Breast Cancer

Breast cancer happens when cells in your breast grow and divide in an
uncontrolled way, creating a mass of tissue called a tumor. Signs of breast
cancer can include feeling a lump in your breast, experiencing a change in the
size of your breast and seeing changes to the skin on your breasts.
Mammograms can help with early detection . Like other cancers, breast cancer
can invade and grow into the tissue surrounding your breast. It can also travel
to other parts of your body and form new tumors. When this happens, it’s
called metastasis.

Breast cancer is one of the most common cancers among women, It’s most
likely to affect women over the age of 50, but it can occur at any age.

Though rare, men can also develop breast cancer.

CA 15.3 is a tumour marker in breast cancer. Cancer antigen 15-3 (CA15-3) is a

protein made by a variety of cells, particularly breast cancer cells. The protein
moves into the blood, where it can be measured.
CA15-3 levels are higher than normal in most women with breast cancer that
has spread to other parts of the body (called metastatic breast cancer). Not all
types of breast cancer will cause CA 15-3 levels to rise, as some types of cancer
cells don’t over-produce the antigen. It is used to check how breast cancer
treatment is working and look for cancer that has come back, or recurred, after
treatment.

CA15-3 is not measured for early stage breast cancer because the levels of this
protein are rarely higher than normal at this stage.
A CA15-3 test is a blood test done with a needle. You don’t need to do anything
special to prepare.

What the results mean?

CA15-3 levels can be higher than normal with cancerous and non-cancerous
conditions. CA15-3 is most often increased in breast cancer that has spread to
other parts of the body.
In general, the higher the level of CA15-3 in the blood, the more cancer there
is in the body. The levels are highest when breast cancer has spread to the
bones, the liver or both. If the level of CA15-3 goes down or returns to normal,
it may mean that treatment is working. If levels increase over time, it may
mean that the cancer is not responding well to treatment, is still growing or is
coming back.
CA15-3 may also be higher than normal in cancer of the lung, pancreas, ovary
and prostate, but these levels are not as high as with breast cancer.
Non-cancerous conditions that increase CA 15-3 include endometriosis, pelvic
inflammatory disease and liver disease. It can also be increased during
pregnancy.

If you are diagnosed with breast cancer, your doctor may order additional lab
tests to assist with prognosis. The two most common lab tests are the hormone
receptor test and the HER2/neu test. Results from these tests can provide
insight into which cancer treatment options may be most effective for you.
Testing The Tumor Cells For Hormone Receptors

A hormone receptor is a specialized protein located on the surface of or within

a cell. The receptor binds to the female hormones estrogen and progesterone,
which flow through the blood. Once bound, the hormone signals the cell to
start growing and multiplying.

Many breast cancer tumors contain hormone receptors, often in large numbers.
When hormone receptors are present, estrogen and/or progesterone can fuel
the growth of the cancer. Such hormone-dependent cancers often respond well
to hormone therapy, which differs from hormone replacement therapy (HRT).
If neither estrogen receptors (ER) nor progesterone receptors (PR) are present,
the cancer is said to be “hormone-receptor-negative,” and hormone therapy
would likely be ineffective. Knowing whether the cancer cells have hormone
receptors can be valuable to your medical team and your treatment plan.

Hormone receptor testing is generally recommended for all breast cancers. If

your doctor orders this test, you may be asked to discontinue taking any
prescribed hormones for a period of time before the breast tissue sample is
obtained. Usually, the sample comes from a biopsy, but the test may also be
performed on tissue removed during a lumpectomy or mastectomy. It is
standard of care however to obtain these types of pathology results on biopsy
tissue.
How Does The Test Work?
The testing lab typically uses a specialized staining process on the breast tissue
sample to see if hormone receptors are present. The technical name for this
procedure is an “immunohistochemical staining assay” or an
“ImmunoHistoChemistry (IHC).”
If the cancer is deemed “estrogen-receptor-positive” (ER+), its cells have
receptors for the estrogen hormone. That means that the cancer cells likely
receive signals from estrogen to promote growth. About two out of every three
breast cancers contain hormone receptors.
If the cancer is progesterone-receptor-positive (PR+), its cells have receptors for
progesterone. This hormone could then promote the growth of the cancer.
The cancer cells being estrogen and/or progesterone receptor-positive
(hormone positive) is a good prognostic factor to have, usually leading to a
better prognosis.

What do the results of hormone testing mean?

Breast cancer patients who test positive for both estrogen receptors and
progesterone receptors usually have a better-than-average prognosis for
survival and a complete recovery than those who have no receptors present.
Also, the more receptors and the more intense their reaction, the better they
respond to hormone therapy. Patients with one type of receptor but not the
other may still reap benefits from this form of treatment, but likely not to the
same degree. As mentioned earlier, if the cancer is both ER- and PR-negative, it
probably won’t respond to hormone therapy.
HER2/neu Test
Similar to the hormone receptor test, the HER2/neu test looks for a specific
kind of protein that is found with certain types of cancer cells and the gene that
produces it. The formal name of that gene is the human epidermal growth
factor receptor 2, and it makes HER2 proteins. These proteins are receptors on
breast cells.
In a sense, genes contain the formula for the number and combination of
proteins a cell needs to remain healthy and function properly. Certain genes
and the proteins they create can determine how breast cancer progresses, as
well as how it responds to various types of treatment.

What is a HER2 receptor and how does it relate to breast cancer?

Healthy HER2 receptors are the proteins that help manage how a breast cell
grows, divides, and repairs itself. However, in about a quarter of all breast
cancer patients, the HER2 gene isn’t functioning properly. It makes an excess
number of copies of itself in a process known as “HER2 gene amplification.”
Then these extra genes instruct the cells to make too many HER2 receptors,
which is called “HER2 protein overexpression.” The ultimate result is that
breast cells grow and divide in an uncontrolled fashion.
The HER2/neu test can discover whether the sample is normal or whether it
has too much of the HER2/neu protein or an excessive number of copies of its
gene. If you have been diagnosed with invasive breast cancer or have had
recurrent breast cancer, your doctor may recommend this test. It will help your
oncology team determine your prognosis, characteristics of the tumor including
how aggressive the tumor is likely to be, and the best treatment options.
This test is often ordered in conjunction with the hormone receptor test.
Typically, the breast cancer tissue sample from a biopsy or the tumor removed
during a mastectomy is used. This test can take about a week to get the
pathology results back, whereas determining if the cells are cancer usually is
known in just a day or two.

What will the HER2/neu results tell me?

There are four tests for HER2, and results of these may appear on your
pathology report, which may take several weeks to come back.
The first one is the IHC test, which is short for “ImmunoHistoChemistry.” It
looks at whether there is excess HER2 protein in the cancerous cells. A result of
0 or 1+ indicates there is no excess, 2+ is borderline, and 3+ means the cells test
positive for HER2 protein overexpression.
The remaining three tests all examine if the cells contain too many copies of the
HER2 gene. These tests include:

• The FISH test (“Fluorescence In Situ Hybridization”)

• The SPoT-Light HER2 CISH test (“Subtraction Probe Technology
Chromogenic In Situ Hybridization”)
• The Inform HER2 Dual ISH test (“Inform Dual In Situ Hybridization”)

There are only two possible results for these three tests: positive, meaning
HER2 gene amplification, or negative, indicating the number of HER2 genes is
not excessive.
In the pathology report, breast cancers with HER2 protein overexpression and
HER2 gene amplification are called HER2-positive. This type of cancer often
grows faster, spreads to other areas more readily, and has a higher likelihood of
recurring versus HER2-negative breast cancer.

Blood Testing for HER2/neu

Sometimes, especially when there is not enough tumor tissue available to
perform the test, a blood sample is drawn from the patient’s arm to collect
similar data. This blood test is called a “serum HER2/neu test,” and it can be
used as part of the initial workup upon cancer diagnosis or to monitor the
effectiveness of treatment. If initially the level of serum HER2/neu is elevated
to more than 15ng/mL and then it falls, the treatment is likely working.
However, if the serum level remains elevated, this indicates the treatment is
not working. If the serum level declines but then, upon later testing, is elevated
once again, this is a sign that the cancer could be recurring.
When all three of the tests come back negative for receptors for hormones
(progesterone and estrogen) and negative for HER2, triple negative breast
cancer may be the diagnosis.