How to understand common immunohistochemical indicators of breast cancer

How to understand the common immunohistochemical indicators of breast cancer? Many breast cancer patients and their families suffer from not being able to understand the common immunohistochemical indicators of breast cancer and are unable to judge the doctor's treatment. Today, the editor will explain in detail how to understand the common immunohistochemical indicators of breast cancer.

What is breast cancer?

Breast cancer is the most common cancer in women after skin cancer. One in eight women in the United States (about 12%) will develop breast cancer in her lifetime. It is also the second leading cause of cancer death in women after lung cancer. Encouragingly, the death rate from breast cancer has decreased in recent years, likely due to greater awareness and screening for this type of cancer, as well as better treatments.

Breast cancer is a disease that occurs when cells in the breast tissue change (or mutate) and continue to multiply. These abnormal cells often clump together to form a tumor. When these abnormal cells invade other parts of the breast or spread (or metastasize) to other areas of the body through the blood or lymphatic system, the tumor is cancerous (or malignant). The lymphatic vessels, or lymphatic system, are a network of blood vessels and lymph nodes in the body that play an important role in fighting infection.

Breast cancer usually starts in the milk-producing glands of the breast, called lobules, or in the tube-like ducts that carry milk from the lobules to the nipple. Less often, cancer starts in the fatty and fibrous connective tissue of the breast.

New cases of breast cancer occur 100 times more often in women than in men, but yes, men can get breast cancer, too. Male breast cancer is rare, but anyone with breast tissue can get breast cancer.

Breast Cancer Symptoms

Symptoms of breast cancer vary from person to person. Knowing how your breasts typically look and feel may help you recognize possible signs and symptoms.

What does breast cancer feel like? You can have breast cancer and not feel anything unusual. However, if you notice thickening of breast tissue, a lump in the breast (usually painless, but not always painful), or swollen lymph nodes under the arm, see your doctor.

What does breast cancer look like? You may notice a change in the shape or size of your breasts. You could have an area of skin that dimples or a leaky nipple.

Often, there are no early warning signs of breast cancer. Even if you develop a lump, it may be too small to feel. That's why breast cancer screening, usually using mammograms, is so important. Some early signs and symptoms of breast cancer that women and men may experience include:

A new lump in the breast or armpit with or without pain. The lump is usually hard, but can be tender. (Not all lumps are breast cancer. Some lumps may be noncancerous or benign fluid-filled cysts, but they should be checked by your doctor.

Changes in breast size or shape. Look for swelling, thickening, or shrinkage, especially in one breast.

Dimples, spots, or redness. The breast skin may take on an orange peel appearance.

Peeling, flaking, or peeling of breast skin.

Red, thick, or scaly nipples.

Pain in the breast, nipple, or armpit.

Inverted nipples. Look for nipples that are pointed inward or flat.

Nipple discharge may be clear or bloody.

Redness or unusual warmth. This could be a sign of inflammatory breast cancer, a rare and aggressive disease.

Swollen lymph nodes under the arms or around the collarbone, which may be a sign that breast cancer has spread.

Breast cancer is one of the most common malignant tumors in women. Its onset is often related to heredity, and the incidence rate is higher in women between the ages of 40 and 60 and before and after menopause. Only about 1-2% of breast patients are male. It is a malignant tumor that usually occurs in the epithelial tissue of the breast gland. It is one of the most common malignant tumors that seriously affects women's physical and mental health and even endangers their lives. The main treatments for breast cancer include surgery, chemotherapy, radiotherapy and modern Chinese medicine. Clinically, different methods must be selected for combined application according to the early or late stage of the disease. When the selection is reasonable, the efficacy is better than a single method. In recent years, studies have found that ginsenoside Rh2 (optimal content 16.2%) has the strongest ability to inhibit the proliferation of cancer cells and is the most important anti-cancer active ingredient in ginsenosides. Ginsenoside Rh2 is effective against a variety of tumors by inhibiting the proliferation of cancer cells and inducing differentiation and apoptosis of cancer cells, and also provides a new weapon for the treatment of breast cancer.

Breast cancer is a hormone-dependent tumor, which means that the growth of breast cancer cells depends on the stimulation of estrogen and progesterone. Estrogen and progesterone exert their effects by binding to corresponding receptors on breast cancer cells. Immunohistochemistry shows positive estrogen receptor (ER) and progesterone receptor (PR). The formation of PR is directly controlled and regulated by ER, so PR-positive breast cancers are mostly ER-positive. However, during the process of carcinogenesis, some cells retain very little or completely lose their receptor system and can no longer serve as target cells for hormones. Their growth is no longer controlled and regulated by hormones, and they appear as ER-negative breast cancer.

Common immunohistochemical markers of breast cancer: estrogen receptor (ER) and progesterone receptor (PR)

Clinically, the level of hormone receptors in tumor cells can be obtained by testing estrogen receptors (ER) and progesterone receptors (PR), thereby providing prognostic information for breast cancer and guiding endocrine therapy. It is reported that well-differentiated tumors or tumors with lower clinical stages are more likely to be ER and PR positive; the ER positivity rate of breast cancer is about 50% to 80%, and the PR positivity rate is about 50%. ER and PR positive tumors are highly responsive to endocrine therapy, with an effective rate of 55 to 60%, while the effective rate of receptor negative patients is 5 to 8%. Patients with ER and (or) PR positive have a better prognosis than those with ER and (or) PR negative.

Common immunohistochemical markers of breast cancer: estrogen-regulated protein PS2

Estrogen regulatory protein PS2 is secreted by hormone-dependent cells and can act through autocrine and paracrine. It is another important indicator for predicting the prognosis of breast cancer and the efficacy of endocrine therapy. Usually, ER-positive breast cancer cells also show high levels of PS2 expression. The positive rate of PS2 expression in breast cancer is between 43% and 58%. The positive correlation between PS2 and ER expression is more obvious in premenopausal women (under 50 years old). PS2(+)ER(+) cases account for about 83%, ER(-) and PR(-) are rare, and PS2(+) (about 4%). As a predictive indicator for anti-estrogen treatment of breast cancer, PS2 may be better than ER and PR. If the three are combined, a satisfactory predictive effect can be achieved.

Common immunohistochemical indicators for breast cancer: prognostic indicator PS2

As a prognostic indicator, PS2 is particularly important for patients without lymph node metastasis. For breast cancer patients with no (no lymph node metastasis), about 20% to 30% of patients will relapse if they are treated with surgery alone. Studies have found that the recurrence rate of N0 patients in the PS2 positive and negative groups differs by 31%, and the mortality rate differs by 13%. Therefore, PS2 has become one of the reference indicators for determining whether N0 patients belong to the risk group or the non-risk group. PS2 detection can also divide patients with positive lymph nodes (N+) into the risk group and the non-risk group, and the prognostic difference between the two groups is very obvious. Patients with breast cancer ER(-), PR(-), and PS2(-) have a poor prognosis, with a treatment failure rate of 85% and a 5-year survival rate of only 45%.

Common immunohistochemical indicators of breast cancer: Ki67 antigen that marks cell proliferation status

Ki67 is an antigen that marks the state of cell proliferation. Its function is closely related to mitosis and is essential in cell proliferation. A positive result indicates that cancer cells are actively proliferating. Monitoring of Ki67 is often used to determine whether a tumor is benign or malignant and the degree of malignancy. It is also used to explore the relationship between cell proliferation activity, cell cycle and biological behaviors and prognosis of tumors, such as growth pattern, infiltration pattern, recurrence, metastasis, etc.

Common immunohistochemical indicators of breast cancer: CyclinD1

The cell cycle is regulated by cyclins, cyclin-dependent kinases (CDKs) and cyclin-dependent kinase inhibitors (CKIs). There are key regulatory points between different phases (G1, S, G2, M). Cyclin D1 combines with specific CDKs to form a complex, which can link the signal transduction pathway with cell cycle regulation at the G1/S junction to complete the conversion of each period. Its overexpression can shorten the G1 phase and reduce dependence on growth factors. Abnormal regulation of this point is closely related to the occurrence and development of tumors. Cyclin D1 has been found to be amplified in many tumors, especially in breast cancer, where the amplification can reach 15% and the overexpression can reach 45%. It is currently recognized as a potential oncogene.

Common immunohistochemical indicators of breast cancer: P53 protein

The p53 gene is a tumor suppressor gene located on human chromosome 17p13.1. It encodes a 53kD nuclear phosphorylated protein composed of 393 amino acids, known as the p53 protein. The p53 gene is a negative regulator in the cell growth cycle and is related to important biological functions such as cell cycle regulation, DNA repair, cell differentiation, and cell apoptosis. It is a common indicator in lung cancer, breast cancer, and other examinations. P53 can be divided into wild type and mutant type. The expression of P53 is positively correlated with axillary lymph node metastasis, and the expression of P53 is positively correlated with poor clinical prognosis. The detection of P53 is helpful in judging the metastatic potential of breast cancer.

Common immunohistochemical markers for breast cancer: human epidermal growth factor receptor 2 (HER2/C-erbB-2)

Human epidermal growth factor receptor 2 (HER2), also formerly known as C-erbB2, is a HER2 receptor encoded by a proto-oncogene. HER2 plays an important role in regulating the growth, development and differentiation of normal cells. The amplification of the HER2 proto-oncogene leads to overexpression of HER2 receptors on the cell surface. HER2 positivity indicates a poor prognosis for breast cancer patients, with significantly shortened disease-free survival and overall survival, increased invasiveness of tumor cells, and possible resistance to endocrine therapy and CMF regimens. Anthracyclines and paclitaxel are relatively effective for HRE2-positive patients. About 25% of breast cancer patients have overexpression/amplification of HER2. The commonly used screening method is immunohistochemistry (IHC). IHC0/1+ is normal expression, and IHC3+ patients have overexpression of HER2. IHC2+ requires further fluorescence in situ hybridization (FISH) to confirm the amplification of the HER2 gene. Negative (3 copies/nucleus) is normal, and positive (>10 copies/nucleus) is abnormal. The study found that the efficacy of Herceptin treatment for IHC (3+) and FISH (+) patients was 35% and 34% respectively.

Triple-negative breast cancer (ER-/PR-/HER2)

Triple-negative breast cancer (ER-/PR-/HER2 or ER-/PR-/C-erbB-2) has a poor histological grade and chemotherapy is the only treatment option. It has a high overall response rate and pathological remission rate to chemotherapy, but is prone to secondary drug resistance and metastasis to important organs such as the brain, lungs and liver. The five-year survival rate of advanced patients is only 14%.

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