Primary tumor size

Staging [determination of the primary tumor size, extent of lymph node involvement, and the presence or absence of metastases, or sometimes referred to theTNM system (Table 85-2)]. Many tumors are staged according to the TNM system. Metastases are cancer cells that have spread to sites distant from the primary tumor site and have started to grow. The most frequently occurring sites of metastasis are the brain, bone, liver and lungs. 

The World Health Organization has established a TNM staging classification for lung cancer based on the primary tumor size and extent (T), regional lymph node involvement (N), and the presence or absence of distant metastases (M). 

For definitive, curative therapy, objective parameters to monitor include primary tumor size, involved lymph nodes, and tumor markers such as PSA. PSA level is checked every 6 months for the first 5 years, and then annually. With metastatic disease, clinical benefit can be documented by evaluating performance status, weight, quality of life, analgesic requirements, and PSA or DRE at 3-month intervals. 

DF, mice were inoculated with 10 Lewis lung cells into right-hind gluteus muscle. Polymers were administered daily by the intraperitoneal route for 10 consecutive days following tumor implantation. Primary tumor size was determined on day lU (55 inhibition) and increased life span (55 ILS) calculated from mean time to death. 

N. Nagamoto, Y. Saito, S. Ohta, et al. (1989). Relationship of lymph node metastasis to primary tumor size and microscopic appearance of roentgenographically occult lung cancer. Am. J. Surg. Pathol., 13, 1009-1013. 

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. 

A cure in oncology implies that the cancer is completely gone, and the patient will have the same life expectancy as a patient without cancer. A complete response (CR) refers to complete disappearance of all cancer for 1 month after treatment. A partial response (PR) is defined as a 50% decrease in tumor diameter along with no new disease for 1 month. The term overall objective response rate refers to the combination of PR and CR. Stable disease refers to tumor that has not grown and has shrunk by less than 25% of the diameter. Disease progression refers to tumor that has spread or the primary tumor has increased in size by 25%. Some cancers, such as leukemia, cannot be measured by size, so biopsy of the bone marrow provides a cellular indication of absence or presence of disease. 

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... 

Stage is based on the size of the primary tumor (T ), presence and extent of lymph node involvement (N1 3), and presence or absence of distant metastases (Mq ). Simplistically stated, these stages may be represented as follows ... 

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. 

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. 

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