet and exercise regularly.
- Breast implants. Having silicone breast implants and resulting scar tissue make it harder to distinguish problems on regular mammograms. It is best to have a few more images to improve the examination. There is also a rare cancer called anaplastic large cell lymphoma that is associated with the implants.
- Choosing not to breastfeed. Not breastfeeding can raise the risk.
- Using hormone-based prescriptions. This includes using hormone replacement therapy during menopause for more than five years and taking certain types of birth control pills.
Non-controllable risk factors for breast cancer
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Predictors For Breast Cancer Survival Rates
It has to be remembered that every single breast cancer patient has itsown , unique scenario. Thus, prognosis and breast cancer survival rates are a rough guide ONLY.
However, there are consistent predictors for breast cancer survival rates and these include:-
- The stage of breast cancer at the time of diagnosis
- The Grade of the breast cancer
- A patients age at diagnosis
How Is The Stage Determined
The staging system most often used for breast cancer is the American Joint Committee on Cancer TNM system. The most recent AJCC system, effective January 2018, has both clinical and pathologic staging systems for breast cancer:
- The pathologic stage is determined by examining tissue removed during an operation.
- Sometimes, if surgery is not possible right away or at all, the cancer will be given a clinical stage instead. This is based on the results of a physical exam, biopsy, and imaging tests. The clinical stage is used to help plan treatment. Sometimes, though, the cancer has spread further than the clinical stage estimates, and may not predict the patients outlook as accurately as a pathologic stage.
In both staging systems, 7 key pieces of information are used:
- The extent of the tumor : How large is the cancer? Has it grown into nearby areas?
- The spread to nearby lymph nodes : Has the cancer spread to nearby lymph nodes? If so, how many?
- The spread to distant sites : Has the cancer spread to distant organs such as the lungs or liver?
- Estrogen Receptor status: Does the cancer have the protein called an estrogen receptor?
- Progesterone Receptor status: Does the cancer have the protein called a progesterone receptor?
- HER2 status: Does the cancer make too much of a protein called HER2?
- Grade of the cancer : How much do the cancer cells look like normal cells?
In addition, Oncotype Dx® Recurrence Score results may also be considered in the stage in certain situations.
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Are New Treatments For Metastatic Cancer Being Developed
Yes. Researchers are now studying new ways to kill or stop the growth of primary cancer cells and metastatic cancer cells. One new area of research includes ways to boost the strength of the immune response against tumors.
Regulatory T-cells and RANKL proteins may play a role in breast cancer metastasisRecent breast cancer research suggests that the bodys regulatory T cells, which are an integral part of the immune response system, may play a key role in metastasis.
It is speculated that the T cells produce a protein which seems to accelerate the spread of breast cancer cells to other areas of the body. The inflammatory protein RANKL seems to influence the T-cells ability to spread cancer cells to distant areas of the body.
It is believed that by interfering with RANKLs ability to interact with the T-cells, the early metastasis of breast cancer cells can be significantly inhibited
Tripe Negative Breast Cancer: The Worst Kind Of Breast Cancer
The effects of cancer are detrimental and vary depending on the type of cancer. Triple Negative Breast Cancer is an aggressive form of breast cancer that has a high frequency of occurrence in women of African descent. Usually breast cancer is a disease that is seen in middle-aged to elderly women. However, triple negative breast cancer is a unique form of the disease that affects young, pre-menopausal women. I attended a lecture on Tuesday, December 9, 2014 titled Triple Negative Breast Cancer across the African Diaspora by Dr. Roberta Troy. The lecture was held in the Marshak Building at City College and presented an exploration of the disease as well as a discussion for preventative measures to help the female community in Africa and women afflicted worldwide.
Dr. Troy grasped the entire audiences attention when she mentioned a Hollywood actress who looked to surgery to save herself from being diagnosed with TNBC. Angelina Jolie underwent a double mastectomy to prevent contraction of the disease because she was a carrier of the BRAC1 gene. A mutation of this gene increases the likelihood of developing triple negative breast cancer. Thus, Ms. Jolie took to the most extreme form of prevention by undergoing surgery but in doing so saved herself despite being at such a high risk to contract the disease.
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How Is Inflammatory Breast Cancer Treated
Inflammatory breast cancer is generally treated first with systemic chemotherapy to help shrink the tumor, then with surgery to remove the tumor, followed by radiation therapy. This approach to treatment is called a multimodal approach. Studies have found that women with inflammatory breast cancer who are treated with a multimodal approach have better responses to therapy and longer survival. Treatments used in a multimodal approach may include those described below.
What Is Stage 4 Breast Cancer
Also known as metastatic breast cancer, the cancer in this stage has spread beyond the breast, underarm and internal mammary lymph nodes to other parts of the body near to or distant from the breast. The cancer has spread elsewhere in the body. The affected areas may include the bones, brain, lungs or liver and more than one part of the body may be involved.
At stage 4, TNM designations help describe the extent of the disease. Higher numbers indicate more extensive disease. Most commonly, stage 4 breast cancer is described as:,
- T: T1, T2, T3 or T4 depends on the size and/or extent of the primary tumor.
- N1: Cancer has spread to the lymph nodes.
- M1: The disease has spread to other sites in the body.
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