Irrationality in the management of breast cancer: I. the staging system

Article Abstract:

Early in the 20th century it became clear that breast cancer progressed through stages. The disease begins as a growth in the breast, some cells spread to the nearby lymph nodes, and ultimately the disease disseminates throughout the body. The likelihood of long-term survival depends most strongly on the stage of the disease at the time of diagnosis. The important prognostic value of the stage of the disease led to more formal descriptions of stage. Unfortunately, several different staging systems were developed, which led to confusion. While subtle differences made little difference in the treatment of patients, they made it difficult to compare the research results obtained at two different institutions using two different staging methods. The tumor-node-metastasis (TNM) system has now been widely adopted, and the uniformity of this system has led to benefits in the ability of physicians to compare results from different studies. Unlike systems which define Stage I, Stage II, etc., the TNM has three separate parameters. The first, T, is a number which indicates the stage of the primary tumor. For example, T1A is a small primary tumor, while T4B is a large tumor invading the surrounding tissue. The N stands for (lymph) node and indicates the extent of cancer in the lymph nodes. N0 would indicate that the lymph nodes are free of cancer while N1 would indicate only a small number of nodes are involved. M stands for metastasis, or the spread of cancer through the body. M0 implies no apparent metastatic disease while M1 means that metastatic cancer spread has been confirmed. While this method has improved the comparability of some studies, the method is also cumbersome in its details and difficult to use on an everyday basis. The older method of staging is more useful on an everyday basis. When the results of cancer research are published, even the TNM system does not include many of the prognostic factors which are currently used, such as the presence or absence of estrogen receptors. It is suggested that the simpler staging system be employed, but that every research report carry a detailed table of the prognostic factors for purposes of comparison. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis

---

Staging and follow-up of breast cancer patients

Article Abstract:

In many forms of cancer, including breast cancer, the greatest single determinant of prognosis is the stage of the cancer. Historically, some staging systems evolved in a haphazard way that permitted little uniformity. However, the TNM system of staging is now more widely adopted and is permitting not only more uniformity, but more precision as well. The TNM system actually involves the specification of three separate stages: T, the stage of the primary tumor; N, the involvement of lymph nodes; and M, for the presence of metastatic disease. Choosing an example from breast cancer, T1N0M0 would indicate a small primary tumor (less than two centimeters) with no evidence of involvement of the lymph nodes and no evidence of metastatic disease. The author briefly reviews the TNM system as it applies to breast cancer, and emphasizes that despite the improvements that have followed the introduction of this system, there is still some disparity, depending upon whether the staging determinations were made clinically (usually by the surgeon) or pathologically (by microscopic examination). As might be expected, the pathological determinations are generally more precise. The author also suggests that there is a tendency to overinvestigate patients who have no symptoms on follow-up. Bone scans and blood tests are often used in the follow-up examination of breast cancer patients, but the prevailing evidence suggests that the most appropriate follow-up is routine physical examination and periodic mammography. (Consumer Summary produced by Reliance Medical Information, Inc.)

---

Primary therapy for limited breast cancer: surgical techniques

Article Abstract:

The combination of better early detection of breast cancer and a better understanding of the natural history of different early cancers has led to changes in the surgical techniques used for limited breast cancer. Lobular carcinoma in situ (LCIS) is often present in multiple sites in both breasts in 20 to 30 percent of the cases. Therefore mastectomy of the affected breast and biopsy of the other breast is suggested. Radiation therapy is generally not regarded as necessary. Ductal carcinoma in situ (DCIS) is less often bilateral, so biopsy of the opposite breast is not necessary, but the risk of recurrence and metastasis suggests that candidates for breast conservation be carefully considered. The presence of calcifications upon mammography (breast radiography) is a contraindication against breast conservation, even if all the affected area can be removed; armpit lymph nodes should be dissected and examined. Stage I breast cancer is treated with the sometimes contradictory aims of removing the tumor completely and preserving the breast. A safe margin around the cancer must be included in the resected tissue. The lymph nodes must be dissected, and radiation therapy should be used. If grossly abnormal lymph nodes are encountered during surgery, the axillary dissection should continue, and arrangements for adjuvant therapy made in coordination with the radiotherapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery

Similar abstracts:

• Abstracts: Alcohol consumption and risk of breast cancer: the Framingham Study revisited. The cancer experience in the Framingham Heart Study cohort
• Abstracts: Overexpression of HER-2/neu in endometrial cancer is associated with advanced stage disease. The effect of antibodies and immunotoxins reactive with HER-2/neu on growth of ovarian and breast cancer cell lines
• Abstracts: The Baltimore experience with laparoscopic management of acute cholecystitis. Laparoscopic guided cholecystectomy
• Abstracts: Combination hormonal therapy with tamoxifen plus fluoxymesterone versus tamoxifen alone in postmenopausal women with metastatic breast cancer: an updated analysis

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.