Вопрос онкологу.
Уважаемый доктор!
Обращаюсь к Вам со следующим вопросом:
Cа левой молочной железы T4вNIM0 -это диагноз,который оставили моей маме.Ей 55 лет,менопауза 6 месяцев.Ей провели уже 2курса в/а химиотерапии,но конкретно нам ничего не говорят, говорят что это подготовительный процесс к операции.Может хоть Вы мне сможете расшифровать, что же это такое?
Вопрос с сайта: "www.rp8.ru"
Добрый день! А вот скажите, прежде чем написать такой ответ, Вы о чем думали? Вы практикующий специалист? Зачем делать выводы, не имея ни малейшего представления о диагнозе??????
Т4-это опухоль, неопределенного размера,т.е., отечность(которая успешно снимается принимаемой химиотерапией)на данный момент, а мы сегодня получили новый результат аналиов- у же Т2)
Но Влад, судя по ответам, таки специалист.
Просто даже в США существуют разногласия по стадиям опухоли.
Вот вопрос и ответ на английском:
Question
For a patient with T4bN1M0 breast cancer, should treatment begin with neoadjuvant systemic therapy or primary surgery?
Response from Lisa A. Newman, MD, MPH
Associate Professor of Surgery; Director, Breast Care Center, University of Michigan, Ann Arbor, Michigan
The American Joint Committee on Cancer staging system for breast cancer defines T4b lesions as tumors that have direct skin involvement, such as malignant edema, ulceration, and/or satellite skin nodules. This definition is frequently applied rather broadly, resulting in the inclusion of patients with small tumors that might be very superficial in location as well as patients who have more virulent or long-neglected disease that has progressed to cutaneous malignant disease. Several studies have documented the inappropriate "lumping" together of these disease patterns, as well as the different outcomes that are observed when they are evaluated independently.
These 2 distinct patterns have very different biologic and prognostic implications and call for different therapeutic strategies. Breast cancers with biologically aggressive skin involvement, including cutaneous metastases and ulceration, are more frequently associated with distant-organ metastatic involvement and are more appropriately managed using clinical standards for locally advanced breast cancer, ie, neoadjuvant chemotherapy followed by surgery, radiation therapy, and endocrine therapy/trastuzumab, as dictated by molecular marker expression. This sequence, which includes systemic therapy prior to surgery, is preferred because of the technical advantages of improved operability toward negative margins, as well as the benefits of monitoring chemosensitivity. Extent of postchemotherapy breast surgery will depend on extent of initial skin involvement: Most cases will require mastectomy because skin involvement is frequently difficult to resolve with lumpectomy, but occasionally a relatively localized fungating tumor responds well to preoperative systemic therapy and may be resectable by lumpectomy.
In contrast, breast tumors that are categorized as T4b lesions solely because of geography may be approached differently. These small, otherwise localized lesions that happen to be located just under the skin surface may even result in puckering or dimpling of the overlying, adjacent skin. It is reasonable to approach these tumors as one would handle any other early-stage breast cancer, ie, with primary breast surgery (breast-conserving or mastectomy based upon standard criteria) followed by systemic therapy that is determined by the surgical pathology findings (pathologic nodal status, molecular markers, genetic profiling, etc). The pathology clearly should be reviewed in a multidisciplinary fashion for a final assessment of whether the skin involvement is biologically significant.
T4b опухоль 4-й стадии, с наличием либо срастания опухоли с кожей, отёк, подкожные уплотнения, либо изъязвления на коже молочной железы
N1 - по крайней мере в одном лимфоузле обнаружены депозиты раковых клеток
M0- отдалённых местастазов не обнаружено