入院时主要症状及体征：
患者双侧乳房外型正常。右侧乳房外上象限可及腺叶内一肿块，圆状，约2X1CM大小，触诊有轻压痛，肿块边界不清，质硬，活动度差，于皮肤无粘连，右侧腋下未及明显肿大淋巴结。左侧乳房未及肿块，左侧腋下未及肿块。

特殊检验及主要会诊：
右乳乳腺癌，浸润为主型，浸润性导管癌II级，癌周浸润III级，淋巴管侵犯(-)，血管累犯(-)，神经累犯(-)。酶标：肿瘤细胞 ER(-)， PR(-)， PCNA(+++)， K1-67 30%+，P53(+)， CerbB-2(-)。右乳房根治标本，乳头，残腔，基底部未见肿瘤累犯，癌旁病变：慢性乳腺病，腋区淋巴结18只未见癌转移。

病程与治疗结果：
患者入院后完善各项辅检，于2008。09。12在全麻下行右乳癌改良根治+冰冻，术后患者安返病房，并抗炎，补液，营养支持治疗。无合并症。

出院时情况：
一般情况可。

出院后用药及建议：
门诊随访，择期化疗。

治疗结果：
治愈。
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请问：

1。 从以上的报告看，我妈的总体情况怎样？发现的还算早吗？我妈本来心情还好，但是被报告中的“浸润性导管癌II级，癌周浸润III级”吓到了。我上网了解了一些，关于前者的分级还是有很多解释的，我妈的情况算是II级中的早期吧。但是所说的“癌周浸润III级”，就没有很多解释。这是怎么分级的呢？III级很严重吗？

2。ER和PR到底是阳性好呢还是阴性好呢？好像有种激素治疗只适合ER和PR阳性的病人，是吗？我还看到有的文章提到，ER和PR阴性是高复发的一个特征，这是真的吗？

3。我妈是不是应该用适合腋淋巴结阴性的化疗方案呢？那到底哪种化疗的组合反应相对较小呢？CMF，AC/EC， CAF/CEF， TC？她准备国庆长假以后就回医院开始第一次的化疗。

谢谢大家。

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