How is it determined how aggressive a breast cancer tumor is. What measurement is used to measure the aggressiveness of breast cancer?

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JoseEstebanMDPhD (Physician - Pathology (Verified) ) - 04 / 16 / 2012

There are multiple parameters used to determine the tumor aggressiveness. Some are histological, some molecular some clinical.

The histologic indicators are: tumor size, tumor histology, tumor differentiation, lymphovascular invasion, multi-focality, and number of mitosis.

Molecular parameters include expression of estrogen and progesterone hormonal receptors; expression of HER2-neu; proliferative activity of the tumor (Ki67, mitosis) and other genetic profiles of the tumor cells as determine by molecular analysis of the cells via RNA or DNA studies such as Oncotype, Mamotomme etc. that provide a “genetic signature” of the tumor cells able to predict the aggressiveness of the tumor and guide to a certain extent the therapeutic approach.

Clinical parameters relate to the clinical and imaging findings such as palpable lymph nodes, positive scans for probable metastasis, etc.

Smaller and single size (<2 cm) tumors with pure mucinous or tubular type of histology or other histology that is well differentiated (grade 1), with no vascular/lymphatic invasion, and ER/PR positive with no overexpression of Her2 neu would be the least aggressive tumors. However, the histologic/molecular parameters are secondary to the stage of the tumor as given by the TNM staging.

Cancer staging system is routinely used to summarize some histologic/clinical characteristics of the tumors. The staging includes three letters: T is for Tumor size; N is for lymph Node metastasis and M is for distant organ Metastasis. Of the four possible stages, Stage 1 will have the best prognosis since the tumors in this group are small and there is no nodal or distant organ metastasis. It is only within the same stage that the histologic and molecular indicator acquire larger relevance.
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