Prospective analysis of favorable prognostic factors in carcinoma breast

Karthikeyan, A S (2015) Prospective analysis of favorable prognostic factors in carcinoma breast. Masters thesis, K.A.P. Viswanatham Government Medical College, Tiruchirappalli.


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BACKGROUND AND OBJECTIVES: The cancer of breast with its uncertain cause has captured the attention of physicians throughout the ages. It is one of the most common carcinoma occurring in females and it is a devastating illness both physically and mentally. In India, Breast cancer is second most common, malignancy among women next to Ca cervix. According to the National Cancer Registry, Bangalore has the highest age adjusted incidence rate in India (36.6). Chennai ranks third (32.6). GLOBOCAN (WHO) reports that India has the highest number of breast cancer deaths in the world (70218) followed by China (47984) and USA (43909). AIM OF THE STUDY: The purpose of the study is to identify the prognostic factors in primary carcinoma breast and emphasize the need of awareness and public education regarding carcinoma breast and its early detection The utility of prognostic factors lies not only in their ability to prognosticate the outcome of the disease but also in detecting early disease, monitoring of disease course, screening for recurrent disease. METHODOLOGY: Study Design and Sampling: This is a prospective analytical study of 95 Cases of Cancer Breast diagnosed and treated at KAPV Government Medical College and Mahatma Gandhi Memorial Government Hospital, Tiruchirapalli over a period of 2 years from May 2012 to August 2014. At presentation a detailed history was taken and clinical examination done. Diagnosis was confirmed histologically and investigations like Blood Biochemistry, chest X-ray, ultrasound abdomen were also done to stage the disease. In patients presenting with locally advanced breast disease or metastatic disease investigations like CT abdomen, CT chest, mammogram of opposite breast, pleural fluid and ascitic fluid cytology were done. The modality of treatment was decided based on stage of disease at presentation and operability. Most of the patients with early breast cancer I II A, II B, III A underwent modified radical mastectomy. Inoperable stage IIIA, IIIB, IIIC were treated with neoadjuvant chemotherapy followed by Modified radical mastectomy. Patients with Metastatic disease received palliative chemotherapy and radiotherapy. All cases were followed up at monthly interval with clinical examination, blood count and biochemistry, ultrasound abdomen, chest X ray, Mammography was done at 3 monthly interval during the follow up period. Data obtained were recorded in a specific proforma and analysed in systematic way. Inclusion Criteria: All histologically proven cases of cancer breast were included in the study. Immunohistochemical studies of ER, PR receptors were done in 20 patients. Exclusion Criteria: patients who where operated and referred for further management from outside hospital were excluded from the study. RESULTS: 1. The commonest age of presentation was 40 – 50 years of age. 2. About 47.36 were premenopausal and 46.31 were postmenopausal 5.26% were Nullipara. 3. Commonest mode of presentation was painless lump in 46.31%. 4. Most of the patients presented with stage III disease 62.09%. 5. Lymphnode positivity during presentation was about 69.46%. 6. Invasive ductal carcinoma was the commonest pathological variety in our stage. Histological grade I was found in 56.84%. 7. Most of our patients presented with tumor size more than 5 cm (67.36%). 8. Modified Radical mastectomy was done in 90 patients. Toilet mastectomy was done in 5 patients presenting with ulceration/fungating lesions. 9. Resected margins were found to be positive in 5 patients all of them were given radiotherapy. Three of them developed locoregional recurrence 2 developed metastasis. One in lung, one in brain. 10. Lymphnode examination for metastatic deposits in pathological specimen showed positivity in 49 patients. More than 6 nodes were positive for metastatic deposits in 13 patients. Of which 4 developed locoregional recurrence and one developed liver, lung metastasis. One patient with supraclavicular node developed spine metastasis. All patients were treated with chemotherapy and radiotherapy. 11. Histologic grade 1 found in 44.21 of patients, grade 3 found in 10.52% of our patients (10 Pts) of which 3 locoregional recurrence had. 2 developed lung secondaries during the follow up period. 12. Patients who developed lung metastasis had Tumor size more than 8cm during presentation and 1 of them had histological grade III invasive ductal carcinoma. Supraclavicular node was involved in one patient. 13. One patient with brain metastasis had Tumor size of 6 cm during presentation, she had more than 6 nodes positive for deposits in pathological resection specimen. 14. One patient who developed both spine and liver metastasis presentedwith tumor involving all quadrants. 15. In the hormone receptor study done in 20 cases. (10 cases in premenopausal age group and 10 cases in postmenopausal age group), estrogenreceptor positivity was seen in 65% (13cases), negativity for both receptors in 35% (7 cases) with increase in positivity in older age group (50-59 years). 1. ER+, PR- tumours (5/10 cases) are more prevalent in postmenopausal age group constituting 50%. 2. Special histological variants like papillary carcinoma, lobular carcinoma are positive for ER and PR.Medullary and Metaplastic variants are negative for both receptors. In our study, ER /PR negative found in 7 patients. Among them one patient with ER/PR –ve medullary carcinoma developed local recurrence, and one patient with ER/PR –ve metaplasic carcinoma developed lung metstasis. 16. Nottingham Prognostic index was found to have direct correlation with prognosis in our study. In 32 of our patients with NPI more than 5.4, 5 had local recurrence, 3 had lung metastasis, 2 developed spine metastasis and one developed brain metastasis during follow up. CONCLUSION: The prognostic markers in carcinoma breast which needs to be routinely assessed are axillary lymphnode status, tumour size, histologic grade, estrogen and progesterone receptor status, post operative findings like positive margins as they are needed in planning of adjuvant treatment.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Modified Radical Mastectomy ; ER/PR Status ; Axillary Node Status ; Localrecurrence ; Metastasis ; Nottingham Prognostic Index,Mammography.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 10 Jul 2018 03:44
Last Modified: 10 Jul 2018 03:44

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