What are the prognostic indicators that affect breast cancer? The prognosis of breast cancer is influenced by many factors, including the type of pathology, grade, stage, ER, PR, HER2 and Ki67 expression status. In clinical practice, doctors need to consider all these factors to make a judgment on the prognosis of patients. Xue Yan, Department of Oncology, Xijing Hospital ① Pathological type: Generally speaking, the prognosis of non-invasive carcinoma (ductal carcinoma in situ and lobular carcinoma in situ) is significantly better than that of invasive carcinoma, and the types of invasive carcinoma with good prognosis include duct-like carcinoma, sieve-like carcinoma and mucinous-like adenocarcinoma. ② Grading: Pathologically, breast cancer is divided into 3 grades: grade I, grade II and grade III. Grade I is often highly differentiated, suggesting low malignancy; grade II is moderately differentiated, with moderate malignancy, and grade III is often poorly differentiated, with high malignancy. ③ Staging: Breast cancer is divided into stages I, II, III and IV. Generally speaking, stage I-IIIA is localized early breast cancer with good prognosis; stage IIIB-IIIC is localized advanced breast cancer with poor prognosis; stage IV is advanced breast cancer with poor prognosis. ④ Molecular expression: ER, PR, HER2 and Ki67 are very important molecules that not only determine the prognosis but also are closely related to the treatment. For example, ER+ and/or PR+ indicates that the tumor is related to the hormone level in the body and is suitable for endocrine therapy, while HER2+ (immunohistochemistry ++ or FISH+) indicates that the development of breast cancer is related to HER2 oncogene and requires anti-HER2 therapy. Ki67 is an indicator of tumor growth ability, and the higher the value, the stronger the tumor growth ability and therefore the worse the prognosis. In clinical work, doctors will combine many factors to determine the prognosis and then give patients the most appropriate treatment plan. Who needs post-operative chemotherapy, radiotherapy and endocrine therapy? In general, chemotherapy is required for large tumors, positive lymph nodes, HER2+ or triple negative breast cancer. Patients with positive lymph nodes, tumors >5cm, positive margins or less than standard width, and those who underwent breast-conserving surgery need to receive post-operative radiation therapy. Endocrine therapy is mainly indicated for patients who are ER+ and/or PR+. What are the common adverse effects of breast cancer treatment and how to prevent them? ① Nausea and vomiting: you can take some medications for nausea, eat small and frequent meals, eat slowly, and listen to some relaxing and soothing music during meals to distract your attention. ② Infection: wash hands frequently, pay attention to dietary hygiene, eat cooked food as much as possible; avoid contact with sick people, monitor body temperature, detect infection early, and do not go to crowded places. ③ Diarrhea or constipation: drink more water or eat a liquid diet, eat some easily digestible food, such as noodles, porridge, steamed buns, etc.; for constipation, eat more high-fiber foods, fruits, vegetables and coarse grains. ④ Hair loss: Cut hair short, reduce the pull on hair when combing, wear a hat, wig or headband. When fixing your hair, be gentle and do not use hair dye, hairspray or perms. ⑤ Mouth ulcers: Brush your teeth after meals and use a soft-bristled toothbrush; rinse your mouth with warm salt water (half a tablespoon of salt in a cup of water) after brushing, do not use mouthwash containing alcohol, and when the pain is severe, contain some crushed ice to reduce the pain. (6) Anemia and fatigue: Don’t force yourself to do things, combine work and rest, and exercise properly; get enough sleep, take a hot bath or listen to some relaxing, pleasant and soothing music before going to bed, which is good for relieving fatigue. (7) Bleeding: avoid contact with sharp or pointed objects, do not participate in activities or sports that may cause physical collision; do not pick your nose, and apply some oil or ointment when the nasal cavity is dry. For itching and burning sensation, use aloe vera oil, or 1% hydrocortisone ointment; if these areas are particularly red, itchy, painful and have a burning sensation, your doctor will prescribe If these areas are particularly red, itchy, painful and burning, your doctor will prescribe a cream with a higher steroid content. What should I do when recovering from breast cancer? ① Diet: A balanced and nutritious diet. During the interval between chemotherapy and radiotherapy or before surgery, you should make an effort to eat and replenish nutrition. The diet should be easy to digest, light, colorful and flavorful. Drink more water or juice to replenish the loss of body fluid caused by vomiting and diarrhea; eat more high-quality protein, such as yogurt, eggs, fish, chicken, lean meat, etc. After the treatment, you can choose some foods that are beneficial to the prevention and treatment of breast cancer, such as seaweed, sea cucumber and soybean products. Pay attention to balanced nutrition and do not overdo it. Excessive nutrition and obesity are not good for breast cancer recovery. Diet should be low-fat diet, with more fresh vegetables and fruits and high-quality protein. ②Life: Live a regular life, get up and down on time, arrange daily activities and do some work that you can do, which can distract your attention and kill time. Appropriate to participate in some outdoor activities, the beautiful scenery of nature can make people feel relaxed, lift the depression in the heart, appropriate activities such as walking can help restore physical strength. ③ Sleep: Good sleep is good for restoring strength and energy and relieving fatigue. Before going to bed, take a hot bath, read some relaxing books, listen to some soothing music, and do not drink coffee or tea before going to bed. ④ Mood: When you are depressed, talk to your family and friends more often. Playing tai chi, practicing yoga, watching movies, listening to beautiful music or participating in some group activities such as painting classes and tea classes can make patients forget their worries temporarily. Join the anti-cancer association to share with cancer patients the experience of fighting against the disease and to increase the confidence of overcoming cancer. You can express your inner feelings and pain by writing a diary. After cancer, some people will become depressed, have low self-esteem and are reluctant to contact and communicate with others, hiding their fear and dread deep inside, which can only intensify the pain and sorrow, and in serious cases, will turn into depression. If you really can’t get rid of this feeling, please see a doctor, antidepressants may help. ⑤ Follow up: Keep track of any side effects and medication taken during treatment to understand changes in your condition. Follow your doctor’s instructions strictly for medication and regular review.