![]() In: Robbins and Cotran Pathologic basis of disease. Vinay kumar, Abul K.Abbas, Nelson Fausto, Jon C.Stage of tumor – Tumor in the stage I has better prognosis than the in stage IV.HER 2 – Overexpression of HER2 is associated with poor prognosis.Key Words: Breast cancer Tumor Prognostic factors. If tumors fail to express ER or PR then less than 10% of them respond to hormonal therapy but respond to chemotherapy portant prognostic and predictive factors in breast cancer management and recurrence.Strongly ER positive cancers are less likely to respond to chemotherapy but respond to hormonal therapy.40% of them show only ER or PR positivity.Proliferative rate – Carcinomas with high proliferation have poor prognosis.8 – 9 points – poorly differentiated (grade III).6 – 7 points – Moderately differentiated (grade II).3 – 5 points – well differentiated (grade I).3 points – marked variation in size and shape.2points – moderate nuclear variation in size and shape.1 point – minimal nuclear variation in size and shape.Grade 1 is well differentiated and grade 3 is poorly differentiated. Depending upon these factors 3 histologic grades have been described. Histologic grade – Nottingham histologic grade depending upon nuclear grade, tubule formation and mitotic rate is an important prognostic factor.Metaplastic and micropapillary carcinoma have poor prognosis.Tubular, mucinous, lobular, papillary, adenoid cystic have better prognosis than invasive ductal carcinoma NOS.Lymphovascular invasion – tumors with lymphatic and vascular invasion has poor prognosis.Inflammatory carcinomas are ER negative and 40%to 50% of cases over express HER2.These clinical signs are caused by dermal lymphatics filled with metastatic carcinoma that blocks lymphatic drainage. Edematous skin is tethered to the breast by cooper ligaments and mimics the surface of an orange peel (Peau d’orange).Breast cancers presenting as breast erythema and skin thickening have poor prognosis.Locally advanced disease – Carcinomas involving skin or skeletal muscle have poor prognosis.But the size is not important risk factor for HER2 – positive and ER negative carcinomas as they metastasize even when they are small. As the size increases the risk of metastasis increases.Tumor size is related to the risk of lymph node metastasis.Involvement of number of lymph nodes influences the survival rate of patient (10 years survival rate is 35% to 40% in patients with one – three positive nodes and 10 -15% with more than 10 positive nodes.Axillary lymph node status is an important prognostic factor.Distant metastasis – patients with distant metastasis have poor prognosis than the patients with tumor confined to the organ.In situ carcinoma – Patients with in situ carcinoma has better prognosis than invasive carcinoma.
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