ABSTRACT
O estadiamento TNMuicc classifica a neoplasia mamária de acordo com o tamanho tumoral, comprometimento linfonodal e metástases à distância. O tratamento da neoplasia mamária é influenciado por esses parâmetros, porém, também é necessário conhecimento sobre uma série de outros fatores. Na realidade, o tratamento eficaz depende da extensão da doença, do status dos receptores hormonais e de outras características biológicas do câncer. Nós propomos uma nova classificação(TNM), que não apenas inclui características biológicas relevantes e amplia o estadiamento para incluir outros fatores quando validados, mas também especifica o tamanho exato do tumor (T2,3 indica um tumor com diâmetro maior que 2,3 cm), fornece mais dados sobre o envolvimento linfonodal e especifica sítio(s) de metástases a distância. Propomos também abolir o termo "carcinoma" quando se trata de condição neoplásica não-invasiva e o termo "infiltrante" para carcinomas. A nova classificação é suficientemente similar à classificação TNMuicc para permitir comparações válidas entre pacientes classificados por ambos os sistemas, porém é mais lógica, fornece informações úteis para guiar a terapia e é flexivel o suficiente para satisfazer as necessidades de pesquisas no presente e no futuro.
The TNMuicc classification of breast cancer categorizes tumor size, regional lymph node involvement, and distant metastases. Treatment is influenced by these characteristics, but requires knowledge of several other factors. In fact, effective treatment is dependent on disease extent, hormone receptor status, and other biologic characteristics of the cancer. We propose a new classification (tumor node metastasis, TNM), that not only includes relevant biologic characteristics and can expand to include others as they are validated but also specifies tumor size exactly (T2,3 indicates a cancer of maximum diameter 2,3 cm), provides more information on regional lymph node involvement, and specifies the site(s) of distant metastases. We also propose abolishing the term "carcinoma" for non-invasive neoplastic conditions and the term "infiltrating" for carcinomas. The new classification is sufficiently similar to the TNMuicc classification to permit valid comparison of patients classified by both systems, but is more logical, provides useful information for guiding therapy, and is flexible enough to satisfy present and future clinical and research needs.
Subject(s)
Neoplasm Staging/classification , Breast Neoplasms/classification , Terminology as TopicABSTRACT
Carcinoma of the male breast (MBC) is an uncommon phenomenon, accounting for <1% of all malignancies in man. It represents a biologically heterogeneous disorder, and its clinical course may vary from indolent and slowly progressive to rapidly metastatic disease. Most of our current knowledge regarding its biology, natural history, and treatment strategies has been extrapolated from its female counterpart. Information regarding prognostic relevance of new molecular markers is limited. At the European Institute of Oncology we performed a study showing data in which p21Waf1 and p27Kip1 proteins were evaluated in a series of male breast cancer patients. Our data suggest that the immunohistochemical evaluation of p21Waf1 and p27Kip1 expression in male breast carcinomas may be a further useful marker for selecting patients who express functional proteins that can be predictive for the most efficient endocrine response. Moreover, searching for more conservative treatment, we introduced in our clinical practice sentinel node biopsy, and if present, sentinel node biopsy of the internal mammary chain. The potential clinical implications of complete nodal staging are far-reaching, and give us a major new opportunity to stratify male patients with breast cancer for appropriate surgery as well as giving valuable prognostic information. Male breast cancer has biological differences compared with female breast cancer. It responds to hormonal manipulation and chemotherapy, but optimal treatment regimens in males are unknown. By analogy to the female breast cancer, post-mastectomy radiotherapy should be proposed in case of advanced T stage and/or lymph node positivity (considering the small volume of the male mammary gland, we suggest post-mastectomy irradiation in case of T >1 cm and/or presence of >1 metastatic axillary lymph node). Breast conserving surgery, performed in selected cases of male breast cancer, should be always followed by radiotherapy. Despite a wealth of small retrospective studies on MBC, its rarity means there is a lack of prospective randomized controlled treatment trials, which needs to be addressed if significant advances are to be made in the treatment of this unusual challenging disease.
