This refers to breast cancer found in its early and treatable stages , namely stage 1&2. It is promising to know that majority of breast cancer patients present in this stage in Singapore This implies that the breast tumour is less than 5cm in diametres and that spread to the axillary lymph nodes is either minimal to nil.
Since 2018 staging of breast cancer became a bit more complex and includes the following biological information of cancer besides the size of tumour and lymph node involvement.
- Grade of tumour. This refers to how aggressive the tumour is. There are 3 different grades of breast cancer.
- Estrogen and Progesterone receptor score. Determines if the cancer cells have receptors for the hormones estrogen and progesterone.
- Her 2 Neu status. Determines if the cancer cells are overproducing the Her 2 Neu protein.
- Oncotype Dx score. This score can be determined sometimes in cancers that are estrogen and progesterone receptor-positive and Her 2 Neu negative and spread to 3 or less lymph nodes.
The above classification allows for different treatment regimes with the same tumour size. For example, a patient with a 2cm tumour with estrogen, progesterone receptors positive, and Her 2 Neu negative is unlikely to be treated with chemotherapy. On the other hand, another patient with a 2cm tumour with estrogen receptor, progesterone receptors, and Her 2 Neu negative ( triple-negative) will require aggressive chemotherapy.
Hence the management of breast cancers is varied in different individuals notwithstanding other patient factors which are important to arrive at a final treatment plan.
Each breast cancer patient will be managed not just by Dr Radhika Lakshmanan (surgeon) but also by her colleagues, the medical and radiation oncologists who discuss and come to a final optimal treatment plan.