Prognosis in breast cancer

introduction

The prognosis of various diseases is often given in percent using the so-called 5-year survival rate in order to be able to compare them better.

For breast cancer, this survival rate is around 85%. This means that 5 years after the diagnosis of breast cancer was made, 85% of those affected are still alive. However, care must be taken when handling such data, as not every person with breast cancer poses the same risk of actually dying from the tumor.

Breast cancer stages

The stage of breast cancer plays a particularly important role in assessing the course of the disease. As with most types of cancer, the so-called TNM classification is used here.

The T stands for tumor and only indicates the extent of the primary tumor (a distinction is made between T1, the smallest form, up to T4). N stands for "nodes", ie lymph nodes.

N0 means that no lymph nodes are involved. In breast cancer, a distinction is still made between N1 to N3, with each number being subdivided into a and b.
The assignment of N1a to N3b depends on how many lymph nodes have metastases and where these lymph nodes are located.
M stands for metastases. Here a distinction is only made between M0, i.e. no distant metastases, and M1, which means that distant metastases are present.

A woman with a very small tumor (T1) that has not yet infected lymph nodes (N0) and has not spread over the blood (M0) has a very favorable prognosis; it is still one of the early stages of cancer and is therefore easy to treat . However, as soon as distant metastases are found, the chances of survival for the sick can only be regarded as very low.

Please also read our topic: Breast cancer stages

The five most important factors of the forecast

The 5 most important factors are:

• age
• the menopausal status (i.e. whether the woman has already had her last period or not)
• the tumor stage or "staging"
• the degree of degeneration or "grading"
  and
• predictive factors such as the hormone receptor status of breast cancer (i.e. whether the breast cancer is hormone-sensitive or not)

In general, it can also be said that the earlier breast cancer is diagnosed, the better the chances of recovery, which is why women are encouraged to regularly scan their own breast and visit the gynecologist regularly.

Please also read our page Chances of a cure for breast cancer.

Bad prognosis

Most of the time, a disease at a young age suggests an unfavorable prognosis, since those affected under 35 are particularly likely to suffer relapses (recurrences).

More information on this topic: Life expectancy in breast cancer

The individual prognosis

The individual prognosis that emerges for each patient ultimately decides which form of therapy is best for them.

Even after successful therapy there is always the risk that the cancer can return. If a tumor recurs, it is called a relapse. The risk of recurrence in successfully treated patients is about 5 to 10% within the first 10 years.

You may also be interested in this topic: Recurrence of breast cancer

What influence do metastases have?

The influence of metastases on the prognosis cannot be generalized. We know from great statistics that the presence of metastases often suggests that the disease can no longer be brought to a standstill.
The lifetime prognosis for metastases can only be made individually. Even then, you should be careful with times, as the course of the disease can be extremely different for every woman with metastatic breast cancer. Many women live many years after the diagnosis, on the other hand there are also brilliant courses with a short lifespan. Only the treating oncologist can provide an individually tailored prognosis. The goal of therapy for metastases is particularly aimed at improving the quality of life and at bringing the disease to a standstill as far as possible.

The prognosis also depends on the location of the metastasis. Metastases in the bones, for example, have a comparatively better prognosis because there are good treatment options. In general, it should be said that metastatic breast cancer belongs prognostically to the high risk group, i.e. a high-risk disease. This classification also has an influence on the choice of therapy.

Read more on this topic at: Metastasis in breast cancer

What influence does lymph node involvement have?

The lymph node involvement in the armpit has an important prognostic value. Lymph nodes are affected when tumor cells have reached the axillary lymph nodes via the lymphatic drainage in the breast along the drainage pathways. However, one speaks of lymph node involvement only when several cells have formed nests there and can also be measured. Based on the number of affected lymph nodes in the armpit, a statement can be made about how high the risk of relapse is after the therapy has been completed.

The prognosis worsens with lymph node involvement, since local cancer has turned into a systemic disease affecting the whole body. It is important to differentiate between the fact that lymph node involvement is not metastatic breast cancer. Metastases are used when other organs, such as the liver or bones, are affected. The lymph node involvement also allows conclusions to be drawn about how aggressive the growth behavior of the tumor is, which can then affect the prognosis.

Read more on the topic: Lymph node involvement in breast cancer

What influence does sentinel lymph node infestation have?

The sentinel lymph node is the first to be infiltrated by the tumor cells when the lymph node is infected.
The lymphatic fluid from the breast first travels to the sentinel lymph node before flowing to the other lymph nodes in the armpit. The sentinel lymph node is therefore more important in operative therapy than in determining the prognosis.
Rather, the prognosis of breast cancer depends on whether the other lymph nodes are also affected. So one could say that it would be prognostically favorable if only the sentinel lymph node is affected, as long as the other lymph nodes in the armpit are free of tumor cells. If the sentinel lymph node is infected, all other lymph nodes in the armpit are removed as part of the surgical treatment and then examined. A well-founded prognosis can only be assessed by looking at the findings together.

Triple negative breast cancer

Triple negative breast cancer includes the type of breast cancer that tested negative for both the hormone receptor and the HER2 receptor. Chemotherapy is therefore the only treatment option alongside surgery. Generally, triple negative breast cancer has a worse prognosis for overall survival than the other groups. This is due to the fact that it grows more aggressively and has often already affected the lymph nodes or has metastasized to other organs at the time of the initial diagnosis.

However, triple negative breast cancer presents very differently and can be divided into further subgroups, the prognosis of which also varies. This division into these subgroups has not yet had any consequence for therapy. Therefore, the prognosis of triple negative breast cancer depends largely on the response to chemotherapy. If breast cancer responds well to chemotherapy, the prognosis is as good as that of other types of breast cancer.

Read more on the topic: What is triple negative breast cancer?

Grading

The Grading assesses the tumor tissue more precisely.
Here the tumor into a group of G1 to G4 assigned. Tumor cells develop from healthy body cells and the more similar they are to them, the less aggressive they are usually. G1 refers to tumor cells that are still relatively similar to their original cell and are well differentiated.
They usually grow quite slowly and don't behave particularly aggressively.
The takes up to G4 Degree of differentiation of the tissue and so G4 tumors are almost completely undifferentiated, have almost no resemblance to their original tissue and tend to behave very aggressively, including ingrowth into neighboring tissue.

Hormone sensitive breast cancer

Some types of breast cancer respond to the female hormone estrogen because they have an estrogen receptor. Others have a receptor called HER2.
These receptors can be used as part of hormone or antibody therapy to slow the growth of the tumor. Therefore, these factors also play an important role in the prognosis, as they have a decisive influence on the choice of therapy.

More on this: Hormone therapy for breast cancer

Breast cancer in men

Breast cancer in men is very rare, but should be mentioned briefly here.
The prognosis is generally the same as for cancer in women, except that familial history is not considered to be as significant in men. In addition, the 5-year survival rate is somewhat lower, but this is due to the fact that men usually only develop the disease at an older age than women.

Read more on the topic: Breast cancer in men