tnm scale ca mammae

8/11/2019 TNM Scale CA Mammae

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TNM

T (Tumor size), ukuran tumor :

T 0 : tidak ditemukan tumor primer

T 1 : ukuran tumor diameter 2 cm atau kurangT 2 : ukuran tumor diameter antara 2-5 cm

T 3 : ukuran tumor diameter > 5 cm

T 4 : ukuran tumor berapa saja, tetapi sudah ada penyebaran ke kulit atau dinding dada atau padakeduanya , dapat berupa borok, edema atau bengkak, kulit payudara kemerahan atau ada

benjolan kecil di kulit di luar tumor utama

N (Node), kelenjar getah bening regional (kgb) :

N 0 : tidak terdapat metastasis pada kgb regional di ketiak / aksillaN 1 : ada metastasis ke kgb aksilla yang masih dapat digerakkan

N 2 : ada metastasis ke kgb aksilla yang sulit digerakkanN 3 : ada metastasis ke kgb di atas tulang selangka (supraclavicula) atau pada kgb di mammaryinterna di dekat tulang sternum

M (Metastasis) , penyebaran jauh :

M x : metastasis jauh belum dapat dinilaiM 0 : tidak terdapat metastasis jauh

M 1 : terdapat metastasis jauh

STADIUM

Setelah masing-masing faktor T,.N,M didapatkan, ketiga faktor tersebut kemudian digabung dandidapatkan stadium kanker sebagai berikut :

Stadium 0 : T0 N0 M0Stadium 1 : T1 N0 M0

Stadium II A : T0 N1 M0 / T1 N1 M0 / T2 N0 M0

Stadium II B : T2 N1 M0 / T3 N0 M0Stadium III A : T0 N2 M0 / T1 N2 M0 / T2 N2 M0 / T3 N1 M0 / T2 N2 M0

Stadium III B : T4 N0 M0 / T4 N1 M0 / T4 N2 M0

Stadium III C : Tiap T N3 M0

Stadium IV : Tiap T-Tiap N -M1

PROGNOSIS

Stadium klinis dari kanker payudara merupakan indikator terbaik untuk menentukan prognosis

penyakit ini.Angka kelangsungan hidup 5 tahun pada penderita kanker payudara yang telah menjalani

pengobatan yang sesuai mendekati:


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- 95% untuk stadium 0

- 88% untuk stadium I

- 66% untuk stadium II- 36% untuk stadium III

- 7% untuk stadium IV.

PENANGANAN

Dalam banyak kasus, dokter akan bekerjasama dengan pasien untuk menentukan rencanapengobatan meskipun pengobatan tiap pasien akan di sesuaikan oleh dokter.

Tapi berikut adalah langkah-langkah umum yang dilakukan dalam pengobatan kanker payudara :

1. Tujuan utama pengobatan kanker stadium awal adalah mengangkat tumor dan membersihkan

jaringan disekitar tumor.Jadi dokter akan merekomendasikan operasi untuk mengangkat tumor. Umumnya kemudian

akan dilakukan terapi radiasi pada jaringan payudara yang masih ada.Untuk keadaan tertentu ( misalnya, pasien dengan problem medis yang serius ) radiasi bisa jadiditunda.

2. Tahapan berikut dalam menangani kanker stadium awal adalah mengurangi resiko kankerakan kambuh dan membuang sel kanker yang masih ada.

Bila tumornya lebar atau saluran kelenjar getah bening telah terserang kanker juga, dokter akan

merekomendasikan terapi tambahan, antara lain : Terapi Radiasi, Chemotherapy, dan atauhormone terapi.

3. Sedang untuk kanker yang kambuh lagi, diperlakukan dengan bermacam-macam cara. Ketika

merencanakan pengobatan, dokter akan mempertimbangkan beberapa faktor :* Stadium dan grade kanker

* Satus tumor hormone receptor (ER, PR) dan status HER2/neu* Umur pasien dan kesehatannya secara umum

* Pasien sudah menopause atau belum

* Adanya mutasi dari gen kanker payudara Kondisi biologi kanker payudara memberi efek pada

tingkah laku kankernya dan pengobatannya. Beberapa tumor ukurannya kecil tapi tumbuhnyacepat atau ukurannya besar tapi tumbuhnya lambat.


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Early, locally advanced and secondary breast cancer

Early breast cancermeans the cancer has not spread beyond the breast or the lymph nodes in

the armpit on the same side of the body. So, the cancer has not spread to any other part of thebody.

Local recurrencemeans cancer that has come back in the area of the breast after treatment.

Locally advanced breast cancermeans the cancer has not spread to another part of the body butmay be

Bigger than 5 cm across

Growing into the skin or muscle of the chest

Present in the lymph nodes in the armpit, and these lymph nodes are either stuck to each

other, or to other structures

Secondary breast canceris also called metastatic breast cancer orstage 4 breast cancer.Itmeans that the cancer has spread to other parts of the body, such as the liver or bones.

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What staging is

The stage of a cancer looks at how big the cancer is and whether it has spread. The tests andscans you have when diagnosing your cancer give some information about the stage.

The stage is important because it helps your breast cancer specialist to decide on the besttreatment for you. Specialists usually make decisions about treatment for breast cancer according

to the TNM stage and thegradeof the cancer.

TMN staging takes into account the size of the tumour (T), whether the cancer has spread to the

lymph glands(lymph nodes) (N), and whether the tumour has spread anywhere else in the body

(Mfor metastases).

Doctors also sometimes usethe number system of staging.

Below is a slightly simplified description of the TNM staging system for breast cancer.

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The T stages (tumour)

TXmeans that the tumour size cannot be assessed
http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/number-stages-of-breast-cancer#4http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/number-stages-of-breast-cancer#4http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/number-stages-of-breast-cancer#4http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#pagehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#pagehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/about/the-breasts-and-lymphatic-system#nodeshttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/about/the-breasts-and-lymphatic-system#nodeshttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/ssLINK/number-stages-of-breast-cancerhttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/ssLINK/number-stages-of-breast-cancerhttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/ssLINK/number-stages-of-breast-cancerhttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#pagehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#pagehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#pagehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/ssLINK/number-stages-of-breast-cancerhttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/about/the-breasts-and-lymphatic-system#nodeshttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#pagehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/number-stages-of-breast-cancer#4


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Tis meansDCIS

T1The tumour is 2 centimetres (cm) across or less

T1 is further divided into 4 groups

T1mithe tumour is 0.1cm across or less

T1athe tumour is more than 0.1 cm but not more than 0.5 cm

T1bthe tumour is more than 0.5 cm but not more than 1 cm

T1cthe tumour is more than 1 cm but not more than 2 cm

ancer type>Breast cancer>Breast cancer treatment> TNM breast cancer staging

Breast cancer About breast cancer

Diagnosing breast cancer

Breast cancer treatment

o TNM stages

o Number stages

o Outlook and stats

o Treatment types

o Surgery

o Lymphoedema

o

Radiotherapyo Chemotherapy

o Hormone therapy

o Biological therapy

o Follow up

o Research

o If it comes back

o What to ask

Living with breast cancer

Secondary breast cancer

About this information

Organisations Reading list

Breast cancer clinical trials

Breast cancer questions and answers
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pe/breast-cancer/breast-cancer-reading-listhttp://www.cancerresearchuk.org/cancer-help/trials/search-results/?cancertype=157%2320%23Breast%20cancer&AdvancedSearchFormType=research_and_trials_adv_search_form&stillrecruiting=Open&TrialSearchBox=truehttp://www.cancerresearchuk.org/cancer-help/trials/search-results/?cancertype=157%2320%23Breast%20cancer&AdvancedSearchFormType=research_and_trials_adv_search_form&stillrecruiting=Open&TrialSearchBox=truehttp://www.cancerresearchuk.org/cancer-help/about-cancer/cancer-questions/search-results/?cancertype=121%2320%23Breast%20cancer&AdvancedSearchFormType=qanda_cancer_type_subject_search_form&QandASearchBox=truehttp://www.cancerresearchuk.org/cancer-help/about-cancer/cancer-questions/search-results/?cancertype=121%2320%23Breast%20cancer&AdvancedSearchFormType=qanda_cancer_type_subject_search_form&QandASearchBox=truehttp://www.cancerresearchuk.org/cancer-help/about-cancer/cancer-questions/search-results/?cancertype=121%2320%23Breast%20cancer&AdvancedSearchFormType=qanda_cancer_type_subject_search_form&QandASearchBox=truehttp://www.cancerresearchuk.org/cancer-help/trials/search-results/?cancertype=157%2320%23Breast%20cancer&AdvancedSearchFormType=research_and_trials_adv_search_form&stillrecruiting=Open&TrialSearchBox=truehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/breast-cancer-reading-listhttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/breast-cancer-organisationshttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/where-this-breast-cancer-information-comes-fromhttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/secondary/http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/living/http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/what-to-ask-your-doctor-about-breast-cancer-treatmenthttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/if-your-cancer-comes-back-after-treatmenthttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/research/http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/breast-cancer-follow-uphttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/biological-therapy-for-breast-cancerhttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/hormone/http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/chemotherapy/http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/radiotherapy/http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/lymphoedema-after-breast-cancer-treatmenthttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/surgery/http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/which-treatment-for-breast-cancerhttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/statistics-and-outlook-for-breast-cancerhttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/number-stages-of-breast-cancerhttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staginghttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/diagnosis/http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/about/http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/http://www.cancerresearchuk.org/cancer-help/type/http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/ssLINK/dcis-ductal-carcinoma-in-situ


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T3The tumour is bigger than 5 centimetres across

T4is divided into 4 groups

T4aThe tumour has spread into thechest wall

T4bThe tumour has spread into the skin and the breast may be swollen

T4cThe tumour has spread to both the skin and the chest wall

T4dInflammatory carcinomathis is a cancer in which the overlying skin is red, swollen and

painful to the touch

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The N stages (nodes)

NXmeans that the lymph nodes cannot be assessed (for example, if they were previouslyremoved)

N0

No cancer cells found in any nearby nodes

Isolated tumour cells (ITCs) are small clusters of cancer cells less than 0.2 mm across, or asingle tumour cell, or a cluster of fewer than 200 cells in one area of a lymph node. Lymph nodes

containing only isolated tumour cells are not counted as positive lymph nodes

N1Cancer cells are in the upper levels of lymph nodes in the armpit but the nodes are not stuck

to surrounding tissues

pN1miOne or more lymph nodes contain areas of cancer cells called micrometastases that are

larger than 0.2mm orcontain more than 200 cancer cells but are less than 2mm

N2is divided into 2 groups

N2athere are cancer cells in the lymph nodes in the armpit, which are stuck to each other and

to other structures

N2bthere are cancer cells in the lymph nodes behind the breast bone (the internal mammary

nodes), which have either been seen on a scan or felt by the doctor. There is no evidence of

cancer in lymph nodes in the armpit
http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/ssLINK/chest-wallhttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/ssLINK/chest-wallhttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/ssLINK/chest-wallhttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#pagehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#pagehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#pagehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/ssLINK/chest-wall


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N3is divided into 3 groups

N3athere are cancer cells in lymph nodes below the collarbone

N3bthere are cancer cells in lymph nodes in the armpit and behind the breast bone

N3cthere are cancer cells in lymph nodes above the collarbone

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The M stages (metastases)

M0means that there is no sign of cancer spread

cMo(i+) means there is no sign of the cancer on physical examination, scans or X-rays butcancer cells are present in blood, bone marrow, or lymph nodes far away from the breast cancer

the cells are found by laboratory tests

M1means the cancer has spread to another part of the body

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How TNM fits together

Your doctor puts the TNM results together to give you your overall stage. This is usually whatthe doctor writes on your test forms. So, for example, you might see a tumour described as T2

N0 M0. This would be

A single tumour 2.1 to 5 cm across

No evidence of spread to any lymph nodes

No evidence of spread outside the breast

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Using staging to predict outcome
http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#pagehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#pagehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#pagehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#pagehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#pagehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#pagehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#pagehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#pagehttp://www.cancerresearchuk.org/cancer-help/type/breast-cancer/treatment/tnm-breast-cancer-staging#page


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Putting the staging information into a formula called the Nottingham Prognostic Indicator (NPI)

can give some idea of how well treatment may work for an individual person with breast cancer.

The NPI can also give some idea of how long a person may live. You can read more abouttheNottingham Prognostic Index (NPI)in this section.

Doctors often also use computer programs such as Adjuvant! Online, which use staginginformation as well as combined results of clinical trials, to help them decide which treatments

may work best for individual people.
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