In breast carcinoma metastasis, prognosis depends best upon -

Ans is 'a' i.e., Estrogen receptor status In case of metastasis, the prognosis no more depends upon the lymph node status. The lymph node status is the most impoant prognostic indicator for tumor localized to breast, as the presence of nodal metastasis implies systemic dissemination of cancer and hence a bad prognosis. But once a metastasis is discovered, the lymph node status is of little significance. Metastatic disease confers the breast tumor TNM stage IV status, with worst prognosis. Currently stage IV diseases are not curative. Schwaz 9/e writes - "Treatment for stage IV breast cancer is not curative, but may prolong survival and enhance a women's quality of life. Hormonal therapies that are associated with minimal toxicity are preferred to cytotoxic chemotherapy. Appropriate candidates for initial hormonal therapy include women with hormone receptor-positive cancers; women with bone or soft tissue metastasis only; and women with limited and asymptomatic visceral metastasis. About hormone receptors, CSDT 11/e, p 329 writes - "the presence or absence of estrogen and progesterone receptors in the cytoplasm of tumor cells is of paramount impoance in managing all patients with breast cancer, especially those with recurrent or metastatic disease. They are of proved value in determining adjuvant therapy and therapy for patients with advanced disease. Upto 60% of patients with metastatic breast cancer will respond to hormonal manipulation if their tumors contain estrogen receptors. However fewer than 5% of patients with metastatic ER-negative tumors can be successfully treated with hormonal manipulation."