BREASTCANCER

Canc
eri
sanab
nor
mal
ormal
ignantgr
owt
hor
igi
nat
ingi
nanyep
ithel
ialt
iss
ueoft
he
b
odyc
har
act
eri
zedb
yrap
idi
nvas
iont
otheot
herp
artoft
heb
ody
.

Ther
ear
esomec
ommonr
epr
oduc
tiv
ecanc
ers
.Theor
ganswhi
char
ecommonl
yaf
fec
ted
i
nor
deroff
requenc
yar
e:

I
nWomen:Canc
eroft
heb
reas
t,c
erv
ix,ut
eri
nec
orp
us,ov
ari
es,v
ulv
aandv
agi
na.

I
nMen:Canc
eroft
hep
ros
tat
ewhi
chi
sver
ycommon,wher
eas
,tes
tic
ularc
anc
eri
s
v
eryr
are.Mos
ttumoroft
hegeni
tal
trac
tisc
anc
erouswi
tht
heexc
ept
ionoff
ibr
oid
s,
s
imp
leov
ari
anc
yst
,fi
bro-ad
enomaandb
eni
gnp
ros
tat
ehy
per
trop
hy.

Annual
lyov
er700,
000womend
ieasar
esul
tifb
reas
tcanc
er,c
erv
icalc
anc
er,ov
ari
an
c
anc
er,andend
omet
rialc
anc
er(
WHOes
timat
ion)
,wher
eas
,pr
ost
atec
anc
erac
count
s
f
ort
hed
eat
hof200,
000menannual
ly
.

 Ov
erv
iewofBr
eas
tCanc
er

Br
eas
tcanc
eri
sanunc
ont
rol
lab
legr
owt
hoft
heb
reas
tcel
ls
.Thec
annc
erb
egi
nswhen
heal
thyc
ell
sint
heb
reas
tchangeandgr
owoutofc
ont
rol
,for
mingamas
sors
heetof
c
ell
scal
ledat
umor
.At
umorc
anb
ecanc
erousorb
eni
gn.Ac
anc
eroust
umori
s
mal
ignant
,meani
ngi
tcangr
owands
preadt
oot
herp
art
soft
heb
ody
.Ab
eni
gnt
umor
meanst
het
umorc
angr
owb
utwi
llnots
pread
.Its
tar
tsi
nthet
iss
ueoft
heb
reas
tand
i
ncr
eas
esab
nor
mal
lyandi
nvad
est
hes
urr
ound
ingt
iss
ues
,ther
efor
egai
ningac
ces
sto
t
hel
ymp
hnod
esandb
loodv
ess
elswhi
chc
arr
ythemt
oot
herar
easoft
heb
ody
.Br
eas
t
c
anc
ers
pread
swhent
hec
anc
ergr
owsi
ntoot
herp
art
soft
heb
odyorwhenb
reas
t
c
anc
erc
ell
smov
etoot
herp
art
soft
heb
odyt
hrought
heb
loodv
ess
elsand
/orl
ymp
h
v
ess
els
.Thi
sisc
all
edmet
ast
asi
s.Theear
ly-s
tageandl
ocal
lyad
vanc
edb
reas
tcanc
er
i
ncl
udess
tagesI
,II
,andI
II.Thes
tageofb
reas
tcanc
erd
esc
rib
eswher
ethec
anc
eri
s
l
ocat
ed,howmuc
hthec
anc
erhasgr
own,andi
forwher
eithass
pread
.

Al
thoughb
reas
tcanc
ermos
tcommonl
ysp
read
stonear
byl
ymp
hnod
es,i
tcanal
so
s
preadf
urt
hert
hrought
heb
odyt
oar
eass
uchast
heb
ones
,lungs
,li
ver
,andb
rai
n.
Thi
sisc
all
edmet
ast
ati
cors
tageI
Vbr
eas
tcanc
er.

I
fbr
eas
tcanc
erc
omesb
ackaf
teri
nit
ial
treat
ment
,itc
anr
ecurl
ocal
ly
,meani
ngi
nthe
b
reas
tand
/orr
egi
onall
ymp
hnod
es.I
tcanal
sor
ecurel
sewher
eint
heb
ody
,cal
leda
d
ist
antr
ecur
renc
eormet
ast
ati
crec
urr
enc
e.

 I
nci
denc
e/Pr
eval
enc
e

Br
eas
tcanc
eri
sthemos
tcommonandt
hewor
stmal
ignantgr
owt
handt
hel
ead
ing
c
aus
eofd
eat
hfr
omc
anc
eri
nwomen.I
tcaus
esd
eat
h3t
imesmor
efr
equent
lyt
han
c
anc
eroft
hec
erv
ix.I
taf
fec
tswomenofager
ange15–50y
ear
s.I
tal
soac
count
sfor
ab
out9%ofal
lcanc
ersandi
srat
edast
hemos
tcommonc
anc
ersaf
fec
tingwomen
wor
ldwi
de.Gl
obal
lymor
ethanonemi
ll
ionnewc
asesofb
reas
tcanc
ersar
edi
agnos
ed
y
ear
ly–t
hisac
count
sforab 5thoft
out1/ hees
timat
edf
emal
eannual
canc
erd
iagnos
is.

Br
eas
tcanc
erhasal
sob
eenr
epor
tedast
hemos
tcommonmal
ignanc
yaf
fec
ting
Ni
ger
ianwomen.I
nther
ecentt
imesr
epor
thass
hownani
mpr
ovementi
nthef
ive-
y
ears
urv
ivalr
atesof50%f
oral
ldi
agnos
edc
asesofb
reas
tcanc
ert
o90%,10–y
ear
s
urv
ivalr
atef
orwomenwi
thl
ocal
izedc
anc
erhasi
mpr
ovedt
o99%.Thi
simp
rov
ementi
s
at
tri
but
edt
oimp
rov
edknowl
edgeab
outp
rev
ent
ion,ear
lyd
etec
tionandav
ail
abi
li
tyof
v
ari
oust
reat
mentop
tions
.

Des
pit
ethep
rogr
essi
nthet
reat
ment
,br
eas
tcanc
erc
ont
inuest
obeoneoft
hemos
t
f
ear
edofal
ldi
seas
eaf
fec
tingwomen.

 Pat
hop
hys
iol
ogyofBr
eas
tcanc
er

Li
keal
lcanc
ers
,br
eas
tcanc
erd
evel
opsd
uet
odef
ect
s(mut
ati
ons
)int
hegenet
ic
mat
eri
alDe-oxy
rib
onuc
lei
cAc
id(
DNA)ofas
ingl
ecel
l.

Res
ear
chhass
hownt
hat5-10%ofb
reas
tcanc
erc
asesar
eas
soc
iat
edwi
thmut
ati
onor
d
efec
tsi
nthet
wogenesknownasBr
eas
tCanc
erAs
soc
iat
ed(
BCRA)genes
,theBCRA1
andBCRA2.Thes
egenesf
unc
tionnor
mal
lyt
opr
eventab
nor
malc
ellf
ormat
ionor
gr
owt
hthatc
oul
dleadt
ocanc
er,b
utwhent
her
ear
emut
ati
onsoft
hes
egenes
,the
c
ell
sbec
omec
anc
erous
.Damaget
otheDNAandgenet
icmut
ati
onsc
anl
eadt
obr
eas
t
c
anc
er.Exp
eri
ment
all
y,b
reas
tcanc
erhasb
eenl
inkedt
oes
trogenexp
osur
e.Some
i
ndi
vid
ual
sinher
itd
efec
tsi
ntheDNAandgenesl
iket
heBRCA1,BRCA2andTP53among
ot
her
s.Tmhos
ewi
thf
ami
lyhi
stor
yofov
ari
anandb
reas
tcanc
erar
eatani
ncr
eas
ed
r
iskofb
reas
tcanc
er.

Thei
mmunes
yst
emnor
mal
lys
eeksoutb
reas
tcanc
erc
ell
sandc
ell
swi
thd
amagedDNA
andd
est
roy
sthem.Br
eas
tcanc
ermayb
ear
esul
toff
ail
ureofs
uchanef
fec
tiv
e
i
mmuned
efens
eands
urv
eil
lanc
e.

 Ty
pesofb
reas
tcanc
er

Br
eas
tcanc
erc
anei
therb
einv
asi
veornoni
nvas
ive.I
nvas
iveb
reas
tcanc
eri
scanc
er
t
hats
pread
sint
osur
round
ingt
iss
ues
.Noni
nvas
iveb
reas
tcanc
erd
oesnotgob
eyond
t
hemi
lkd
uct
sorl
obul
esi
ntheb
reas
t.Mos
tbr
eas
tcanc
erss
tar
tint
hed
uct
sorl
obes
andar
ecal
ledd
uct
alc
arc
inomaorl
obul
arc
arc
inoma.

Ther
ear
efourd
iff
erentt
ypesofb
reas
tcanc
er,t
woofnon-i
nvas
iveandt
woi
nvas
ive
b
reas
tcanc
ers
:
Twot
ypesofnon-i
nvas
iveb
reas
tcanc
er:

1)Duc
talc
arc
inomai
nsi
tu(
DCI
S):Thi
scanc
ers
tar
tsi
nthec
ell
sli
ningt
hemi
lkd
uct
s
andmakeupt
hemaj
ori
tyofb
reas
tcanc
ers
.Iti
sloc
atedonl
yint
hed
uct
s.

2)Lob
ularc
arc
inomai
nsi
tu(
LCI
S):LCI
Sisc
anc
ert
hator
igi
nat
esi
nthel
obul
eand
l
ocat
edonl
yint
hel
obul
es.LCI
Sisnotc
ons
ider
edc
anc
er.Howev
er,LCI
Sisar
isk
f
act
orf
ord
evel
opi
ngi
nvas
iveb
reas
tcanc
eri
nbot
hbr
eas
ts.

Thes
etwot
ypesofnon-i
nvas
ived
onoti
nvad
etheb
asementmemb
raneoft
heb
reas
t.
Ast
hei
rnamess
ugges
t,d
uct
alc
arc
inomai
nsi
tuc
anc
erc
ell
sar
efoundi
nthel
obul
es.
Al
so,t
her
ear
etwot
ypesofi
nvas
iveb
reas
tcanc
er:

3)I
nvas
iveori
nfi
lt
rat
ingd
uct
alc
arc
inoma:Thi
sisc
anc
ert
hathass
preadout
sid
eof
 t
hed
uct
.Ast
hei
rnamess
ugges
t,i
nfi
lt
rat
ingd
uct
alc
arc
inomap
enet
rat
ethewal
l
oft
hed
uctandt
rav
elst
oar
easout
sid
eofi
t.I
nfi
lt
rat
ingd
uct
alc
arc
inomai
sthe
mos
tcommont
ypeofb
reas
tcanc
erac
count
ingf
orb
etween70%-80%oft
hec
ases
ofb
reas
tcanc
er.

4)I
nfi
lt
rat
ingLob
ularc
arc
inoma:Wher
eas
,inf
il
trat
ingl
obul
arc
arc
inomas
pread
s
t
hrought
hewal
loft
hel
obul
eandal
sot
rav
elst
oar
easout
sid
eofi
t.

Les
scommont
ypesofb
reas
tcanc
eri
ncl
ude:

1.Med
ull
aryCar
cinoma:t
hisf
ormsar
ound15%ofal
lbr
eas
tcanc
ers
.Itaf
fec
tsmi
ddl
e
agedwomenmor
ecommonl
yandt
hec
ell
ularhi
stol
ogyr
esemb
lest
hemed
ull
a(gr
ey
mat
ter
)oft
heb
rai
n.I
tor
igi
nat
esi
nthec
ent
ralb
reas
tti
ssue.

2.Tub
ularc
arc
inoma:t
hec
anc
erc
ell
sap
pearl
iket
inyt
ubul
es.Thi
sty
peofb
reas
t
c
anc
eri
sty
pic
all
yfoundi
nwomenb
etweenage50andab
ove.Thi
stumorr
esp
ond
s
wel
ltot
reat
mentandi
tisus
ual
lyund
etec
tab
leb
ypal
pat
ion.
3.Muc
inousc
arc
inomaorc
oll
oid
:Thi
sisar
aret
ypeofi
nvas
iveb
reas
tcanc
er.That
r
arel
ysp
read
stot
hel
ymp
hnod
es.Thec
anc
erc
ell
spr
oduc
emuc
usandt
hes
ecel
ls
ar
edi
sti
nctf
romnor
malc
ell
sund
erami
cros
cop
e.Themuc
usandc
anc
erc
ell
s
c
omb
inet
ofor
mjel
ly
-li
ket
umor
.Itus
ual
lyoc
cur
sinp
ost
-menop
aus
alwomen.
4.I
nfl
ammat
oryb
reas
tcanc
er:t
hisi
sar
areb
utaggr
ess
ivet
ypeofb
reas
tcanc
er,i
s
af
ast
er-gr
owi
ngt
ypeofc
anc
ert
hatac
count
sforab
out1%t
o5%ofal
lbr
eas
t
c
anc
ers
.Thec
anc
erl
ead
stob
loc
kageoft
hel
ymp
hves
sel
sint
hes
kinoft
heb
reas
t.
Thec
anc
erap
pear
stoc
overt
heb
reas
tov
eral
argear
eal
ikeas
heetr
athert
hana
l
ump
.Theb
reas
tap
pear
sswol
len,r
ed,andi
nfl
amed
.Br
eas
tti
ssuei
swar
mand
ap
pear
sred
,tendt
osp
readqui
ckl
y.

5.Paget
’sd
iseas
e:i
sat
ypeofc
anc
ert
hatb
egi
nsi
nthed
uct
soft
heni
ppl
e.Al
though
i
tisus
ual
lyi
nsi
tu,i
tcanal
sob
eani
nvas
ivec
anc
er.Thi
slead
stoec
zema-l
ike
c
hangei
nthes
kinoft
heni
ppl
e.Ther
eisi
tchi
nes
s,s
cal
ingandoozi
ngd
isc
har
ge
f
romt
heni
ppl
e.90%ofwomenwhoexp
eri
enc
ethes
esy
mpt
omshav
eanund
erl
ying
b
reas
tcanc
er.Paget
’sd
iseas
ecanoc
curatanyageb
utwi
llmor
eli
kel
yoc
curi
n
womenwhoar
eint
hei
r50s
.
6.Tr
ipl
enegat
iveb
reas
tcanc
er:t
hisi
sab
reas
tcanc
ert
hati
snegat
ivef
ores
trogen
r
ecep
tor(
ER)
,pr
oges
ter
oner
ecep
tor(
PR)
,andHumanep
ider
malgr
owt
hrec
ept
or
I
I/neup
rot
ein(
HER2)
.

 Di
agnos
isofBr
eas
tCanc
er
Ther
ear
esev
eralt
est
stof
ind
,ord
iagnos
ebr
eas
tcanc
er;t
her
ear
eal
somanyt
est
sto
l
ear
nift
hec
anc
erhass
preadt
oap
artoft
heb
odyot
hert
hant
heb
reas
tandt
hel
ymp
h
nod
esund
ert
hear
m.Al
sot
her
ear
etes
tst
olear
nwhi
cht
reat
ment
scoul
dwor
kbes
t.
Thef
oll
owi
ngf
act
orsmayb
econs
ider
edwhenc
hoos
ingad
iagnos
tict
est
:
-Thet
ypeofc
anc
ers
usp
ect
ed
-Thes
ignsands
ymp
toms
-Theageandgener
alheal
th
-Ther
esul
tsofear
li
ermed
icalt
est
s
Thes
eri
esoft
est
sneed
edt
oev
aluat
eap
oss
ibl
ebr
eas
tcanc
erus
ual
lyb
egi
nswhena
womanoraheal
thc
aregi
verd
isc
overamas
sorab
nor
malc
alc
ifi
cat
ionsonas
creeni
ng
mammogr
am,oral
umpornod
ulei
nthewoman’
sbr
eas
tdur
ingac
li
nic
alors
elf
-
exami
nat
ion.Les
scommonl
y,awomanmi
ghtnot
icear
edors
wol
lenb
reas
toramas
sor
nod
uleund
ert
hear
m.
Thef
oll
owi
ngt
est
smayb
eus
edt
odi
agnos
ebr
eas
tcanc
erorf
orf
oll
ow-upt
est
ing
af
terab
reas
tcanc
erd
iagnos
is.

1)I
magi
ngt
est
s
I
magi
ngt
est
sshowp
ict
uresoft
hei
nsi
deoft
heb
ody
.Thef
oll
owi
ngi
magi
ngt
est
sof
t
heb
reas
tmayb
edonet
olear
nmor
eab
outas
usp
ici
ousar
eaf
oundi
ntheb
reas
tdur
ing
s
creeni
ng.I
nad
dit
iont
othes
e,t
her
ear
eot
hernewert
ypesoft
est
sthatar
ebei
ng
s
tud
ied
.
a)Di
agnos
ticmammogr
aphy
:Di
agnos
ticmammogr
aphyi
ssi
mil
art
osc
reeni
ng
mammogr
aphyexc
eptt
hatmor
epi
ctur
esoft
heb
reas
tar
etaken.I
tisof
tenus
edwhen
awomani
sexp
eri
enc
ings
igns
,suc
hasanewl
umporni
ppl
edi
schar
ge.Di
agnos
tic
mammogr
aphymayal
sob
eus
edi
fsomet
hings
usp
ici
ousi
sfoundonas
creeni
ng
mammogr
am.
b
)Ul
tras
ound
:Anul
tras
oundus
ess
oundwav
est
ocr
eat
eap
ict
ureoft
heb
reas
tti
ssue.
Anul
tras
oundc
and
ist
ingui
shb
etweenas
oli
dmas
s,whi
chmayb
ecanc
er,andaf
lui
d-
f
il
ledc
yst
,whi
chi
sus
ual
lynotc
anc
er.
c
)MRI
:AnMRIus
esmagnet
icf
iel
ds,notx-r
ays
,top
rod
uced
etai
ledi
magesoft
heb
ody
.
As
pec
iald
yec
all
edac
ont
ras
tmed
iumi
sgi
venb
efor
ethes
cant
ohel
pcr
eat
eac
lear
p
ict
ureoft
hep
oss
ibl
ecanc
er.Thi
sdy
eisi
njec
tedi
ntoap
ati
ent
’sv
ein.Ab
reas
tMRI
mayb
eus
edaf
terawomanhasb
eend
iagnos
edwi
thc
anc
ert
ochec
ktheot
herb
reas
t
f
orc
anc
erort
ofi
ndouthowmuc
hthed
iseas
ehasgr
ownt
hroughoutt
heb
reas
t.
Br
eas
tMRIi
sal
soas
creeni
ngop
tion,al
ongwi
thmammogr
aphy
,fors
omewomenwi
tha
v
eryhi
ghr
iskofd
evel
opi
ngb
reas
tcanc
er

2)Bi
ops
y
Formos
tty
pesofc
anc
er,ab
iop
syi
stheonl
ysur
ewayt
oknowi
fanar
eaoft
heb
ody
hasc
anc
er.I
nab
iop
sy,as
mal
lsamp
leoft
iss
uei
stakenf
ort
est
ingi
nal
abor
ator
y.I
t
i
sther
emov
alofas
mal
lamountoft
iss
uef
orexami
nat
ionund
erami
cros
cop
e.Ot
her
t
est
scans
ugges
tthatc
anc
eri
spr
esent
,butonl
yab
iop
syc
anmakead
efi
nit
e
d
iagnos
is.Ap
athol
ogi
stt
henanal
yzest
hes
amp
le(
s).Ap
athol
ogi
sti
sad
oct
orwho
s
pec
ial
izesi
nint
erp
ret
ingl
abor
ator
ytes
tsandev
aluat
ingc
ell
s,t
iss
ues
,andor
ganst
o
d
iagnos
edi
seas
e.Ther
ear
edi
ffer
entt
ypesofb
iop
sies
,cl
ass
ifi
edb
ythet
echni
que
and
/ors
izeofneed
leus
edt
ocol
lec
tthet
iss
ues
amp
le.
a)Fi
neneed
leas
pir
ati
onb
iop
sy:Thi
sty
peofb
iop
syus
esat
hinneed
let
oremov
eas
mal
l
s
amp
leofc
ell
s.
b
)Cor
eneed
leb
iop
sy:Thi
sty
peus
esawi
derneed
let
oremov
eal
argers
amp
leoft
iss
ue.
Thi
sisus
ual
lyp
ref
err
edb
iop
syt
echni
quef
orf
ind
ingoutwhet
heranab
nor
mal
it
yona
p
hys
icalexami
nat
ionorani
magi
ngt
esti
scanc
er.I
tisus
ual
lyd
oneund
erl
ocal
anes
thes
ia,whi
chi
sus
edt
oles
senap
ati
ent
’sd
isc
omf
ortd
uri
ngt
hep
roc
edur
e.
c
)Sur
gic
alb
iop
sy:Thi
sty
per
emov
est
hel
arges
tamountoft
iss
ue.Bec
aus
esur
ger
yis
b
estd
oneaf
terac
anc
erd
iagnos
ishasb
eenmad
e,as
urgi
calb
iop
syi
sus
ual
lynott
he
r
ecommend
edwayt
odi
agnos
ebr
eas
tcanc
er.Mos
tof
ten,non-s
urgi
calc
oreneed
le
b
iop
siesar
erec
ommend
edt
odi
agnos
ebr
eas
tcanc
er.
d
)Image-gui
dedb
iop
sy:Dur
ingt
hisp
roc
edur
e,aneed
lei
sgui
dedt
othel
ocat
ionwi
th
t
hehel
pofani
magi
ngt
echni
que,s
uchasmammogr
aphy
,ul
tras
ound
,orMRI
.A
s
ter
eot
act
icb
iop
syi
sdoneus
ingmammogr
aphyt
ohel
pgui
det
heneed
le.As
mal
lmet
al
c
li
pisus
ual
lyp
uti
ntot
heb
reas
ttomar
kwher
etheb
iop
sys
amp
lewast
aken,i
ncas
e
t
het
iss
uei
scanc
erousandmor
esur
ger
yisneed
ed.Thi
scl
ipi
sus
ual
lyt
itani
ums
oitwi
ll
notc
aus
epr
obl
emswi
thf
utur
eimagi
ngt
est
s.Ani
mage-gui
dedb
iop
syc
anb
edone
us
ingaf
ineneed
le,c
ore,orv
acuum-as
sis
tedb
iop
sy,d
epend
ingont
heamountoft
iss
ue
b
eingr
emov
ed.I
magi
ngt
est
smayal
sob
eus
edt
ofi
ndt
heb
estp
lac
etot
akeab
iop
sy
s
amp
leofal
umpt
hatc
anb
efel
t.
e)Sent
inell
ymp
hnod
ebi
ops
y:Thi
spr
oced
urei
sawayt
ofi
ndouti
fther
eisc
anc
eri
n
t
hel
ymp
hnod
esneart
heb
reas
t.
NOTE:Wes
hal
lknowmor
eab
outs
ent
inel
lymp
hnod
ebi
ops
yund
erd
iff
erentt
ypesof
Tr
eat
mentl
ater
.

3)Tes
tsf
ort
het
umors
amp
let
ofi
ndouti
fthec
anc
eri
s:
Hor
moner
ecep
tor
-pos
iti
ve:Br
eas
tcanc
ersexp
res
singes
trogenr
ecep
tor
s(ER)and
/or
p
roges
ter
oner
ecep
tor
s(PR)ar
ecal
led“
hor
moner
ecep
tor
-pos
iti
ve.
”Thes
erec
ept
ors
ar
epr
otei
nsf
oundi
nandonc
ell
s.Tumor
sthathav
ees
trogenr
ecep
tor
sar
ecal
led“
ER-
p
osi
tiv
e.”Tumor
sthathav
epr
oges
ter
oner
ecep
tor
sar
ecal
led“
PR-p
osi
ti
ve.
”Onl
y1of
t
hes
erec
ept
orsneed
stob
epos
iti
vef
orac
anc
ert
obec
all
edhor
moner
ecep
torp
osi
ti
ve.
Thi
sty
peofc
anc
ermayd
ependont
hehor
moneses
trogenand
/orp
roges
ter
onet
ogr
ow.
Hor
moner
ecep
tor
-pos
iti
vec
anc
ersc
anoc
curatanyage,b
utmayb
emor
efr
equenti
n
womenwhohav
egonet
hroughmenop
aus
e.Ab
out60%t
o75%ofb
reas
tcanc
ershav
e
es
trogenand
/orp
roges
ter
oner
ecep
tor
s.Canc
erswi
thoutt
hes
erec
ept
orsar
ecal
led
“
hor
moner
ecep
tor
-negat
ive.
”
i
.Es
trogenRec
ept
orandPr
oges
ter
oneRec
ept
orTes
t:Tes
tingf
orERandPRhel
ps
d
eter
mineb
otht
hep
ati
ent
’sr
iskofr
ecur
renc
eandt
het
ypeoft
reat
mentt
hati
smos
t
l
ikel
ytol
owert
her
iskofr
ecur
renc
e.ERandPRar
eof
tenmeas
uredf
orDCI
Saswel
l.
Gener
all
y,hor
monal
ther
apywor
kswel
lforER-p
osi
ti
veand
/orPR-p
osi
ti
vec
anc
ers
.
HER2-p
osi
tiv
e:Ab
out20%t
o25%ofb
reas
tcanc
ersd
ependont
hegenec
all
edhuman
ep
ider
malgr
owt
hfac
torr
ecep
tor2(HER2)t
ogr
ow.Thes
ecanc
ersar
ecal
led“
HER2-
p
osi
tiv
e”andhav
eexc
ess
ivenumb
ersofHER2r
ecep
tor
sorc
opi
esoft
heHER2gene.
TheHER2genemakesap
rot
eint
hati
sfoundont
hec
anc
erc
ellandi
simp
ort
antf
or
t
umorc
ellgr
owt
h.Thi
sty
peofc
anc
ermaygr
owmor
equi
ckl
y.HER2-p
osi
ti
vec
anc
ers
c
anb
eei
therhor
moner
ecep
tor
-pos
iti
veorhor
moner
ecep
tor
-negat
ive.Canc
erst
hat
d
onotexp
res
sHER2ar
ecal
led“
HER2-negat
ive.
”
i
i.HumanEp
ider
malGr
owt
hRec
ept
or2(
HER2)
:TheHER2s
tat
ushel
psd
eter
mine
whet
herd
rugst
hatt
argett
heHER2r
ecep
tor
,suc
hast
ras
tuzumab(
Her
cep
tin,
Her
zuma,Ogi
vri
,Ont
ruzant
),mi
ghthel
ptr
eatt
hec
anc
er.Thi
stes
tisonl
ydoneon
i
nvas
ivec
anc
ers
.Ift
hec
anc
erhass
preadt
oanot
herp
artoft
heb
odyorc
omesb
ack
(
rec
urr
enc
e)af
tert
reat
ment
,tes
tings
houl
dbed
oneagai
nont
henewt
umororar
eas
wher
ethec
anc
erhass
pread
,es
pec
ial
lyi
fres
ult
swoul
dinf
luenc
ethet
reat
ment
op
tions
.
HER2t
est
sar
eus
ual
lyc
lear
lyp
osi
tiv
eornegat
ive,meani
ngt
hatt
hec
anc
erhasei
ther
ahi
ghorl
owl
evelofHER2.I
fthet
estr
esul
tsar
enotc
lear
lyp
osi
ti
veornegat
ive,
t
est
ingmayneedt
obed
oneagai
n,ei
theronad
iff
erentt
umors
amp
leorwi
tha
d
iff
erentt
est
.Somet
imes
,ev
enwi
thr
epeat
edt
est
ing,t
her
esul
tsmaynotb
e
c
onc
lus
ives
othep
ati
entandt
heonc
ologi
stwi
llhav
etod
isc
usst
heb
estt
reat
ment
op
tion.
I
fthec
anc
eri
sHER2p
osi
tiv
e,HER2-t
arget
edt
her
apymayb
ear
ecommend
ed
t
reat
mentop
tionf
ors
uchp
ati
ent
.Ift
hec
anc
eri
sHER2negat
ive,HER2-t
arget
ed
t
her
apyi
snotat
reat
mentop
tionf
ort
hep
ati
ent
,soot
herop
tionsf
ort
reat
ingt
he
b
reas
tcanc
ermayb
egi
ven.
Tr
ipl
e-negat
ive:I
fat
umord
oesnotexp
res
sER,PR,and
/orHER2,t
het
umori
scal
led
“
tri
ple-negat
ive.
”Tr
ipl
e-negat
iveb
reas
tcanc
ermakesupab
out15%ofi
nvas
iveb
reas
t
c
anc
ers
.Tr
ipl
e-negat
iveb
reas
tcanc
ers
eemst
obemor
ecommonamongy
ounger
women,p
art
icul
arl
yyoungerb
lac
kwomen.Tr
ipl
e-negat
ivec
anc
eri
sal
somor
ecommon
i
nwomenwi
thamut
ati
oni
ntheb
reas
tcanc
erBRCA1andBRCA2genes
.Exp
ert
s
r
ecommendt
hatal
lpeop
lewi
tht
rip
le-negat
iveb
reas
tcanc
erb
etes
tedf
orBRCAgene
mut
ati
ons
.

4)Gr
ade:Thet
umorgr
adei
sal
sod
eter
minedf
romab
iop
sy.Gr
ader
efer
stohow
d
iff
erentt
hec
anc
erc
ell
slookf
romheal
thyc
ell
sandwhet
hert
heyap
pears
lower
gr
owi
ngorf
ast
ergr
owi
ng.I
fthec
anc
erl
ookss
imi
lart
oheal
thyt
iss
ueandhas
d
iff
erentc
ellgr
oup
ings
,iti
scal
led"
wel
ldi
ffer
ent
iat
ed"ora"
low-gr
adet
umor
."I
fthe
c
anc
eroust
iss
uel
ooksv
eryd
iff
erentf
romheal
thyt
iss
ue,i
tisc
all
ed"
poor
ly
d
iff
erent
iat
ed"ora"
high-gr
adet
umor
."
Ther
ear
e3gr
ades
:gr
ade1(
wel
ldi
ffer
ent
iat
ed)
,gr
ade2(
mod
erat
elyd
iff
erent
iat
ed)
,
andgr
ade3(
poor
lyd
iff
erent
iat
ed)
.

5)Mol
ecul
art
est
ingoft
het
umor
:Thi
sisanot
herl
abor
ator
ytes
tst
hatmayb
e
r
ecommend
edf
ort
est
ingat
umors
amp
let
oid
ent
ifys
pec
ifi
cgenes
,pr
otei
ns,andot
her
f
act
orsuni
quet
othet
umor
.Ifi
tisal
ocal
lyad
vanc
edormet
ast
ati
cbr
eas
tcanc
er,t
he
onc
ologi
stmayr
ecommendt
est
ingf
ort
hef
oll
owi
ngmol
ecul
arf
eat
ures
:
a)PD-L1:Thi
sisap
rot
einwhi
chi
sfoundont
hes
urf
aceofc
anc
erc
ell
sands
omeoft
he
b
ody
'si
mmunec
ell
s.Thi
spr
otei
nst
opst
heb
ody
’si
mmunec
ell
sfr
omd
est
roy
ingt
he
c
anc
er.
b
)Mi
cros
atel
li
tei
nst
abi
li
ty-hi
gh(
MSI
-H)orDNAmi
smat
chr
epai
rdef
ici
enc
y(d
MMR)
:
Tumor
sthathav
eMSI
-Hord
MMRhav
edi
ffi
cul
tyr
epai
ri
ngd
amaget
othei
rDNA.Thi
s
meanst
hatt
heyd
evel
opmanymut
ati
onsorc
hanges
.Thes
echangesmakeab
nor
mal
p
rot
einsont
het
umorc
ell
sthatmakei
teas
ierf
ori
mmunec
ell
stof
indandat
tac
kthe
t
umor
.
6)Genomi
ctes
tst
opr
edi
ctr
ecur
renc
eri
sk
Agenomi
ctes
tisus
edt
olookf
ors
pec
ifi
cgenesors
ubs
tanc
esmad
ebyt
hegenesc
all
ed
p
rot
einst
hatar
efoundi
noronc
anc
erc
ell
s.Thes
etes
tshel
ptound
ers
tandb
ett
ert
he
uni
quef
eat
uresofeac
hpat
ient
’sb
reas
tcanc
er.Genomi
ctes
tsc
anal
sohel
pes
timat
e
t
her
iskoft
hec
anc
erc
omi
ngb
ackaf
tert
reat
ment
.Knowi
ngt
hisi
nfor
mat
ionhel
ps
d
oct
orsandp
ati
ent
smaked
eci
sionsab
outs
pec
ifi
ctr
eat
ment
sandc
anhel
psome
p
ati
ent
sav
oidunwant
eds
ideef
fec
tsf
romat
reat
mentt
hatmaynotb
eneed
ed.
Thef
oll
owi
nggenomi
ctes
tsar
edoneonas
amp
leoft
het
umort
hatwasal
read
y
r
emov
edd
uri
ngb
iop
syors
urger
y.Mos
tpat
ient
swi
llnotneedanext
rab
iop
syormor
e
s
urger
yfort
hes
etes
ts.
a)Onc
oty
peDx:Thi
stes
tisanop
tionf
orp
eop
lewi
thER-p
osi
ti
veand
/orPR-p
osi
ti
ve,
HER2-negat
iveb
reas
tcanc
ert
hathasnots
preadt
othel
ymp
hnod
es.Thi
stes
tcanhel
p
b
othp
ati
ent
sandd
oct
orst
omaked
eci
sionsab
outwhet
herc
hemot
her
apys
houl
dbe
ad
dedt
ohor
monal
ther
apy
.Thi
stes
tlooksat16c
anc
er-r
elat
edgenesand5r
efer
enc
e
genest
ocal
cul
atea“
rec
urr
enc
esc
ore”t
hates
timat
est
her
iskoft
hec
anc
erc
omi
ng
b
ackwi
thi
n10y
ear
saf
terd
iagnos
is.Ther
ecur
renc
esc
orei
sus
edt
ogui
de
r
ecommend
ati
onsont
heus
eofc
hemot
her
apy
,whi
chmayal
sod
iff
erb
yage.
b
)MammaPr
int
:Thi
stes
tisanop
tionf
orp
eop
lewi
thER-p
osi
ti
veand
/orPR-p
osi
ti
ve,
HER2-negat
iveb
reas
tcanc
ert
hathasnots
preadt
othel
ymp
hnod
esorhasonl
ysp
read
t
o1t
o3l
ymp
hnod
es.Thi
stes
tus
esi
nfor
mat
ionf
rom70genest
oes
timat
ether
iskof
r
ecur
renc
eforear
ly-s
tageb
reas
tcanc
er.Forp
eop
lewi
thahi
ghr
iskoft
hec
anc
er
c
omi
ngb
ack,t
hist
estc
anhel
ptomaked
eci
sionsab
outwhet
herc
hemot
her
apys
houl
dbe
ad
dedt
ohor
monal
ther
apy
.
c
)Br
eas
tCanc
erI
ndex:Thi
stes
tisanop
tionf
orp
eop
lewi
thER-p
osi
ti
veand
/orPR-
p
osi
tiv
e,HER2-negat
iveb
reas
tcanc
ert
hathasnots
preadt
othel
ymp
hnod
es.Thi
s
t
estmayhel
ptomaked
eci
sionsab
outhowl
ongap
ati
ents
houl
drec
eiv
ehor
monal
t
her
apy
.
Ad
dit
ionalt
est
s
Bl
oodt
est
s
Thed
oct
ormayal
soneedt
oreques
tfors
ever
alt
ypesofb
loodt
est
s.Thes
etes
tsmay
b
edoneb
efor
eoraf
ters
urger
y.
Ful
lbl
oodc
ount
:Ac
omp
let
ebl
oodc
ounti
sus
edt
omeas
uret
henumb
erofd
iff
erent
t
ypesofc
ell
s,s
uchasr
edb
loodc
ell
sandwhi
teb
loodc
ell
s,i
nas
amp
leofap
ers
on’
s
b
lood
.Iti
sdonet
omakes
uret
hatt
heb
onemar
rowi
sfunc
tioni
ngwel
l.

Bl
oodc
hemi
str
y:Thi
stes
tev
aluat
eshowwel
lthel
iverandki
dney
sar
ewor
king.
Hep
ati
tist
est
s:Thes
etes
tsar
eoc
cas
ional
lyus
edt
ochec
kforev
idenc
eofp
rior
exp
osur
etohep
ati
ti
sBand
/orhep
ati
tisC.I
fther
eisev
idenc
eofanac
tiv
ehep
ati
ti
sB
i
nfec
tion,p
ati
entmayneedt
otakeas
pec
ial
med
icat
iont
osup
pres
sthev
irusb
efor
e
r
ecei
vingc
hemot
her
apy
.Wi
thoutt
hismed
icat
ion,t
hec
hemot
her
apyc
anc
aus
ethev
irus
t
ogr
owandd
amaget
hel
iver
.