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Ans. is 'a' i.e., Ca breast Prognostic factors of breast carcinoma:* The most important prognostic variables are provided by tumor staging.* The size of the tumor and the status of the axillary lymph nodes provide reasonably accurate information on the likelihood of tumor relapse.* There is rarely justification for adjuvant chemotherapy in most women with tumors <1 cm in size whose axillary lymph nodes are negative. HER2-positive tumors are a potential exception.* Detection of breast cancer cells either in the circulation or bone marrow is associated with an increased relapse rate.* Estrogen and progesterone receptor status are of prognostic significance. Tumors that lack either or both of these receptors are more likely to recur than tumors that have them.* Several measures of tumor growth rate correlate with early relapse. S-phase analysis using flow cytometry is the most accurate measure. Indirect S-phase assessments using antigens associated with the cell cycle, such as PCNA (Ki67), are also valuable.* Tumors with a high proportion (more than the median) of cells in S-phase pose a greater risk of relapse; chemotherapy offers the greatest survival benefit for these tumors.* Assessment of DNA content in the form of ploidy is of modest value, with nondiploid tumors having a somewhat worse prognosis.* Histologic classification of the tumor has also been used as a prognostic factor. Tumors with a poor nuclear grade have a higher risk of recurrence than tumors with a good nuclear grade.* Molecular changes in the tumor are also useful. Tumors that overexpress erbB2 (HER2/neu) or have a mutated p53 gene have a worse prognosis. Tumors that overexpress erbB2 are more likely to respond to higher doses of doxorubicincontaining regimens and predict those tumors that will respond to HER2/neu antibodies (trastuzumab) (herceptin) and HER2/ neu kinase inhibitors.* The presence of more microvessels in a tumor, particularly when localized in socalled hot spots, is associated with a worse prognosis.* Other variables that have also been used to evaluate prognosis include proteins associated with invasiveness, such as type IV collagenase, cathepsin D, plasminogen activator, plasminogen activator receptor, and the metastasissuppressor gene nm23. None of these has been widely accepted as a prognostic variable for therapeutic decision-making. One problem in interpreting these prognostic variables is that most of them have not been examined in a study using a large cohort of patients.
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