BREAST CANCER

COMPLICATIONS AND
PROGNOSIS

P R E PA R E D B Y
DR. ADIL ALALMAI
MBBS, ABFM

SPECIALIST OF FAMILY
MEDICINE

:Objectives
To know common complications of breast cancer.
To know prognostic factors of breast cancer.
To know staging system of breast cancer.

COMPLICATIONS

:Complications

Organic:
1)Local.
2) Systemic.

Psychosocial:

Local Complications

Cosmetic disfiguration:
Destruction of the
breast,

.destruction of the chest wall surrounding the breast

Nipple discharge

Mastitis:
Patient present with
tenderness and erythema,
accompanied by a fever of
101F (38.5 C).

:Chest Pain
about 70 to 90 percent of those with advanced solid

tumors, experience chronic pain.

Appropriate treatment of pain can result in 90
percent of cancer patients achieving adequate relief.
There are many choices to treat cancer pain starting
from non opioid such as acetaminophen to
opioid(narcotics) such as morphine.

:Systemic

:Fatigue
Cancer-related fatigue
National Comprehensive Cancer Network as a
persistent, subjective sense of tiredness related to
cancer or cancer treatment that is not proportional to
recent activity and interferes with usual functioning.
It has been shown that exercise, including
walking and aerobic and resistance training,
have beneficial effects on some symptoms related to
cancer, including fatigue, distress, anxiety, and
depressive symptoms.

metastsis

:Common Sites of Metastsis

BONE>LUNG>LIVER>BRAIN

:Complications of metastasis include

Pneumonia.
Collapsed lung.
Respiratory failure.
Liver failure.
Bone fractures.
Hip fracture
Wrist fracture

side effectsRadiation therapy

Skin burns
Confusion (with radiation to the brain)
Difficulty swallowing
Fatigue
Hair loss
Headaches (with radiation to the brain)
Nausea and vomiting
Other cancers
Rashes and skin changes (discoloration)
Weight loss

:Side effects of chemotherapy include

Anorexia.
Bone marrow damage.
Constipation and diarrhea.
Hair loss.
Increased risk of infection.
Mouth sores (mucositis).
Nausea and vomiting.
Weakness or fatigue.

:Psychosocial
Studies have shown an increased prevalence of

depression in cancer patients.

Depression has been linked to a reduced chance of

survival in breast cancer patients.

Physicians may accept affective symptoms as normal

and may underestimate the severity of depressive

symptoms.

Prognosis

prognosis
Defintion:

is the doctors best estimate of how cancer will affect a

person, and how it will respond to treatment.

:The following are prognostic and predictive factors for breast cancer

Age
Stage
Lymph node status
Tumour size
Type of tumour
Lymphatic and vascular invasion
Hormone receptor status
HER2 status

:Age
Younger women (under 35 years of age) usually have

a greater risk of recurrence and a poorer overall

prognosis than older, post-menopausal women.
Younger women with breast cancer tend to have

more aggressive, higher-grade cancer and more

advanced breast cancer at the time of diagnosis.

:Lymph node status

The most important prognostic factor for breast cancer is whether

axillary lymph nodes involved or not.

Breast cancer that has spread to the lymph nodes has a higher risk of

recurring and a less favourable prognosis than breast cancer that has
not spread to the lymph nodes.
Breast cancer may also spread to the internal mammary lymph nodes,

without having spread to the axillary lymph nodes. In this situation,

the risk of recurrence is high, even though the axillary lymph nodes
are negative.

The number of positive lymph nodes is also an

important prognostic factor.

The greater the number of positive lymph nodes, the
higher the risk of recurrence.
The highest risk of recurrence is for breast tumours
with 4 or more positive lymph nodes.

Tumour size
The size of a breast tumour is the second most important prognostic

factor for breast cancer. The tumour size is an independent

prognostic factor, regardless of the lymph node status.
The size of the tumour increases the risk of recurrence. Large breast

tumours (5 cm or greater) have the greatest risk of recurrence.

Breast tumours smaller than 1 cm with no positive lymph nodes

have the most favourable prognosis.

Type of tumour
The type of breast cancer tumour can affect the

prognosis.
For invasive ductal carcinoma, the tubular,
mucinous, medullary and papillary types have a
more favourable prognosis and a better overall
survival than invasive ductal carcinoma, not
otherwise specified (NOS).
Inflammatory breast cancer has a less favourable
prognosis.

Lymphatic and vascular invasion

Cancer cells that have spread from the breast tumour

into the lymphatics or blood vessels in the breast

tissue around the tumour have a greater risk of
recurrence and a less favourable outcome.

Hormone receptor status

Hormone receptor status is a predictor of whether or not a

tumour will respond to hormonal therapy.

Breast tumours that are hormone receptor positive (HR+) are

more likely to respond to hormonal therapy.

Estrogen receptorpositive (ER+) and progesterone receptor

positive (PR+) tumours are often less aggressive, low-grade

tumours that are less likely to spread than tumours that are
hormone receptor negative (HR).

HER2 status
HER2 status is another prognostic factor and may

also be used to predict response to certain therapies.

Tumours that overexpress HER2 (HER2-positive
tumours) tend to be higher grade tumours that are
more likely to spread than tumours that do not
overexpress HER2.
Women with HER2-positive tumours may not
respond well to hormonal therapies like tamoxifen
(Novadex, Tamofen) and are likely to respond well to
trastuzumab (Herceptin).

Tumour recurrence or metastasis after primary treatment:

There are some factors that may affect prognosis of

recurrent breast cancer:

1) length of time from treatment to recurrence
2) type of recurrence
3) type of metastasis

length of time from treatment to recurrence

Women whose cancer comes back more than 5 years

after their diagnosis have a better outcome than

those who have a recurrence less than 2 years after
diagnosis.
The longer period of time a woman is disease-free,
the better the outcome

Type of Recurrence
local recurrence after a lumpectomy and radiation

therapy has a more favourable prognosis than cancer

that recurs in other organs (distant recurrence or
metastases).
A recurrence in the chest wall sometimes indicates a
higher chance of distant metastases, although
sometimes a single recurrence occurs without distant
disease.

Type of Metastasis
Liver, lung or brain metastases have a poorer

outcome than local metastases in the breast, chest

wall or axilla.
Bone metastases have an intermediate prognosis, in

between that of liver, lung and brain metastases and

local or chest wall metastases.

Staging system

TNM - system
Most common
Based on : T extent of the tumor

N extent of spread to the lymph nodes

M presence of metastasis

AJCC Staging System

Stage

0-2

0-1

IIa

2-3

0-1

IIb

0-3

1-2

IIIa

4 or 0-1

1-2

IIIb

Any

IIIc

any

any

IV

Roles and Responsibilities of the Primary Care

Physician After the Diagnosis of Cancer
Be a case manager.
Maintain regular contact.
Be available.
Have knowledge of community resources.
Address ongoing health maintenance needs.
Provide appropriate pain management.
Assess for pathologic depression and other psychiatric

pathology.
Be aware of therapeutic options.
Communicate with and support the patient.

QUESTIONS

:References
American Cancer Society www.cancer.org
American academy of family physician.
Uptodate .
NICE guidelines.
National Cancer Institute http://cancer.gov

THANK YOU