Carcinomul mamar: concepte moleculare de structură și patogenie

Abstract

Background: Several pathological and clinical factors are used to categorize patients with breast cancer in order to assess the prognosis and establish the appropriate treatment. These include patient age, lymph node status, tumor size, and some tumor histologic features, such as histologic type, histologic grade, lymphovascular invasion. Unfortunately, these data can’t predict the potential effect of different treatment modalities, especially in breast tumours. In order to personalize the treatment, molecular profiles detecting becomes a necessity. The identification of tumour initiating cancer stem cells and the molecular subtypes seems to have predictive and prognostic information. This approach is based on expression patterns of intrinsic genes and results in breast cancer classification into subgroups with particular biological properties and response to treatment. The molecular subtypes have a different metastatic activity and correlates with tumour recurrence, response to systemic treatment and survival. In addition they are related to different risk factors and differ by geographic distribution. The aim of this article is to highlight modern concepts of breast cancer pathology having clinical implications and prognostic values. Conclusions: In spite of multiple genetic researches, only 3 markers have a predictive power and commonly are used to define the therapeutic tactic. The estrogen and progesterone receptors are predictive markers for endocrine therapy and HER2 is a molecular target for trasutuzumab and lapatinib. These markers are implemented in oncological practice in combination with other receptors, offered as diagnostical guides (as example StGallen) or included in multivariable algorithms aimed to adjust the personalised treatment (as Adjuvant! Online). The acquired results are scattered, due to morphological heterogenity of breast carcinoma, different cellular sources, a quiet complicated molecular structure, and low number of markers approved for diagnostic. Although some schemes of treatment seem to be effective, it is not sufficient potential still to achieve a personalized treatment.