Breast Cancer, Staging and Prognosis, Treatments, and Treatment Results

Breast Cancer

The Cancer Monthly database currently has the clinical results (survival, side effects, and more) for 50 recent breast cancer therapies including hormone therapy, biological therapy, immunotherapy, gene therapy and chemotherapy.

Introduction

Breast cancer is the malignant proliferation of epithelial cells that line the ducts or lobules of the breast. In 2004 there were about 216,000 cases of invasive breast cancer and 40,000 breast cancer deaths in the United States.

Breast cancer is a hormone-dependent disease. For example, women without functioning ovaries and who never received estrogen replacement do not develop breast cancer.

Nearly half of all patients who are treated for apparently localized breast cancer develop metastatic disease. And half of all initial cancer recurrences occur more than 5 years after initial therapy. Although a very small number of these patients can enjoy long remissions when treated with combinations of systemic and local therapy, most eventually succumb to their cancer.

Staging and Prognosis

The prognosis for breast cancer generally depends on its stage and there are typically five stages (0 to 5) with sub-stages:

Stage	TNM	Description	5-year Survival
0	Tis N0 M0	Carcinoma in situ. No tumor is regional lymph nodes, No distant metastases	99%
I	T1 N0 M0	Tumor is less than or equal to 2 centimeters, No tumor is regional lymph nodes, No distant metastases	92%
IIA	T0 N1 M0 T1 N1 M0 T2 N0 M0	No evidence of primary tumor, metastases to movable ipsilateral nodes, No distant metastases. Tumor is less than or equal to 2 centimeters, metastases to movable ipsilateral nodes, No distant metastases. Tumor is between 2 and 5 centimeters, No tumor is regional lymph nodes, No distant metastases	82%
IIB	T2 N1 M0 T3 N0 M0	Tumor is between 2 and 5 centimeters, metastases to movable ipsilateral nodes, No distant metastases. Tumor is over 5 centimeters, No tumor is regional lymph nodes, No distant metastases.	65%
IIIA	T0 N2 M0 T1 N2 M0 T2 N2 M0 T3 N1, N2 M0	No evidence of primary tumor, metastases to fixed ipsilateral nodes, no distant metastases. Tumor is less than or equal to 2 centimeters, metastases to fixed ipsilateral nodes, No distant metastases. Tumor is between 2 and 5 centimeters, metastases to fixed ipsilateral nodes, no distant metastases. Tumor is over 5 centimeters, metastases to movable or fixed ipsilateral nodes, no distant metastases.	47%
IIIB	T4 Any N M0 Any T N3 M0	Tumor extends to chest wall, any nodal involvement, no distant metastases. Any primary tumor involvement, metastases to ipsilateral internal mammary nodes, no distant metastases.	44%
IV	Any T Any N M1	Any primary tumor involvement, any nodal involvement, distant metastases.	14%

T= Status of Primary tumor; N = Regional lymph nodes; M = Distant Metastases

Treatment

Radiation is often prescribed in an attempt to reduce the rate of recurrence. In addition, chemotherapy is typically prescribed for women with cancer detected in the lymph nodes. However, there is little agreement about optimal chemotherapy regimens and most comparisons of chemo drugs show little difference among them. Different combinations of chemotherapy (include high dose chemotherapy with autologous bone marrow transplantation) have been found to improve response rates somewhat, but they have little effect on survival.

Many breast cancers (primary and metastatic) are hormone dependent. This means that the tumor cells may have receptors for estrogen and/or progesterone. In most patients, the initial endocrine therapy is the anti-estrogen drug tamoxifen. The median survival of breast cancer patients with metastatic disease is about 2 years but many patients with hormone dependent tumors may live longer.

New breast cancer treatments include attempts to block the cell surface receptor erB2, anti-angiogenic therapies, and agents aimed at blocking cell surface tyrosine kinases and other signaling pathways. The treatment results and survival rates of some of these therapies have been reported.

Treatment Results

Source: Marc E. Lippman, Breast Cancer, in HARRISON'S PRINCIPLES OF INTERNAL MEDICINE, pt. 5 § 76, at 516-523 (Dennis L. Kasper, M.D. et al., eds, 16th ed 2005).

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