1.What information do breast cancer patients need to prepare when they visit the clinic?
First, pathological information, such as pathology report and biopsy, preferably unstained white biopsy or paraffin tissue block, for review of hormone receptor and HER-2 expression, as well as Ki-67 expression level; second, information about staging, such as imaging examination; third, information about assessment of overall organ function of the patient, such as heart function, liver and kidney function, etc. The fourth is the previous treatment experience, such as drug regimen, treatment effect, etc.
2.Why must pathological examination be performed? What pathological information must patients bring to the clinic?
The diagnosis of breast cancer requires pathological results, including information about molecular typing. The choice of treatment plan for breast cancer is based on the risk of recurrence. Previously, this information was based on age, menopause, number of lymph node metastases, HER-2 expression status, and the size of the Bell Willow mass; however, in recent years, it has been found that this information is not sufficient. It is now believed that hormonal expression status, such as positive or negative ER and PR, whether HER-2 is overexpressed, and Ki-67 (high or low nuclear proliferation index), which are molecular staging indicators, are of great importance in determining the risk of recurrence of breast cancer. Based on these features, breast cancers are classified as.
(1) Luminal A (ER/PR positive, HER-2 negative, Ki-67 low expression, less than 14%).
(2) Luminal B (HER-2 negative type: ER/PR positive, HER-2 negative, high Ki-67 expression, >14%)
(3) Luminal B (HER-2-positive type): ER/PR positive, HER-2 overexpressed, Ki-67 arbitrary.
(4) HER-2-positive type: ER/PR negative, HER-2 overexpression, Ki-67 arbitrary.
(5) Triple-negative breast cancer: ER/PR negative, HER-2 negative, Ki-67 arbitrary.
Based on these characteristics, the protocol can be developed to circumvent inappropriate over- or under-treatment to a greater extent. Of course, other indicators such as the presence of lymphatic vessels or nerve infiltration, whether the mass is large, and whether it is staged too late and has distant metastases are also referred to as features.
There are many ways to obtain pathology, such as obtaining pathology specimens by surgical resection, or by ultrasound or CT-guided puncture of the metastatic or primary lesion, and possibly by lymph node dissection biopsy. The first recommended route to obtain pathology is a less invasive test, such as a puncture.
Patients should always bring a previous pathology report with them when they visit the clinic. For cases where the local diagnosis is less clear or doubtful, it is better to borrow the slides from the pathology department of the local hospital.
3.What are the main examination data for clarifying the breast cancer staging?
The main purpose of breast cancer staging is to understand the extent of tumor lesions, the organs involved, the presence of intracranial metastases, the presence of bone metastases, and the involvement of lymph nodes. Different staging will directly affect the best treatment option.
For early stage breast cancer, the doctor will recommend surgical excision and then decide whether adjuvant treatment is needed based on the postoperative pathology. For patients with locally advanced or locally progressive stage, neoadjuvant chemotherapy or neoadjuvant endocrine therapy is mostly recommended first to obtain downstaging surgery or breast-conserving surgery. It is worth stating that breast cancer is a curable disease, therefore, it is important to seize the opportunity to strive for early or create conditions to obtain a cured treatment effect.
The information to determine the tumor stage is mainly the imaging findings, including enhanced chest and abdomen CT, bone scan, brain MRI, etc.
Is PET-CT necessary? PET-CT is a functional imaging and is not necessary for breast cancer, except as a differential measure when there are abnormal imaging features with uncertainty of important organs. Moreover, it has certain disadvantages: firstly, it is more expensive and not reimbursed by medical insurance; secondly, it does not show very well for very small tumor lesions, or well differentiated tumors, and it can also show false positive results in cases of trauma, chronic inflammation, etc.
Therefore, for breast cancer staging, the most important examinations are enhanced chest and abdomen CT, bone scan and brain MRI, while the indications for PET-CT examination need to be strictly controlled.
4.What tests can be used to assess the function of organs of breast cancer patients?
Before treatment, doctors need to evaluate the overall organ function of the patient to see if there are any other concomitant diseases, for example, whether the patient has had heart surgery, whether there is diabetes, hypertension, whether the kidney function is normal, and whether the patient is infected with hepatitis B virus, and so on. In general, a more comprehensive assessment of overall organ function can be made through blood sampling, electrocardiogram, ultrasound and other examinations.
5.For patients who have been treated locally, what information do I need to bring about the treatment history?
Many patients have already been treated locally before coming to me, so it is best to give a brief description of the past. This is because the later treatment is based on the previous treatment, and if the doctor does not know the past treatment history, he or she will not be able to develop an appropriate treatment plan.
In general, the patient needs to briefly describe the following: what treatment regimen has been used, what medications have been used, how many cycles of treatment, any evaluation after treatment, and what the results were.
The evaluation after the application of a certain treatment plan is a rather important thing. After treatment, patients will undergo appropriate tests, such as CT, blood tests, etc., which can reflect the real situation of the treatment at that time and provide guidance and suggestions for further treatment. Some patients, who may doubt the accuracy of the local hospital’s examination, discard the local hospital’s examination information, which is a big no-no.
Therefore, some examination data during the treatment are very precious and patients must keep them. When you go to the doctor again, you must bring these data.
6.Does the patient need to sort out the information when he/she visits the hospital in order to facilitate the doctor’s visit?
Some patients will hold a large pile of information when they visit the doctor, without categorizing and organizing it. Some may even take the daily checkout sheets from previous hospitalizations, and some of the drugs on the checkout sheets are trade names. Because of the many drug manufacturers, the doctor may not even be able to quickly understand which drug the patient is specifically applying.
When this happens, the doctor has to spend a lot of time organizing the information for the patient and looking for the patient’s previous treatment experience from a large pile of information. After that, the doctor can sort out the ideas to communicate the follow-up treatment plan to the patient.
However, some patients will sort out the treatment process in chronological order, and some even make a curve of the tests so that the doctor can see it at a glance. In this case, the doctor will soon be able to fully understand his previous treatment process and current physical condition, and will then have more time to communicate with the patient about future treatment.
Therefore, it is advisable for patients to have their previous information sorted when they visit the clinic. This is done in accordance with the four aspects of pathology, staging, systemic organ function, and past treatment as mentioned above.