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Questions and Answers
Which of the following tumor characteristics is associated with a worse prognosis in breast cancer?
What is the primary reason for the poor prognosis of breast cancer in pregnant women?
Which of the following patient-related factors is associated with a worse prognosis in breast cancer?
What is the most important prognostic factor among tumor-related factors in breast cancer?
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Which of the following tumors has a good prognosis in breast cancer?
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What is the significance of internal mammary lymph node involvement in breast cancer?
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Which of the following breast cancer stages has the best prognosis?
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What is the significance of skin and nipple invasion in breast cancer?
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What is the effect of obesity on breast cancer prognosis?
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Which of the following is a tumor-related factor that affects breast cancer prognosis?
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Study Notes
Breast Cancer Pathology and Staging
- Cells can seed into the peritoneal cavity
- Intercostal veins can metastasize to the vertebral plexus (Batson plexus), causing:
- Nodules in Douglas pouch
- Vertebral metastases (Lumbar vertebrae), which are osteolytic (90%), osteosclerotic (5%), or mixed (5%)
TNM Staging
- Tx: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- Tis: Carcinoma in situ (ductal or lobular CIS, Paget's disease without mass)
- T1: < 2cm (Tmic: microinvasion < 1mm, T1a: >0.5cm, T1b: >0.5-1cm, T1c: 1-2cm)
- T2: 2-5 cm
- T3: >5 cm
- T4: Any size with:
- T4a: Fixation to chest wall (ribs, intercostal ms, serratus anterior ms)
- T4b: Skin involvement (direct infiltration, ulceration, peaud orange, satellite nodules)
- T4c: a & b
- T4d: Mastitis carcinomatosis
Lymph Node Metastasis
- Nx: Regional L.N. cannot be assessed
- N0: No regional L.N. metastasis
- N1: Ipsilateral mobile axillary L.N.
- N2:
- A: Ipsilateral matted axillary L.N.
- B: Ipsilateral internal mammary L.N. without axillary L.N.
- N3:
- A: Ipsilateral infraclavicular L.N.
- B: Ipsilateral internal mammary with axillary L.N.
- C: Ipsilateral supraclavicular L.N.
- M0: No evidence of metastasis
- M1: Distant metastasis or contralateral breast or L.N.
AJCC Staging
- American Joint Committee Cancer (AJCC) staging system
Pathology
- Skin changes due to direct infiltration:
- Skin dimpling, tethering, and puckering (earliest sign)
- Skin changes due to lymphatic infiltration:
- Peau d'orange (thick, non-pitting edematous skin)
- Cancer en cuirasse (late sign, pathognomonic)
- Cancerous satellite nodules (late sign, pathognomonic)
Prognostic Factors
- Patient-related factors:
- Age (young age = worse prognosis)
- Sex (male = worse prognosis)
- Pregnancy (worse prognosis)
- Obesity (bad prognosis)
- Tumor-related factors:
- L.N. involvement (most important)
- Number of L.N.
- Size (< 1cm = better, > 2cm = worse)
- Discrete vs. matted L.N.
- Level of L.N.
- Site (lower inner quadrant = worst)
- Metastasis (presence of distant metastases = worse)
- Pathology type (medullary, mucinous = better prognosis)
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Description
Test your knowledge on pathology concepts related to the peritoneal cavity, vertebral metastases, and TNM staging.
