A Study to Evaluate the Presence of Disseminated Tumour Cells in the Bonemarrow as an Independent Prognostic Factor in Breast Carcinoma.

Gayathri, P (2011) A Study to Evaluate the Presence of Disseminated Tumour Cells in the Bonemarrow as an Independent Prognostic Factor in Breast Carcinoma. Masters thesis, Tirunelveli Medical College, Tirunelveli.


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Breast Cancers Are One Of The Most Common Non Dermatological Cancers Occurring In Women And Are One Of The Leading Causes Of Cancer Related Deaths In Women. It Is Reported That More Than 1000000 Cases Occur World Wide Annually (Parkins DM Et Al 2001)1 It Is Quintessential In Clinical Practice To Understand The Growth, Spread, And Outcome Of These Tumours To Give The Patients A Significant And Comfortable Long Term Survival. This Needs A Strict Pattern Of Diagnostic, Prognostic And Treatment Methods That Shall Take Into Account The Behaviour Of The Tumour, Characteristics Of The Treatment And Milieu Of The Patient. The Important Prognostic Information In Breast Cancers Is Provided By The Clinical Staging Of The Tumour And Pathological Grading. The Various Grading And Staging Methods Use Parameters Like Nuclear Grade, Tumour Size, Presence Or Absence Of Lymphatic And Vascular Invasion, Axillary Lymphnode Involvement, Sanctity Of The Resection Margins And Steroid Receptor Status. Nonetheless, 20-30% Of These Patients Who Had Been Accorded A Favourable Prognosis During Or Immediately After Completion Of Treatment, Do Suffer Relapses / Recurrences Within 5 Years, While Paradoxically Some Patients Who Were Assigned A Poorer Prognosis Initially, Do Survive For More Than 10 Years (Vincent Salomon A Et Al 2007)2. Hence This Throws Up A Very Interesting Question Of What Makes This Difference. This Paradox Indicates The Existence Of Certain Factors That Point To Some Specific Biological Nature Of The Tumour That Subsumes All Such Existing And Accepted Parameters Of Prognostication This Disease. The Haematogenous Dissemination Of Breast Cancers Is Not Significantly Addressed In The Present Prognostic Criteria, Though They Can Occur Independent Of The Spread By Lymphogenous Routes (Akiyama H Et Al 1994)3. Hence It Is Primarily Imperative That All Patients Need To Be Searched For Evidence For Such Haematogenous Dissemination. The Presence Of Bone Marrow Micro-Metastases Have Been Shown To Be Associated With Such Early Treatment Failures And Hence To Be Considered As A Poor Prognostic Factor In The Treatment And Management Of Patients With Cancers Of Breast (Braun S Et Al 2005)4. The Presence Of Bone Marrow Disseminated Tumour Cells (DTC) Is Associated With A Poor Outcome For Patients In Stage I To III Disease In Breast Cancer. (Braun S Et Al Loc. Cit 2005). The Dissemination Is Represented As Either Isolated Or Microaggregates Of Tumour Cells, Which Have The Potential To Establish Overt Metastases At A Later Time, And Are Not Detectable By Serological Tests Such As Tumour Markers Or By Radiological Imaging (Liotta LA Et Al 1991)5. These Micro-Metastases Have Been Detected In Approximately 90% Of Patients Who Have Had Curative Therapy According Existing Protocols. This Explains The Frequent Early Tumour Recurrences That Occur In Patients After Such Curative Treatments (O’Brien Et Al 1995)6. Early Spread Of Tumour Cells Usually Remain Undetected Even By Very High Resolution Imaging Technologies. The CT Scan Detects Peritoneal Or Hepatic Metastases With A Sensitivity Of 21 % And 47% Respectively (Posner MR Et Al 1994)7. Sensitivity And Specificity Of Serum Tumour Antigen Is Limited. These Techniques Analyse The Primary Tumours For Its DNA Content, Oncogenes, Tumour Suppressor Genes And Proliferative Markers. They Do Not Provide A Direct Measure Of Tumour Burden Of Metastatic Spread (Pandha HS Et Al 1995) 8. In Contrast, The Clearance Of Such Metastatic Cells From The Bone Marrow Either Spontaneously Or As A Response To Targeted Antibody Therapy Is Seen To Be Associated With An Improved Patient Survival . (Akiyama H Et Al Loc.Cit 1994). In This Context, There Is A Real Need For Newer And More Accurate Methods For The Identification Of These Disseminated Tumour Cells In The Bone Marrow. The Current Challenge For The Pathologist Is To Improve And Standardise The Methods Of Early Detection Of DTC And Hence This Study Is Taken.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Evaluate Presence ; Disseminated Tumour Cells ; Bonemarrow Independent ; Prognostic Factor ; Breast Carcinoma.
Subjects: MEDICAL > Pathology
Depositing User: Subramani R
Date Deposited: 29 Jun 2017 10:25
Last Modified: 29 Jun 2017 10:25
URI: http://repository-tnmgrmu.ac.in/id/eprint/638

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