Define or describe the “receptor testing”.
Refers to the determination of receptor overexpression in breast cancer biopsy samples
Receptor status is crucial in the development of treatment strategies because tumors with overexpression can be targeted directly with hormone therapy or biologics
Estrogen and progesterone receptors are present on all breast tissue cells. However, in cancerous breast tissue, overexpression of such receptors may be detected, in which case the breast cancer is referred to as receptor-positive.
Describe the expression types of breast cancer.
Analysis involves immunohistochemical staining.
80% of breast cancers are positive for overexpression of at least one hormone receptor:
∼ 75% of breast cancers are estrogen receptor-positive (ER-positive).
∼ 65% of breast cancers are progesterone receptor-positive (PR-positive).
∼ 65% of breast cancers are positive for both receptors.
∼ 20% of breast cancers are negative for both receptors.
Distribution of hormone receptor status in breast cancer (table).
What is the HER2/neu testing?
An epidermal growth factor receptor with intracellular tyrosine-kinase activity that promotes cell growth and differentiation and inhibits apoptosis.
∼ 20% of breast cancers are HER2-positive.
Analysis involves immunohistochemical staining for HER2/neu and, in some cases, FISH.
HER2-positive breast cancer can be treated with therapeutic receptor inhibition, which can help to slow cancerous growth and decrease cancer mass
HER2 overexpression is associated with…?
HER2 overexpression is associated with increased risk of recurrence and poorer prognosis compared to hormone receptor-positive breast cancer.
Describe “triple-negative breast cancer”.
∼ 10–15% of breast cancers are hormone receptor-negative and HER2-negative.
Most commonly seen in African American women
Typically more aggressive, high-grade tumors
Treated with chemotherapy
Breast cancer subtypes (picture).
List 3 important tumor markers for breast cancer.
CEA
CA 15-3
CA 27-29
Can tumor markers be used to detect breast cancer?
Tumor markers can not be used to detect breast cancer because they lack sensitivity and specificity.
In newly diagnosed breast cancer, however, they can be used for monitoring therapeutic success (e.g., the response to systemic therapy or success of surgical tumor removal).
What is meant by “lymph node status”?
includes axillary, infraclavicular, and supraclavicular lymph nodes
assessed via physical examination, ultrasonography, and/or CT scan.
What are clinically suspicious lymph nodes?
Nontender, firm, immobile, size > 1 cm
Require workup with CNB prior to surgical management
How are lymph nodes that appear normal assessed?
assessed during surgery (sentinel lymph node biopsy)
Describe the workup of distant metastasis.
Imaging usually involves the following:
Chest x-ray
CT of the chest, abdomen, and pelvis
MRI of the brain
Individuals with advanced disease or inflammatory breast cancer should undergo a full body PET-CT or a bone scan with CT (chest, abdomen, and pelvis).
Laboratory results may show ↑ ESR, ↑ ALP, and/or ↑ calcium.
Describe the workup and findings of bone metastasis.
Contrast-enhanced MRI
In patients with localized bone pain or ↑ ALP
Classically shows mixed lytic and blastic lesions in the vertebrae (most common site), pelvic bone, and/or long bones
If MRI detects a metastatic lesion, a bone scan should be performed to identify additional occult lesions.
Describe the workup and findings of liver metastasis.
Abdominal CT showing metastatic lesions and/or ascites
Describe the workup and findings of lung metastasis.
Chest x-ray or chest CT
Usually multiple lesions
Mostly unilateral pleural effusion
Thoracocentesis in cases of pleural effusion to detect malignant cells in the fluid
Describe the workup and findings of brain metastasis.
MRI with contrast shows well-circumscribed tumors at the junction of gray and white matter and/or watershed areas of the arterial system.
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