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staging of breast cancer

Indications: - evaluation of breast cancer Clinical significance: Primary tumor (T) T stage tumor TIS carcinoma in situ T1 T =< 2 cm T2 T 2.1-5 cm T3 T > 5 cm T4 T of any size with direct extension to the chest wall or skin Regional nodes (N)# N stage Nodes N0 No involved nodes N1 Moveable ipsilateral axillary nodes N2 Matted or fixed nodes Distant metastases (M) M stage Metastases M0 None detected M1 Distant metastasis* present (includes ipsilateral supraclavicular nodes) Stage grouping: Stage TN designation assessment Stage 1 T1 N0 operable disease Stage 2A T1 N1 operable disease Stage 2A T2 N0 operable disease Stage 2B T2 N1 operable disease Stage 2B T3 N0 operable disease Stage 3A T1 N2 locally advanced disease Stage 3A T2 N2 locally advanced disease Stage 3A T3 N1, N2 locally advanced disease Stage 3B T4, any N locally advanced disease Stage 4 any T, any N, M1 advanced or metastatic disease Prognosis: (5 year survival) - Stage 1: 99% - Stage 2: 92% - Stage 2a: 82% - Stage 2b: 65% - Stage 3a: 47% - Stage 3b: 44% - Stage 4: 14% Radiology: - CT, PET, or bone scan not indicated for asymptomatic women with newly diagnosed stage 0-2 breast cancer [6] Notes: 1) the majority of woman with positive axillary node(s) will have recurrence, thus are candidates for adjuvant therapy to surgery 2) 25-30% of axillary node negative women will experience disease recurrence a) 10% of women with tumors < 1 cm will have recurrence b) receptor status, tumor grade, DNA index & S-phase fraction also affect likelihood of recurrence 3) sentinel node biopsy a) associated with fewer arm complications than axillary dissection (standard treatment) b) alternative to axillary dissection in patients with clinically negative axillary nodes [4] 4) Bone marrow aspirate to assess micrometastasis may be indicated [3] 5) a risk score point-based system using grade, estrogen receptor,& HER2 status complements the anatomic AJCC staging system [5]

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breast cancer

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staging of cancer

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 667
  2. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 563-64
  3. Braun S, Vogl FD, Naume B, Janni W, Osborne MP, Coombes RC, Schlimok G, Diel IJ, Gerber B, Gebauer G, Pierga JY, Marth C, Oruzio D, Wiedswang G, Solomayer EF, Kundt G, Strobl B, Fehm T, Wong GY, Bliss J, Vincent-Salomon A, Pantel K. A pooled analysis of bone marrow micrometastasis in breast cancer. N Engl J Med. 2005 Aug 25;353(8):793-802. PMID: 16120859
  4. Mansel RE et al, Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: The ALMANAC trial J Natl Cancer Inst 2006; 98:599 PMID: 16670385
  5. Kuznar W with comment by Klil-Drori AJ 8th AJCC Breast Cancer Staging System Incorporates Tumor Biology. Newest update called more clinically relevant. MedPage Today. ASCO Reading Room 05.01.2018 https://www.medpagetoday.com/reading-room/asco/breast-cancer/72618 - Chavez-MacGregor M, Mittendorf EA, Clarke CA et al Incorporating Tumor Characteristics to the American Joint Committee on Cancer Breast Cancer Staging System. Oncologist. 2017 Nov;22(11):1292-1300. Epub 2017 Jun 7. PMID: 28592619
  6. Medical Knowledge Self Assessment Program (MKSAP) 19. American College of Physicians, Philadelphia 2021