For the prognosis of a breast cancer disease it is decisive in which stage of the disease the patient is. Early detection measures significantly improve the chance of recovery and can be over 90%. This applies to women whose tumor is at an early stage of diagnosis. In general, the prognosis and thus the chances of a cure for breast cancer are also dependent on many other factors.
The age of the patient, concomitant diseases, aggressiveness and type of breast cancer, as well as lymph node involvement and the presence of metastases play a role. Whether the tumor reacts sensitively to hormone therapy can also be decisive (hormone-dependent breast cancer).
In general, the prognosis of cancer is given in the form of the so-called 5-year survival rate (5Y), ie the proportion of women who are still alive five years after diagnosis.
At an early stage of the disease, the 5-year survival rate is up to 97%.
Statistically, every eighth woman has breast cancer in the course of her life. The fear of even getting sick is therefore high in many women. Patients often wonder what the chances of survival with the disease are and which factors significantly influence survival. Lymph node involvement plays a crucial role in breast cancer. Breast cancer metastasizes through the lymph nodes, therefore, in breast cancer surgery, the surrounding lymph nodes are examined for an infection and if necessary removed. In fact, this so-called lymph node status is the most important prognostic factor in breast cancer. Tumors that have already affected lymph nodes are classified in the so-called high-risk group. Such a breast cancer has worse chances of recovery than a localized tumor that has not yet metastasized. The prognosis worsens with the number of affected lymph nodes. Lymph node involvement is also very important for the treatment decision. Tumors that have infiltrated lymph nodes have a higher risk of recurrence, ie a relapse. Therefore, more aggressive treatment options are usually used to prevent this. However, the chances of survival and recovery can not be expressed in numbers, as they depend on many different factors. They must therefore be assessed individually for each woman.
If cancer cells are already found in the lymph nodes in the armpit area, this is a sign that breast cancer is already at a more advanced stage. Accordingly, the chance of recovery is less than in a localized tumor.
The 5-year survival rate at this stage is about 81%. Nowadays, the lymph nodes are cleared out directly in infestation, which is why this stage is often still good to treat.
Probably the most important prognostic factor for a good cure in breast cancer is the lymph node status. This is determined on the basis of metastases in lymph nodes. Depending on the malignancy, breast cancer tends to rapidly metastasize to the lymph nodes of the chest wall and armpits and spread from there to other lymph nodes in the body. At a later stage, organ metastases, for example in the lungs, liver, skeleton or brain, are also formed. Breast cancer, which has already formed lymph node metastases at diagnosis, tends to have a worse prognosis than non-metastatic cancer. Also, the number of lymph node metastases is important for the cure prognosis. But not only lymph node metastases play an important role, but also organ metastases.
If the breast cancer is even more advanced, it can lead to metastasis, ie removal of degenerate cells in more distant tissues and organs, where then also forms a malignant ulcer.
Metastases are not always easy to treat, especially if they are very numerous and occur in many different places. Accordingly, the chance of recovery at this stage is significantly lower than in earlier stages.
The 5-year survival rate is about 23%. Therefore, therapy at such a stage is no longer primarily focused on the healing of the patient, but rather aims to slow the progression of the disease and improve the quality of life of the woman.
An early or early stage is when breast cancer does not already show metastases in organs and lymph nodes. It is a localized tumor in the breast. In this phase, the chances of recovery for breast cancer are particularly high. However, the treatment decision is always made individually within the framework of a tumor board, in which surgeons, gynecologists, radiologists and oncologists consult with one another. In some cases, surgical intervention with postoperative radiation is sufficient for healing. Chemotherapies are also used at such an early stage if they make sense for the respective tumor. Apart from the stage of the tumor, other factors such as grading and receptor status are very important for the chances of recovery. Some types of breast cancer are very aggressive and difficult to treat at an early stage, while others respond very well to therapy. Generally, however, chances of a cure are higher if breast cancer is detected and treated early.
The staging of breast cancer is based on the criteria tumor size, lymph node involvement and distant metastasis. In stage I, breast cancer has no distant metastases and at most lymph node metastasis. Its size must also be less than 2 cm. It is a very early stage of breast cancer with usually good chances of recovery. Often, at this stage, the disease can be cured by surgical removal of the tumor followed by radiation and chemotherapy. Unlike advanced stages, chemotherapy at this stage is curative-that is, healing-intention. Lymph node involvement also removes lymph nodes from the axilla.
In stage II, the tumor is up to 5 cm in size, but organ metastases may not be present, as in stage I. At most one lymph node may be affected. Although Stage II may initially sound more negative than Stage I, this need not be the case. The chances of recovery can be basically similar or even good. The tumor is also localized at this stage and has not metastasized remotely. As a result, the chances of recovery are not necessarily worse than with a stage I tumor. It is important to have a good response to therapy. If this is the case, the chances of recovery are also very good in a stage II.
Stage III is characterized by multiple lymph node involvement and advanced tumor size. Even aggressive tumors that invade the chest wall or break through the skin are allocated to this stage. The particularly aggressive "inflammatory mammary carcinoma" is also a stage III tumor. At this stage, the cancer is quite advanced. However, this does not mean that a healing approach to therapy is not possible in principle. However, the chances of recovery are generally worse than those of less advanced tumor stages.
At stage IV of breast cancer, distant metastases are already present in various organs of the body. To the best of our knowledge, long-term healing is unlikely in this advanced tumor stage. In exceptional cases, however, a long-term healing can be achieved. In such an advanced tumor stage, the therapeutic goals are primarily freedom from symptoms and the maintenance of a good quality of life for those affected. However, there are also factors that have a positive effect on the long-term survival of the patients. Above all, a failure to relapse within the first 2 years after the therapy is prognostically favorable. In this case, a long-term cure is more likely than if it comes to early recurrence after therapy.
Apart from important prognostic factors, such as the lymph node involvement and receptor status of the tumor, histological grading also plays an important role. Under the microscope, the cells of the tumor from a tissue sample of the breast are assessed and on the basis of the grading is determined. Tumors whose cells closely resemble the tissue of origin are referred to as G1 tumors. A strong similarity to healthy breast tissue is prognostically favorable. Such tumors, if they meet other favorable criteria, can be classified in the low-risk group. They do not require particularly aggressive tumor therapy and are associated with better chances of survival and recovery. Also, the likelihood of recurrence is lower than for tumors of the high-risk group.
G2 grading means that the tumor is already poorly differentiated and structurally more different from the original breast tissue. Such tumors are usually more aggressive and malignant. They are therefore associated with a higher risk of metastasis. Such tumors are classified in a higher risk group than G1 tumors. However, a tumor with G2 grading does not necessarily have to be associated with worse chances of survival and recovery than a tumor with G1 differentiation. Decisive are other factors such as lymph node metastases and the receptor status of the tumor.
The grading of breast cancer, among other factors, plays an important role in the prognosis of the woman. A breast tumor undergoing G3 grading shows poorly differentiated tissue under the microscope. This means that the tissue of the tumor is very different from the original tissue of the breast. A G3 grading is therefore considered to be prognostically unfavorable. The chances of a cure appear at first worse than with a tumor with a better grading. This is not always the case. Much more important than the grading of the tumor are, for example, factors such as a response to therapy or metastasis. Tumors that are not metastatic have a better prognosis even those with a higher grading than those who have a low grading and are metastasized. On the basis of grading alone, therefore, chances of a cure can not be stated.
The hormone dependence of breast cancer can also be decisive for the prognosis of the disease. Hormone dependence means that the cancer is stimulated by female sex hormones (estrogens) to grow. Specially developed drugs can suppress the estrogen effect on the cancer cells and thereby prevent the progression of the disease.
A hormone dependence of the breast cancer can therefore have a positive effect on the survival rate and chance of recovery by this further therapy option. In addition, hormone-dependent tumors are less likely to form metastases. Especially in women who develop such a breast cancer before the age of 35, however, the recurrence rate (recurrence rate) is significantly increased, ie they develop more often in their further life again breast cancer.
The hormone-independent breast cancer grows more aggressive, but if it is completely removed, recurrences are less common. It depends on the prognosis in the individual case. However, at a higher age, the prognosis for hormone-dependent breast cancer is better than for hormone-independent breast cancer.
The HER2 receptor is a protein located on the surface of cells. This receptor influences the cell division. The more HER2 receptors the cell carries, the more pronounced is their division behavior.
In some breast cancers, extremely many of the receptors are located on the surface of the degenerate cells, ie the breast cancer grows very fast and aggressive due to its high rate of division. This is accompanied by a worse prognosis of the patient.
However, there are now drugs that block the HER2 receptors, so that they can no longer pass on the growth signals to the malignant cells (so-called antibody therapy). This can increase the survival rate of affected patients. However, the prognosis is still poorer than breast cancers without HER2 receptor overexpression.
Triple negative tumors are characterized by the fact that they have no hormone receptors (estrogen and progesterone) and do not form the so-called HER2 / neu receptor. These receptors are important targets for drugs used in the modern treatment of breast cancer. However, new studies suggest that this does not always go hand in hand with a generally poor response to therapy. Such triple-negative tumors can sometimes respond very well to other chemotherapeutic agents and can be treated with healing intent. However, there are also triple negative tumors known to have very aggressive growth and poor response to therapeutics. The chances of recovery of a triple negative tumor can therefore not be stated as a whole.
uPA and PAI1 are special proteins that can be produced by breast cancer cells. Low levels of these proteins correlate with a more favorable course of the disease, while high levels indicate a more aggressive breast cancer and therefore a worse prognosis.
Women with high levels of uPA and PAI1 are therefore more likely to benefit from chemotherapy immediately after breast cancer surgery.
There are several genes that increase the risk of developing breast cancer. Particularly well known are the genes BRCA1 and BRCA2, which are associated with an increased incidence of breast cancer in younger women.
In principle, the prognosis for genetic predisposition is worse. Especially if the breast cancer occurs early, the likelihood that it will develop again after a few years, increased significantly.
In many cases, the treatment is more difficult, since breast cancer of genetic predisposition is usually a particularly aggressive form.
A mastectomy, also called mastectomy, is performed whenever a breast-conserving operation is not possible for a variety of reasons, or the patient desires amputation. Very extensive tumors, so-called inflammatory breast cancers or multiple tumors in the breast ( multicentricity ) make breast-conserving surgery impossible. A mastectomy increases the chances of recovery in such cases. The likelihood of a recurrence, for example due to remaining in the tissue remains of the tumor is thus minimized. However, a mastectomy is not always necessary and absolutely beneficial. In tumors that do not require a mastectomy, the chances of recovery are not increased over breast-conserving surgery.
The biggest fear of most people suffering from cancer is the onset of a relapse. Recurrences are disease relapses that can also occur after a cured breast cancer. One distinguishes between early and late recurrences. Early recurrences occur within the first two years after the cure of breast cancer, late relapses in the period thereafter. Particularly feared are the early recurrences, as they speak for a very aggressive tumor. The chances for a cure are significantly lower in such early recurrences than in late recurrence. The chances for recurrences and distant metastases are also increased. The probability of survival of the disease over several years therefore decreases. It also plays a role, where the recurrence arises and after which therapeutic measures. Recurrences occurring at one site after radiotherapy and breast conserving surgery show a 5-year survival rate of approximately 64%. This means that 5 years after relapse, 64% of the patients are still alive. On the other hand, recurrences that occur in several places only have a 5-year survival rate of about 24%. Furthermore, the chances of survival and the chances of recovery depend strongly on the general condition of the person concerned and on many individual factors.
The age of the patient is equally important in terms of prognosis and chance of recovery. In women who become ill before the age of 35, the prognosis is rather poor. Such an early onset suggests a genetic predisposition and often leads to aggressive tumors with a high rate of relapse.
In contrast, breast cancer in older age (from 67 years of age) often does not reduce life expectancy with adequate therapy. Relapses are rarer and in many cases breast cancer is less aggressive.
Men can also get breast cancer. Although this is much less common, it is no less dangerous. The danger lies above all in the fact that breast cancer is usually recognized late in men. For men, there are no screening tests, such as mammography, which has become established in women's breast cancer screening.
Knots or other changes in the chest are often not perceived as potentially dangerous by men. Therefore, on average, the doctor is on the move much later and the cancer has already spread further in the meantime.
However, the treatment is carried out as for the woman. The prognosis of the disease is then similar, that is, the cancer is detected at an early stage, the prospect of healing is also very good. With an increasingly advanced stage prognosis and chances of recovery worsen.
In particular, early detection plays a major role in the prognosis and chance of recovery in breast cancer. If the cancer is detected early and adequately treated, it is usually good to treat and the chance of recovery high.