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Difference between revisions of "Invasive breast cancer"
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→Standard work-up: add table
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Ref.: <ref>PBoD NEED PAGE No.</ref> | Ref.: <ref>PBoD NEED PAGE No.</ref> | ||
==Standard work-up== | ==Standard IHC work-up== | ||
===Overview=== | |||
*Immunostaining of any sentinel lymph nodes - to look for isolated tumour cells and small lymph node mets. | *Immunostaining of any sentinel lymph nodes - to look for isolated tumour cells and small lymph node mets. | ||
**Sunnybrook uses ''CAM5.2''. | **Sunnybrook uses ''CAM5.2''. | ||
*ER (estrogen receptor) | *ER (estrogen receptor). | ||
** | **Positive in most breast cancers; +ve in ~75-80%.<ref>Lester. 2nd Ed. PP.241-2.</ref> | ||
*PR (progesterone receptor). | |||
**Positive in most breast cancers; +ve in ~65-70%.<ref>Lester. 2nd Ed. PP.241-2.</ref> | |||
*HER2/neu. | *HER2/neu. | ||
**Positivity | **Usually negative; -ve in 70-80%.<ref>Lester. 2nd Ed. PP.241-2.</ref> | ||
** | **Positivity association with a worse prognosis. | ||
===ER & PR scoring<ref>Lester. 2nd Ed. PP.241-2.</ref>=== | |||
*Give a percentage, i.e. 0-100%. | |||
**Important cut points: 1% and 10%. | |||
***0% = negative - not treated. | |||
***<10% = low positivity - treated. | |||
===HER2 scoring<ref>Lester. 2nd Ed. PP.241-2.</ref>=== | |||
{| class="wikitable" | |||
| '''Score''' | |||
| '''Staining intensity''' | |||
| '''Cells stained (%)''' | |||
| '''Membrane staining''' | |||
| '''Management''' | |||
| '''Percentage of cases''' | |||
|- | |||
| '''0''' | |||
| nil | |||
| <10% | |||
| incomplete | |||
| No HER2 blocker | |||
| ~60% | |||
|- | |||
| '''1+''' | |||
| minimum | |||
| >10% | |||
| incomplete | |||
| No HER2 blocker | |||
| ~10% | |||
|- | |||
| '''2+''' | |||
| weak | |||
| >10% | |||
| complete | |||
| Needs SISH | |||
| ~10% | |||
|- | |||
| '''3+''' | |||
| strong | |||
| >10% | |||
| complete | |||
| HER2 blocker | |||
| ~20% | |||
|} | |||
===Clinical=== | |||
*ER & PR status determine whether a patient will get tamoxifen or other estrogen modulators. | |||
*HER2 status determines whether patient will get traztuzumab (Herceptin) or other HER2/neu modulators. | |||
==Characteristics of the subtypes== | ==Characteristics of the subtypes== | ||