Histopathology 3/10/22

Question 1

What is histopathology?

Answer 1

Study of disease

Question 2

What is immunohistochemistry?

Answer 2

Determine the cell type

Question 3

How common is breast cancer?

Answer 3

Most common cancer in UK (15%)

Question 4

How many die a year from breast cancer?

Answer 4

~12,000

Question 5

How many will get breast cancer a year?

Answer 5

1 in 8 will get breast cancer
55,000 women and 400 men

Question 6

How does breast cancer present?

Answer 6

Lump
Pulled nipple
Dimpling
Dripping
Rash
Skin changed

Question 7

Anatomy of a female breast?

Answer 7

Fatty tissue
Lobe/lobules (broccoli head)
Ducts (broccoli stem)
Areola (area around nipple)
Nipple

Question 8

What bio markers are there for breast cancer?

Answer 8

ER - oestrogen receptor
PR - progesterone receptor
HER2 - human epithelial growth factor receptor 2
Ki67 - proliferation marker

Question 9

What does a positive ER or PR diagnose mean?

Answer 9

Better prognosis and cancer may respond to anti-oestrogen drugs

Question 10

What does a positive HER2 mean?

Answer 10

Worse diagnosis and more aggressive cancer May respond to anti-HER2 drugs

Question 11

What is taken into consideration when determining a breast cancer?

Answer 11

Size
Grade
Tumour subtype
Lymphobascular invasion
Excision margins
Lymph nodes
Bio markers
Gene expression studies

Question 12

What are the molecular subtypes of breast cancer?

Answer 12

Liminal A - grade 1, +ER/PR, -HER2, Ki67 low, good prognosis
Liminal B - grade 2-3, +ER/PR, -HER2, Ki67 intermediate, intermediate prognosis
HER2 - grade 2-3, -ER/PR, +HER2, Ki67 high, poor prognosis
Triple negative breast carcinoma - grade 3, -ER/PR, -HER2, Ki67 high, +BRCA, poor prognosis

Question 13

What genetic testing can be done to test for recurrence?

Answer 13

OncotypeDX
Sample sent to San Francisco where level of expression of 21 specific genes is tested to predict recurrence
<18 unlikely
18-32 intermediate
>32 likely
Chemotherapy continued for those >18