Relationship among outcome, stage of disease, and histologic grade for 22,616 cases of breast cancer: the basis for a prognostic index

Article Abstract:

Two characteristics of a cancer that may be considered in arriving at a prognosis are stage and grade. Stage is a relatively objective characteristic, and indicates the extent of the cancer's development: the size of the tumor, the degree of invasion of local tissues, the spread to lymph nodes, and the extent of metastatic spread to distant parts of the body. The grade of a cancer is somewhat vaguer. A low-grade tumor has structure that more closely resembles normal tissues when viewed under the microscope. A high-grade cancer has wildly abnormal cells. Decisions about the grade of a particular cancer, however, are made on the basis of the subjective judgment of an individual pathologist. In the case of breast cancer, there are differences of opinion on the best criteria for determining grade. Furthermore, although high-grade cancers have, in general, a worse prognosis than low-grade cancers, physicians treating patients with breast cancer have been disinclined to consider grading in the course of making treatment decisions. A large-scale review of 22,616 cases of breast cancer has now been conducted and has shown that a prognosis that is arrived at by consideration of both stage and grade is more accurate than one determined by stage alone. The researchers found that the five-year survival rate for patients with stage I and grade 1 breast cancer, the ''best'' stage and grade, was 99 percent. For patients whose cancer was still stage I but who had high-grade breast cancer (grade 4), the five-year survival rate was 89 percent. Patients with advanced stage III cancer were very unlikely to have low-grade disease. However, the five year-survival rate for stage III, grade 1 cancer seemed to be about 85 percent, in contrast with the rate for stage III, grade 4 disease, which was 42 percent. The authors suspect that part of the reason why more attention is not given to grading is that it is easier to rely on factors that are either present or absent rather than factors along an ill-defined continuum. The authors suggest that the present system of four grades is unnecessary, as no significant survival differences were found between grades 3 and 4 tumors, and a simpler and more objective system may result if these two grades are simply combined so that pathologists need only consider a three-grade system. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Identification and classification, Tumors

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Prolactin-producing pituitary carcinoma with pulmonary metastases

Article Abstract:

The overwhelming majority of pituitary tumors are benign, the most common being an adenoma, which secretes the pituitary hormone prolactin. These can frequently be controlled with dopamine agonist drugs such as bromocriptine. The pituitary may be removed in cases where drug treatment is ineffective. Although rare, pituitary gland cancer may occur, as illustrated by the case of a 34-year old man. The patient had developed a worsening of his peripheral vision, as well as a sudden increase in the severity of his headaches. Examination showed some weakness in eye muscles. Computed tomography revealed a mass that extended out of the sella turcica, the indentation where the pituitary is located. (A tumor in this spot presses on the optic pathways, accounting for the visual symptoms.) The likelihood of a pituitary tumor was confirmed by a blood test, which showed several hormonal abnormalities, including increased amounts of prolactin. The patient's visual acuity continued to deteriorate despite bromocriptine treatment, and the tumor was surgically removed. The tumor was classed as an adenoma (a benign tumor) upon pathological examination. Three years later the patient developed shoulder pain accompanied by numbness and tingling. The pain grew in area and severity, and examination revealed several nodules in the lungs. Upon surgical removal and examination these nodules proved to be prolactin-secreting tumor, indicating that the apparently benign pituitary tumor had spread. Despite further treatment, the patient deteriorated and succumbed to the effects of a tumor within the brain. The medical literature appears to contain descriptions of only 38 cases of cancerous spread of pituitary tumors. Of these, only six have been prolactin-secreting tumors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Physiological aspects, Pituitary gland tumors, Pituitary tumors, Prolactinoma

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Progress in early breast cancer detection

Article Abstract:

The incidence of breast cancer is increasing. But rather than being a cause for alarm, this fact is really a consequence of improvements in screening and public awareness. Much of the increase in breast cancer incidence is early breast cancer and in situ disease. The rate of in situ carcinoma has risen from 4.2 per 100,000 population per year in 1976 to 10.0 in 1986 in women younger than 50. Among older women, the rate rose from 12.7 to 33.5 per 100,000 over the same period. The overall incidence of breast cancer in the San Francisco area is roughly 105 per 100,000 population per year. The improvements in diagnosis are reflected by improvements is survival. Unfortunately, black women are not sharing in this improvement; the mortality from breast cancer among white women is decreasing, while among black women it is on the rise. It is uncertain how long these trends will continue, and it is uncertain whether further improvements in early detection will have further benefit in the form of improved survival. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Statistics, Cancer, Health, Health and race, Ethnic groups

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