Breast cancer tumor size

Studies show a decrease in estrogen receptor-positive breast cancer tumor size in animals administered diets of 2.5 to 10% flaxseed (Bergman Jungestrom et al. 2007 Chen et al. 2007b Dabrosin et al. 2002 Saarinen et al. 2006 Serraino and Thompson 1992 Thompson et al. 1996). 

Intraarterial infusion of microspheres containing adriamycin was used for the local treatment of breast cancer and recurrent breast cancer with liver metastases (123). A reduction in tumor size was noted when the microspheres were injected into the internal and lateral thoracic arteries for treatment of the primary tumor. However, hepatic artery injection for liver metastases resulted in improvement in only one of three patients treated. 

An NIH Consensus Development Conference Statement22 advises that adjuvant hormonal therapy should be recommended to women whose tumors contain hormone-receptor protein regardless of age, menopausal status, involvement of axillary lymph nodes, or tumor size. They also support a benefit of adjuvant chemotherapy for most women with lymph node metastases or with primary breast cancers larger than 1 cm in diameter (both node-negative and node-positive).22... 

Locally advanced breast cancer often is treated with neoadjuvant therapy to make the tumor surgically respectable. During neoadjuvant chemotherapy, laboratory values to monitor chemotherapy toxicity are obtained prior to each cycle of chemotherapy, and a physical examination and ultrasound exams to detect size of tumor are performed after the cycles of neoadjuvant therapy are completed. After a complete surgical resection, monitoring proceeds as described earlier for early breast cancer. 

Tumor size and the presence and number of involved axillary lymph nodes are primary factors in assessing the risk for breast cancer recurrence and subsequent metastatic disease. Other disease characteristics that provide prognostic information include histologic subtype, nuclear or histologic grade, lymphatic and vascular invasion, and proliferation indices. 

Breast tumors that develop in HRT users have prog-nostically favorable histological features, but it is unclear if this is the case for both short-term and long-term use. In 2000 women aged over 55 years with invasive breast cancer diagnosed over 7 years short-term users of HRT (5 years or less) were about 50% less likely to develop poorly differentiated breast tumors or node-positive tumors than non-users (177). Longer term users of HRT were also less likely to develop poorly differentiated tumors, but the incidence of node-positive tumors was not reduced compared with controls. Tumor size was not significantly related to the duration of treatment. 

However, be aware that in spite of the usefulness of the MIB-1 antibody in assessing the rate of cell proliferation, the classification of cancers (e.g., breast cancer) by the size of the primary tumor and the presence and extent of lymph node metastases does not adequately explain differences in the clinical outcome of individual patients. Cell proliferation indices are commonly used, along with other diagnostic parameters, to estimate the risk of recurrence of a cancer for individual patients. Therefore, it is important to understand the relationship between various indices of proliferation such as MIB-1 labeling index and detection by either in situ hybridization or polymerase chain reaction. This approach will lead to quality assurance in diagnosis. 

Shrinkage in tumor size is a useful measure of clinical response, and this effect can be demonstrated by physical examination, chest film or other x-ray, or special scanning procedures such as bone scanning (breast, prostate cancer), CT scan, magnetic resonance imaging (MRI), or ultrasonography. 

Fig. 23. Time course of the effect of treatment with the pure antiestrogen EM-800 or tamoxifen at the daily oral dose of 50 pg, 150 pg, or 400 pg for 4 months on the average size of ZR-75-1 human breast cancer xenografts in ovariectomized nude mice supplemented with an implant of estrone. The size of tumors at start of treatment was 31.1 0.8 mm2. Ovariectomized mice receiving the vehicle alone were used as additional controls. Results are expressed as percentage of pretreatment values (means + SEM of 28 to 37 tumors per group) (Couillard et al., 1998a).

Amplification of HER-2/neu is found in breast, ovarian, and gastrointestinal tumors. In breast cancer, it appears to be as useful a prognostic indicator of overall survival as tumor size or ER and PR expression, but not as good as the number of lymph nodes involved in metastases. Elevated serum HER-2/neu antigen levels have been shown to correlate witli decreased response to hormone therapy of breast cancer. Of the three oncogenes—HER-2/ e , ras, and c-myc— HER-2/neu has the strongest prognostic value in breast cancer. 

Serum levels of pi 05 are most useful in breast cancer with some use in ovarian cancer patients. pl05 levels in breast cancer correlate with a worse prognosis and a shorter disease-free state. Elevated HER-2/ ew levels also correlate with larger tumor size, lymph node positivity, and high grading score. HER-2/ eu serum levels are not only to be used for prognosis, but may be used to guide treatment. One study of 719 breast cancer patients showed that elevated levels of... 

---