What Is Her2 And What Does It Mean
HER2 is a protein that helps breast cancer cells grow quickly. Breast cancer cells with higher than normal levels of HER2 are called HER2-positive. These cancers tend to grow and spread faster than breast cancers that are HER2-negative, but are much more likely to respond to treatment with drugs that target the HER2 protein.
All invasive breast cancers should be tested for HER2 either on the biopsy sample or when the tumor is removed with surgery.
Complications And Side Consequences
All therapies have some degree of adverse effect, ranging from minor to severe. Most clear up after therapy, but there may be some long-term consequences. Its critical to inform your oncologist about any symptoms, no matter how small they seem. Your healthcare team will collaborate with you to manage side effects and problems.
How Can I Tell If My Treatment Is Working
One way youll know is if your pain starts going away, Brufsky says. Your doctor will also monitor your progress every few months with a variety of assessments, which may include a physical exam, blood tests to check for tumor markers, and imaging tests: X-ray, CT scan, PET scan, or bone scan. The results of these tests, combined with the symptoms you report, will help your cancer team understand whether your treatment is helping to control tumor growth, according to Breastcancer.org.
Treatment is typically continued if its working and your side effects are manageable, but if the treatment is no longer working or the side effects are problematic, your doctor may switch you to a different drug. We expect that just about every treatment we choose will work for a period of time and then likely stop working as the cancer develops resistance, Brufsky says. Fortunately, we have many treatments that are effective with HR-positive/HER-2-negative metastatic breast cancer.
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What Are The Side Effects Of Treatment
Generally, the side effects of hormonal therapies tend to be mild and fairly well tolerated, says Brufsky. The most common side effects are menopausal symptoms , achiness in the joints and bones, and fatigue. AIs can cause some bone loss , but that can typically be well controlled with bone-modifying medications, Brufsky notes. CDK4/6 inhibitors may cause low white blood cell counts as well as some nausea and diarrhea.
What Are Estrogen And Progesterone Receptors
Receptors are proteins in or on cells that can attach to certain substances in the blood. Normal breast cells and some breast cancer cells have receptors that attach to the hormones estrogen and progesterone, and need these hormones for the cells to grow.
Breast cancer cells may have one, both, or none of these receptors.
- ER-positive: Breast cancers that have estrogen receptors are called ER-positive cancers.
- PR-positive: Breast cancers with progesterone receptors are called PR-positive cancers.
- Hormone receptor-positive: If the cancer cell has one or both of the receptors above, the term hormone-receptive positive breast cancer may be used.
- Hormone receptor-negative: If the cancer cell does not have the estrogen or the progesterone receptor, it’s called hormone-receptor negative .
Keeping the hormones estrogen and progesterone from attaching to the receptors can help keep the cancer from growing and spreading. There are drugs that can be used to do this.
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Will I Need Chemotherapy
Typically chemotherapy is a consideration for patients with high-risk breast cancers. Some factors that may indicate the need for chemotherapy are:
- Lymph node involvement.
- Tumors that are higher-grade, ER/PR-negative, HER2-negative or triple-negative .
- Tumors that are HER2-positive.
- Breast cancers in younger patients, especially those below the age of 40.
If you need chemotherapy, it will be given as an outpatient treatment every two to three weeks, delivered either directly into a vein or through a port.
Determining Your Her2 Status
A breast biopsy is used to determine HER2 status. The biopsy can be sent for laboratory testing with an immunohistochemistry test. The fluorescence in situ hybridization test looks for the HER2 gene in breast cancer cells.
The results of an immunohistochemistry test show different levels of HER2 positivity. For example, a tumor may be reported as 0, 1+, 2+, or 3+. Tumors with a higher number may be referred to as having an overexpression of HER2.
According to the American Cancer Society, immunohistochemistry test results should be considered as follows:
The impact of being HER2-positive on breast cancer survival is, of course, a top concern. Unfortunately, statistics can be misleading without considering other aspects of your diagnosis, including cancer stage at diagnosis and whether the tumor is also estrogen and/or progesterone receptor-positive.
With this in mind, you may also be tested for progesterone and estrogen receptors. Triple-negative breast cancers are negative for HER2, estrogen, and progesterone, while triple-positive breast cancers are positive for all three.
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What Does It Mean To Have Her2
When you were diagnosed with breast cancer, the tissue taken during your biopsy was likely tested for several biologic markers. Those results helped your doctor tailor your treatment. If the tissue was diagnosed as HER2-positive, that means that your cancer produced too much of a growth-promoting protein. About 15% of the 268,000 women living in the U.S. diagnosed with breast cancer each year fall into this group.
Hormone Receptor Status And Early Breast Cancer Prognosis
Hormone receptor status is related to the risk of breast cancer recurrence.
Hormone receptor-positive tumors have a slightly lower risk of breast cancer recurrence than hormone receptor-negative tumors in the first 5 years after diagnosis .
After about 5 years, this difference begins to decrease and over time, goes away .
For a summary of research studies on hormone receptor status and survival, visit the Breast Cancer Research Studies section.
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Why Is It Called Triple
Triple-negative breast cancer is when the pathology test shows negative for estrogen receptors , progesterone receptors , and HER2 . These negative results mean that the growth of the cancer is not affected by the hormones estrogen and progesterone, or by the existence of too many HER2 receptors. This means that triple-negative breast cancer does not respond to hormonal therapy such as tamoxifen, or therapies that target HER2 receptors, such as Herceptin.
Triple-negative breast cancer can still be treated with other methods such as surgery, radiotherapy and chemotherapy, and there is a lot of research being carried out to find new medications that can treat this type of cancer.
What Do The Results Mean
If HER2 protein levels are higher than normal or extra copies of the HER2 gene are found, it probably means you have HER2-positive cancer. If your results show normal amounts of HER2 protein or the normal number HER2 genes, you probably have HER2-negative cancer.
If your results were not clearly positive or negative, you will probably get retested, either using a different tumor sample or using a different testing method. Most often, IHC is done first, followed by FISH . IHC testing is less expensive and provides faster results than FISH. But most breast specialists think FISH testing is more accurate.
Treatments for HER2-positive breast cancer can substantially shrink cancerous tumors, with very few side effects. These treatments are not effective in HER2-negative cancers.
If you are being treated for HER2-positive cancer, normal results may mean you are responding to treatment. Results that show higher than normal amounts may mean your treatment is not working, or that cancer has come back after treatment.
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What Is The Risk For Triple
The disease can affect anyone, but is more likely to show up in those who are:
- Younger than age 50 .
- Black or Latinx.
- Living with a genetic condition called BRCA mutation that increases the risk for breast cancer and other forms of cancer. Most cancers diagnosed in people with the BRCA1 mutation are triple negative.
Chemotherapy For Early Tnbc
Early TNBC is treated with chemotherapy. People with TNBC tend to get more treatment benefit from chemotherapy than people with hormone receptor-positive breast cancers do .
Some people get chemotherapy before breast surgery. This is called neoadjuvant chemotherapy.
For people with TNBC who have cancer remaining in their breast after neoadjuvant chemotherapy, treatment with the chemotherapy drug capecitabine may lower the risk of recurrence and improve survival .
Learn more about chemotherapy.
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New Advances In Targeted Therapy Of Her2
- 1Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, China
- 2State Key Laboratory Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, China
How Do I Know If My Breast Cancer Is Her2 Positive Or Her2 Negative
All invasive breast cancers are tested for HER2 levels. This is done in a hospital laboratory on a sample of breast cancer tissue removed during a biopsy or surgery. The results are usually available between one and three weeks later.
There are various tests to measure HER2 levels. IHC is usually done first. It involves a special staining process performed on a sample of breast cancer tissue.
Its reported as a score of 03. A score of 0 or 1+ means the breast cancer is HER2 negative. A score of 2+ is borderline and a score of 3+ means the breast cancer is HER2 positive.
Breast cancers with a borderline result should be retested using more specialised techniques to determine if they are truly HER2 positive or negative.
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Do I Need Genetic Counseling And Testing
Your doctor may recommend that you see a genetic counselor. Thats someone who talks to you about any history of cancer in your family to find out if you have a higher risk for getting breast cancer. For example, people of Ashkenazi Jewish heritage have a higher risk of inherited genetic changes that may cause breast cancers, including triple-negative breast cancer. The counselor may recommend that you get a genetic test.
If you have a higher risk of getting breast cancer, your doctor may talk about ways to manage your risk. You may also have a higher risk of getting other cancers such as ovarian cancer, and your family may have a higher risk. Thats something you would talk with the genetic counselor about.
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What Does Breast Cancer Stage 2 Mean And What Is The Prognosis
Stage 2 breast cancer indicates that cancer has not progressed beyond the breast tissue or adjacent lymph nodes.
Cancer is not a single illness. Breast cancer is one of a larger range of disorders. Because of the variety of kinds, not all stage 2 breast cancers are treated in the same manner. In this post, well look at how breast cancer is diagnosed and treated, as well as the overall prognosis.
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What Happens During A Her2 Breast Cancer Test
Most HER2 testing involves taking a sample of tumor tissue in a procedure called a biopsy. There are three main types of biopsy procedures:
- Fine needle aspiration biopsy, which uses a very thin needle to remove a sample of breast cells or fluid
- Core needle biopsy, which uses a larger needle to remove a sample
- Surgical biopsy, which removes a sample in a minor, outpatient procedure
Fine needle aspiration and core needle biopsies usually include the following steps:
- You will lay on your side or sit on an exam table.
- A health care provider will clean the biopsy site and inject it with an anesthetic so you won’t feel any pain during the procedure.
- Once the area is numb, the provider will insert either a fine aspiration needle or core biopsy needle into the biopsy site and remove a sample of tissue or fluid.
- You may feel a little pressure when the sample is withdrawn.
- Pressure will be applied to the biopsy site until the bleeding stops.
- Your provider will apply a sterile bandage at the biopsy site.
In a surgical biopsy, a surgeon will make a small cut in your skin to remove all or part of a breast lump. A surgical biopsy is sometimes done if the lump can’t be reached with a needle biopsy. Surgical biopsies usually include the following steps.
What Exactly Is Stage 2 Breast Cancer
Your doctor will assign a clinical-stage to your cancer diagnosis when it is initially verified that you have breast cancer. This is known as clinical staging, and it is based on:
- a physical examination
- imaging examinations
- results of a biopsy
Laboratory test findings on the tissue and lymph nodes will be able to offer additional information if surgery is performed to evaluate the breast tissue. Your doctor will be able to establish the pathologic stage, or surgical stage, of cancer-based on these data. This is more precise than a clinical stage.
The TNM method is used in breast cancer staging, and it offers particular information about:
- T: The tumors size is denoted by the letter T
- N: involvement of lymph nodes
- M: how far has the cancer spread?
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Dna Damage Response Inhibitors
DNA damage response detecting and repairing damaged genes through a variety of ways is a vital protective mechanism to maintain genome stability and prevent breast cancer. DNA single-strand break is mainly repaired by three ways: base excision repair , nucleotide excision repair , and mismatch-repair , and the more serious DNA double-strand break is repaired through two additional pathways: homogeneous recombination and non-homologous end joining .
HR is an error-free repair process, depending on the availability of homologous DNA templates and mainly playing a role in the G2/M phase of the cell cycle. Although NHEJ is more error-prone compared to HR, it is considered to be the main way of DSB repair and works in all phases of the cell cycle .
Mutations in the DDR gene occur in all kinds of breast cancer. Deletion or mutation of BRCA1/2 is present in 10% of patients . DNA dependent protein kinase catalytic subunit , a member of the phosphatidyl inositol-3-kinase-like kinase family that is involved in NHEJ and maintains the structural stability of telomeres, is down-regulated in 57% of early breast cancer cases . In TNBC, BRCA, nonâBRCA HR, and nonâHR DDR genes have mutations , and quite a few proteins involved in DDR including PARP-1 are overexpressed .
A large number of studies have represented that DDR targeted drugs have the potential to treat breast cancer. As shown in Figure 2, an overview of the DNA damage response and repair pathways is detailed below.
Is It Better To Be Hr Positive Or Negative
What is the survival rate for HR positive breast cancers? The survival rate for breast cancers are excellent if the cancer is detected early, and in general HR positive cancers grow slower and have a better prognosis. Overall, breast cancers that are both HR positive and HER2 negative have the best outcomes.
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Breast Cancer Cell Lines
Part of the current knowledge on breast carcinomas is based on in vivo and in vitro studies performed with cell lines derived from breast cancers. These provide an unlimited source of homogenous self-replicating material, free of contaminating stromal cells, and often easily cultured in simple standard media. The first breast cancer cell line described, BT-20, was established in 1958. Since then, and despite sustained work in this area, the number of permanent lines obtained has been strikingly low . Indeed, attempts to culture breast cancer cell lines from primary tumors have been largely unsuccessful. This poor efficiency was often due to technical difficulties associated with the extraction of viable tumor cells from their surrounding stroma. Most of the available breast cancer cell lines issued from metastatic tumors, mainly from pleural effusions. Effusions provided generally large numbers of dissociated, viable tumor cells with little or no contamination by fibroblasts and other tumor stroma cells.Many of the currently used BCC lines were established in the late 1970s. A very few of them, namely MCF-7, T-47D, MDA-MB-231 and SK-BR-3, account for more than two-thirds of all abstracts reporting studies on mentioned breast cancer cell lines, as concluded from a Medline-based survey.
Will I Need Surgery And What Kind Should I Have
This is an important question but the answer may be less than definitive. It will vary from patient to patient and you may have more than one choice.
According to the American Cancer Society, most women with breast cancer have some type of surgery. But some breast cancers cant initially be surgically removed. In other cases, whether to operate and the type of surgery may depend on the cancers stage, the tumors size and location, the size of your breast and your personal preference.
In women whose breast cancers are operable, the choices are breast-conserving surgery or mastectomy. Mastectomy is the removal of most or all breast tissue and possibly nearby lymph nodes. Within each of those two broad categories are further options. Talk with your oncologist and breast surgeon. If you have any doubts, you may choose to seek a second opinion.
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