入院時主要症狀及體征：
患者雙側乳房外型正常。右側乳房外上象限可及腺葉內一腫塊，圓狀，約2X1CM大小，觸診有輕壓痛，腫塊邊界不清，質硬，活動度差，於皮膚無粘連，右側腋下未及明顯腫大淋巴結。左側乳房未及腫塊，左側腋下未及腫塊。

特殊檢驗及主要會診：
右乳乳腺癌，浸潤為主型，浸潤性導管癌II級，癌周浸潤III級，淋巴管侵犯(-)，血管累犯(-)，神經累犯(-)。酶標：腫瘤細胞 ER(-)， PR(-)， PCNA(+++)， K1-67 30%+，P53(+)， CerbB-2(-)。右乳房根治標本，乳頭，殘腔，基底部未見腫瘤累犯，癌旁病變：慢性乳腺病，腋區淋巴結18隻未見癌轉移。

病程與治療結果：
患者入院後完善各項輔檢，於2008。09。12在全麻下行右乳癌改良根治+冰凍，術後患者安返病房，並抗炎，補液，營養支持治療。無合並症。

出院時情況：
一般情況可。

出院後用藥及建議：
門診隨訪，擇期化療。

治療結果：
治愈。
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請問：

1。 從以上的報告看，我媽的總體情況怎樣？發現的還算早嗎？我媽本來心情還好，但是被報告中的“浸潤性導管癌II級，癌周浸潤III級”嚇到了。我上網了解了一些，關於前者的分級還是有很多解釋的，我媽的情況算是II級中的早期吧。但是所說的“癌周浸潤III級”，就沒有很多解釋。這是怎麽分級的呢？III級很嚴重嗎？

2。ER和PR到底是陽性好呢還是陰性好呢？好像有種激素治療隻適合ER和PR陽性的病人，是嗎？我還看到有的文章提到，ER和PR陰性是高複發的一個特征，這是真的嗎？

3。我媽是不是應該用適合腋淋巴結陰性的化療方案呢？那到底哪種化療的組合反應相對較小呢？CMF，AC/EC， CAF/CEF， TC？她準備國慶長假以後就回醫院開始第一次的化療。

謝謝大家。

ANSWER:
Just get a short time, let me answer some of the questions:

The pathology report missed one important info: the size of tumor (clinically 2 cm, but pathologic size more accurate).Usually margin status should be mentioned, though with mastectomy it is not as important because they should be negative for small tumors.

 Your mom's breast cancer is called triple negative breast cancer (ER, PR and Her-2/neu negative; if you want to search online, you could look at this specific type); this is an aggressive type of cancer, but her is in early stage. High levels of PCNA, and KI-67 are consistent with the aggressive nature of her disease. A lot of triple negative breast cancers have p53 mutation, it is not surprising to see that her p53 was positive which also makes her tumor more aggressive as well.

 Though aggressive, but still early stage, the cure rate is still very high. She does benefit from chemotherapy. Because she has modified radical mastectomy and tumor is small, radiation is not needed. Adequate number of lymph nodes were dissected, which gives us confidence that her lymph nodes are indeed negative. Chemotherapy is usaully AC+taxol in this country (if not this type of cancer, taxol may not be needed if nodes are negative). Some use dose dense chemo (shorter interval between doses), which may be more effective in her case. Currently there is trend to treat with TC omitting adriamycin due to cardiac toxicity, people say it is equally effective.

 Good luck with your mom's treatment.  

  By stonypoint