Classification and staging of breast cancer i. Classical TNM staging.
The basic framework is to comprehensively analyze TNM according to tumor size (T), lymph node metastasis and metastasis number (N) and distant organ metastasis (M) to determine the stage of breast cancer. TNM is an anatomical and pathological stage of tumor, which can not be underestimated in predicting tumor recurrence and metastasis, and it is a mature risk assessment index in clinic.
Primary tumor (T) stage: Tx primary tumor is unknown (resected). T0 Primary tumor is untouchable. Tis carcinoma in situ (including lobular carcinoma in situ and intraductal carcinoma), Paget's disease is confined to nipple, and no mass is touched in breast. T 1 The maximum diameter of tumor is less than 2Cm. The largest diameter of T2 tumor is 2 ~ 5 CrN. The maximum diameter of T3 tumor exceeds 125px. T4 tumor of any size directly invades chest wall and skin (including inflammatory breast cancer).
Regional lymph node (N) staging: There are no palpable regional lymph nodes. The lymph nodes in Nx area are unknown (previously removed). N 1 ipsilateral axillary lymph nodes are swollen and movable. N2 ipsilateral axillary lymph nodes are swollen, fused with each other, or adhered to other tissues. N3 ipsilateral mammary lymph nodes have metastasis, ipsilateral subclavian and superior lymph nodes have metastasis.
Distant transfer (M) stage: Whether Mx has distant transfer is unknown. M0 has no distant metastasis. M 1 long distance transmission.
Second, practical clinical staging.
According to the different TNM, it can be divided into different clinical stages, and it is also the most commonly used stage for clinicians to explain the condition to patients and their families.
Three, pathological classification, histological grading.
The pathological morphology of breast cancer is complex and there are many types. There are often more than two types in the same cancer tissue or even the same slice. The comprehensive treatment methods and prognosis of each type of breast cancer are different, and the clinical treatment plan should also be combined with pathological types and histological grades. At present, the international and domestic pathological classification of breast cancer has not been unified in practical application.
(1) At present, pathological classifications widely used in China are as follows.
1, non-invasive carcinoma.
① Intraductal carcinoma (cancer cells did not break through the basement membrane of the duct wall);
② lobular carcinoma in situ (cancer cells did not break through the terminal mammary duct or basement membrane of acinus);
③ Intraductal papillary carcinoma;
④ Papillary eczema-like breast cancer. This type belongs to the early stage and has a good prognosis.
2. Early invasive cancer.
① Early invasive ductal carcinoma (cancer cells broke through the basement membrane of the ductal wall and began to infiltrate into the stroma);
② Early invasive lobular carcinoma (cancer cells broke through the basement membrane of the distal mammary duct or acinus and began to infiltrate into the stroma, but they were still confined in lobules). This type is still in the early stage and has a good prognosis. (Early invasion means that the infiltration component of cancer is less than 10%).
3. Invasive cancer.
(1) Invasive special cancers: papillary carcinoma, medullary carcinoma (with a large number of lymphocytes infiltrating), tubular carcinoma (well-differentiated adenocarcinoma), adenoid cystic carcinoma, mucinous adenocarcinoma, eccrine adenoid carcinoma, squamous cell carcinoma, etc. This type of differentiation is generally high and the prognosis is good.
(2) Invasive nonspecific carcinoma: including invasive ductal carcinoma (the most common clinical type), invasive lobular carcinoma, hard carcinoma, medullary carcinoma (without a large number of lymphocytes infiltration), simple carcinoma, adenocarcinoma, etc. This type is generally poorly differentiated and its prognosis is worse than the above types. It is the most common type of breast cancer, accounting for 80%. However, the prognosis still needs to be combined with factors such as disease stage.
4. Other rare cancers.
(2) Histological grading standard.
The relationship between histological grade of tumor and prognosis of patients has long been concerned by oncologists. The degree of differentiation of breast cancer is closely related to the prognosis, but there are great differences in various grading standards. The histological grading of breast cancer is mainly evaluated from the following three aspects:
1, the degree of glandular duct formation.
2. Nuclear polymorphism.
3, nuclear division count.
Classification standard for diagnosis and treatment of common malignant tumors in China;
1, glandular duct formation: ① the most obvious glandular duct score 1. ② Moderately differentiated glandular duct is 2 points. ③ The growth of cells in solid patches or strips is three points.
2. The size, shape and chromatin of the nucleus are irregular ① The consistency of the size, shape and chromatin of the nucleus is 1. ② Moderate nuclear irregularity is 2 points. ③ The nuclear polymorphism is 3 points.
3, chromatin increase and mitosis (? 400) ① 110 HPF is1. ② 2 ~ 3/ 10 HPF is 2 points. ③& gt； 3/ 10HPF is 3 points.
The scores determined by the three indicators of each standard are added together, and 3 ~ 5 is divided into Grade I (well differentiated), 6 ~ 7 is divided into Grade II (moderately differentiated), and 8 ~ 9 is divided into Grade III (poorly differentiated).
Four, molecular typing (new classification based on gene level).
In recent years, molecular typing of breast cancer based on DNA microarray technology and multigene RT-PCR quantitative detection method has been used to predict the risk of recurrence and metastasis of breast cancer and its response to treatment. At present, molecular subtypes of gene chip technology are often combined with immunohistochemistry, and breast cancer can be divided into four categories clinically [55-57]: Lumina type A (ER+/PR+, HER-2-), Lumina type B (ER+/PR+, HER-2+) and Her-2+(ER-/PR-/Her). Different molecular subtypes of breast cancer have different clinical response and survival time, which has attracted more and more clinical attention.
V. Risk classification (2007 St, Gallen*** knowledge).
According to patients' age, tumor size, hormone receptor status, tumor cell classification, vascular tumor thrombus, HER2 status and lymph node status, in 2007, St and Gallen experts divided them into low, medium and high recurrence risk groups, which provided a basis for clinicians to choose appropriate treatment plans.
Breast diseases, causes of breast cancer, causes of breast cancer:
Menstruation is early and menopause is late. The age of menarche is less than 12 years old, and the relative risk of breast cancer is 2.2 times that of 17 years old. The risk of breast cancer in amenorrhea patients over 55 years old is higher than that in those under 45 years old 1 fold. Early menarche and late menopause are two main risk factors for breast cancer.
Causes of breast cancer 2:
Genetic factors. It is found that if a woman whose mother has bilateral breast cancer before menopause, her own risk of breast cancer is 9 times that of the average woman, and the average age of the second generation of breast cancer patients is about 10 years earlier than that of the average woman. Women with breast cancer among their sisters are three times as dangerous as ordinary people. It should be emphasized that breast cancer is not directly inherited, but a kind of? Cancer? Hereditarily, relatives of patients with breast cancer may not have breast cancer, but they are more likely to have breast cancer than the general population.
Three causes of breast cancer:
Get married and have children. Epidemiological studies show that although women are infertile after marriage or their first child is after the age of 30, the risk of breast cancer among unmarried people is twice that of married people. Experts believe that childbirth has a protective effect on breasts, but it only refers to full-term delivery before the age of 30. Recent studies have shown that breast-feeding has a protective effect on the occurrence of breast cancer, mainly for premenopausal women.
Four reasons for breast cancer:
Ionizing radiation. Breast is a tissue sensitive to carcinogenic activity of ionizing radiation. When you are young, it is the mitotic stage of the breast, which is the most sensitive to the carcinogenic effect of ionizing radiation, and the effect of ionizing radiation is cumulative. The risk of repeated low-dose exposure is the same as that of high-dose exposure, and there is a dose-effect relationship.
Five reasons for breast cancer:
Unhealthy eating habits. The incidence and mortality of breast cancer have a strong correlation with the amount of digested fat per capita. The high income of employees in some companies leads to high living standards, unscientific and unhealthy? High in calories and fat? Eating habits have greatly increased the incidence of breast cancer.
Six reasons for breast cancer:
An unhealthy lifestyle. Some female white-collar workers who have been engaged in office work for a long time sit more and move less, lack exercise and get less sunshine. Most professional women hold their bras tightly for a long time because of their work, so they seldom give them breasts? Untie? ; There are also some professional women who, under the pressure of working or pursuing career success, live a single aristocratic or double-income childless life, with no family or children.
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