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The TNM staging system for breast cancer: Do you know how it affects prognosis?
Breast cancer is classified into several categories based on different criteria and purposes. The main classifications include histopathological type, tumor grade, tumor stage, and protein and gene expression. These classifications are continually updated as our knowledge of cancer cell biology increases, with the goal of finding the most appropriate treatment.
Studies of breast cancer classifications have shown that some cancers require more aggressive treatments that may have significant side effects, while other types of breast cancer can be treated with gentler treatments.
Treatment algorithms rely on the classification of breast cancer to define treatment for each specific subgroup. These classifications must be carefully tested and validated to minimize confounding effects so that they become true prognostic factors capable of estimating disease outcomes such as disease-free survival or overall survival in the absence of treatment.
Overview of Breast Cancer Classification Schemes
Breast cancer can be divided into different classification systems, each of which affects treatment response and prognosis. Comprehensive classification should include histopathological type, grade, stage (TNM), receptor status, and the presence or absence of genes determined by genetic testing.
1. HistopathologyWhile there are many different histological forms of breast cancer, most arise from the glandular epithelium and are primarily classified as ductal carcinomas. Cancer types are mainly divided into carcinoma in situ and invasive carcinoma, and the former grows within the tissue without invading the surrounding tissue, while the latter does.
2. RatingThe grade of a tumor focuses on how breast cancer cells look compared to normal breast tissue. Normal cells become differentiated, while cancer cells gradually lose this differentiation. Pathologists classify cancers as low-grade, intermediate-grade, or high-grade by evaluating how differentiated the cells are.
3. TNM stageThe TNM classification system assesses the stage of a tumor based on characteristics such as tumor size, lymph node spread, and the presence of distant metastases. Larger tumors, lymph node spread, and metastasis generally result in a higher grade and a worse prognosis.
TNM system subdivision
- T: The tumor is smaller than 2 cm (T1) or larger than 5 cm (T3).
- N: Whether there is lymph node metastasis (N0 means no metastasis, N1 means a small amount of lymph node metastasis).
- M: Whether there is distant metastasis (M0 means no, M1 means yes).
4. Receptor status
There are multiple receptors on breast cancer cells, the three most important ones include estrogen receptor (ER), progesterone receptor (PR) and HER2/neu. Breast cancer can be divided into subtypes based on the presence or absence of these receptors, and these subtypes affect prognosis and treatment options.
5. DNA gene classificationUnderstanding biomarkers directly related to treatment continues to improve our treatment plans and prognosis assessments.
Breast cancer classification is further enhanced by the genetic signature of the tumor cells. Scientists use a variety of laboratory methods to detect specific DNA mutations or gene expression patterns, which can help choose the most effective treatment.
The significance of installment
Staging is not only for understanding the severity of cancer, but also an important reference for formulating treatment plans for patients. The UNITE International Cancer Union (UICC) and the American Joint Committee on Cancer (AJCC) jointly use the TNM staging system to help doctors obtain more accurate clinical information before making a diagnosis.
However, cancer staging and prognosis vary over time, diagnostic methods, and individual differences, making clinical decision-making challenging. Advances in science and technology have opened up new avenues for breast cancer diagnosis and treatment, and the development of evidence-based medicine has made it possible to improve treatment outcomes for patients.
As research progresses, where will breast cancer treatment go in the future?
A deep understanding of breast cancer classification and staging is not only the cornerstone of treatment, but also gives us a clearer understanding of cancer treatment outcomes, but how will these changes affect your diagnosis and choices?
