Introduction
The prognosis of various diseases is often given as a percentage using the so-called 5-year survival rate in order to be able to compare them better. For breast cancer this survival rate is about 85%. This means that 5 years after the diagnosis of breast cancer has been made, 85% of those affected are still alive. However, one must be careful when dealing with such data, as not every person with breast cancer has the same risk of actually dying from this tumour.
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 tumour and refers solely to the extent of the primary tumour (a distinction is made between T1, the smallest form, and T4).
N stands for “nodes”, i.e. lymph nodes. N0 means that no lymph nodes are affected. In breast cancer, a further distinction is made between N1 to N3, whereby each number can be subdivided into a and b.
The classification of N1a to N3b depends on how many lymph nodes have metastases and where these lymph nodes are located. M stands for metastases. A distinction is only made here between M0, i.e. no distant metastases, and M1, which means that distant metastases are present.
A woman with a very small tumour (T1) that has not yet affected any lymph nodes (N0) and has not spread through the blood (M0) has a very favourable prognosis. It is still one of the early stages of cancer and is therefore easily treatable. However, as soon as distant metastases have been found, the chances of survival for patients are very low.
The five most important factors in the forecast
The top 5 factors are: In addition, it can generally be said that the chances of recovery are better the earlier the breast cancer is detected, which is why women are also encouraged to have regular breast palpation and regular visits to the gynaecologist. . – the age
- The menopause status (i.e. whether the woman has already had her last period or not)
- The tumor stage or “staging”
- The degree of degeneracy 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)
Unfavourable forecast
In most cases, a disease at a young age speaks for an unfavourable prognosis, as those under 35 are particularly likely to suffer relapses (recurrences).
The individual forecast
The individual prognosis that results for each patient ultimately determines which form of therapy is best suited to her. Even after successful therapy, there is always the risk that the cancer may return. If a tumour recurs, this is known as a relapse.
The risk of a relapse in successfully treated patients is about 5 to 10% within the first 10 years. This topic might also be of interest to you: Recurrence of breast cancerWhich metastases have an influence on the prognosis cannot be generalized. Large statistics show that the presence of metastases often indicates that the disease can no longer be brought to a standstill.
The lifetime prognosis for metastases can only be made individually. Even then, one should be careful with time estimates, 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 fulminant courses with short lifetimes.
Only the treating oncologist can give an individually tailored prognosis. The therapeutic objective in the case of metastases is particularly directed towards improving the quality of life and bringing the disease to a standstill as far as possible. Furthermore, the prognosis 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, metastasized breast cancer is a high-risk disease in terms of prognosis. This classification also has an influence on the choice of therapy.
The lymph node involvement in the armpit has an important prognostic value. Lymph nodes are affected when tumour cells have reached the axillary lymph nodes via the lymph drainage system in the breast along the drainage routes. However, lymph node infestation only occurs when several cells have formed nests and can be measured.
Based on the number of affected lymph nodes in the armpit, a statement can be made as to how high the risk of relapse is after completed therapy. The prognosis worsens in the case of lymph node infestation, since a local cancer has become a systemic disease affecting the entire body. It is important to distinguish that lymph node involvement is not a metastatic breast cancer.
One speaks of metastases when other organs, such as the liver or bones, are affected. Lymph node infestation also allows conclusions to be drawn about how aggressive the tumour’s growth behaviour is, which can then have an effect on the prognosis. The sentinel lymph node is the first node to be infiltrated by the tumour cells.
The lymph fluid from the breast first reaches the sentinel lymph node before it flows into the other lymph nodes in the armpit. Therefore, the sentinel lymph node is more important in surgical therapy than in determining the prognosis. The prognosis of breast cancer rather depends on whether the other lymph nodes are also affected.
One could say that it would be prognostically favourable if only the sentinel lymph node was affected, as long as the other lymph nodes in the armpit were free of tumour cells. If the sentinel lymph node is affected, all other lymph nodes in the armpit are also removed as part of the surgical therapy and then examined. Only by looking at the findings together can a well-founded prognosis be assessed.
Triple negative breast cancer includes breast cancer that has been tested negative for both the hormone receptor and the HER2 receptor. Chemotherapy is therefore the only treatment option besides surgery. In general, 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 often has already affected the lymph nodes or metastasised to other organs at the time of initial diagnosis. However, triple negative breast cancer presents very differently and can be divided into further subgroups, whose prognosis also varies. This subdivision into these subgroups has not yet had any consequences for therapy. Therefore, the prognosis of triple-negative breast cancer depends largely on the response to chemotherapy. If the breast cancer responds well to chemotherapy, the prognosis is similarly good as for the other breast cancer types.
