Breast Cancer Recurrence (cont.)

What Factors Determine The Likelihood Of A Recurrence?

Prognostic indicators are characteristics of a patient and her tumor that may help a physician predict a cancer recurrence. These are some common indicators:

  • Lymph node involvement. Women who have lymph node involvement are more likely to have a recurrence.
  • Tumor size. In general, the larger the tumor, the greater the chance of recurrence.
  • Hormone receptors. About two-thirds of all breast cancers contain significant levels of estrogen receptors, which means the tumors are estrogen receptor positive (ER+). ER-positive tumors tend to grow less aggressively and may respond favorably to treatment with hormones.
  • Histologic grade. This term refers to how much the tumor cells resemble normal cells when viewed under the microscope; the grading scale is 1 to 4. Grade 4 tumors contain very abnormal and rapidly growing cancer cells. The higher the histologic grade, the greater chance of recurrence.
  • Nuclear grade. This is the rate at which cancer cells in the tumor divide to form more cells. Cancer cells with a high nuclear grade (also called proliferative capacity) are usually more aggressive (faster growing).
  • Oncogene expression. An oncogene is a gene that causes or promotes cancerous changes within the cell. Tumors that contain certain oncogenes may increase a patient's chance of recurrence.

How Will My Prognosis Affect My Treatment?

Following surgery or radiation, your treatment team will determine the likelihood that the cancer will recur outside the breast. This team usually includes a medical oncologist, a specialist trained in using medicines to treat breast cancer. The medical oncologist, who works with your surgeon, may advise the use of tamoxifen (tamoxifen citrate, Nolvadex) or possibly chemotherapy. These treatments are used in addition to, but not in place of, local breast cancer treatment with surgery and/or radiation therapy.

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