Download Breast Cancer Awareness

Practical Of
Histopathology
2015
Breast Cancer Biopsy
Practical of Histopathology
Objectives:
1. To
evaluate
the
clinical
and
histopathologic features of our patients
registered into the program.
2. To understand methods for diagnosis of
the breast cancer biopsy.
3. To learn the current guidelines for breast
cancer screening.
CANCER
• Cancer starts when cells begin to
grow out of control.
• Cells in nearly any part of the
body can become cancer, and can
spread to other areas of the body.
What is Breast Cancer?
• Breast cancer is a
disease in which
malignant (cancer)
cells form in the
tissues of the breast.
Breast Cancer
• Metastatic breast cancer occurs in one
third of patients affecting bone, liver and
lung, ultimately leading to death.
• Breast cancer cells may or may not have three
important
receptors:
estrogen
receptor (ER), progesterone receptor (PR),
and HER2.
More than 70% of human breast cancers
(BCs) are hormone-dependent and
approximately 15% are hormone-receptornegative which includes BCs lacking
estrogens receptor expression .
Overview:
• Breast cancer is a heterogeneous disease with
varied morphological appearances, molecular
features, behavior, and response to therapy.
•
Current routine clinical management of breast
cancer relies on the availability of robust clinical
and pathological prognostic and predictive factors
to support clinical and patient decision making in
which potentially suitable treatment options are
increasingly available.
Types of breast cancers
Most breast cancers are carcinomas, a
type of cancer that starts in the cells
(epithelial cells) that line organs and tissues
like the breast.
Cont.
Other types of cancers can occur in the
breast, too, such as sarcomas, which start
in the cells of muscle, fat, or connective
tissue.
Cont.
•
One of the best-established prognostic factors in
breast cancer is histological grade, which
represents the morphological assessment of
tumor biological characteristics and has been
shown to be able to generate important
information related to the clinical behavior of
breast cancers.
Cont.
• In early-stage breast cancer, where the
use of systemic therapy has to be
determined for every patient, the three
main prognostic determinants used in
routine practice are :
• lymph node (LN) status,
• Tumor size
• Histological grade.
Cont.
• Although the current well-established
clinical and histological factors and some
well-defined biological factors (that is,
hormone receptors and HER2 expression)
show strong association with prognosis
and outcome, there are increasing
concerns that these variables are limited
in their ability to capture the diversity of
clinical behaviors of breast cancer and
that they would not be sufficient to tailor
the therapy to individual patients.
Cont.
• Tumor grade has increased these
concerns.
• The introduction of high-throughput
technologies that survey thousands of
genes and their products in a single
assay, coupled with powerful analytical
tools, has opened up new avenues for
classifying breast cancer into biologically
and clinically distinct groups based on
gene expression patterns and DNA copy
number alterations.
Cont.
• To evaluation of Histological tumor grade
it is prepared hematoxylin-eosin-stained
tumor tissue sections to be assessed by
an appropriately trained pathologist using
a standard protocol.
• Histology Grade based on the evaluation
of three morphological features:
(a) Degree of tubule or gland formation, (b)
nuclear pleomorphism, and (c) mitotic count.
Cont.
• The same line of therapy however
had little or no effect on patients with
estrogen receptor negative (ER-)
breast cancer.
Cont.
• Another important progress in breast
cancer therapy was identifying and
targeting the Her2 subtype of epidermal
growth factor receptors (EGFR) which
improved the outcome of Her2 positive
patients.
• Triple negative breast cancers (TNBCs)
are called such because they lack
receptors for estrogen, progesterone and
Her2.
Is the breast abnormality
a cancer?
• A lump or spot in the breast can be made of normal
cells or cancer cells. Cancer cells are cells that grow in
an uncontrolled way.
• They may stay in the place where they started to grow,
or they may grow into the normal tissue around them.
• Cancer cells may also spread beyond the breast.
• The abnormal lump or spot may be found using
mammography or other testing methods.
• A procedure called a biopsy removes a piece of tissue
from the lump or spot to find out if cancer cells are
present.
Is the breast cancer
invasive?
• If breast cancer is found, it’s important to
know whether the cancer has spread outside
the milk ducts or lobules of the breast where it
started.
• Non-invasive cancers stay within the milk
ducts or milk lobules in the breast. They do
not grow into or invade normal tissues within
or beyond the breast.
Cont.
• Non-invasive cancers are sometimes called in
situ or pre-cancers. If the cancer has grown into
normal tissues, it is called invasive.
• Most breast cancers are invasive. Sometimes
cancer cells spread to other parts of the body
through the blood or lymph system.
• When cancer cells spread to other parts of the
body, it is called metastatic breast cancer. In
some cases, a breast cancer may be both
invasive and non-invasive.
There are four types of biopsy used
to check for breast cancer:
Excisional biopsy : The removal of an
entire lump of tissue.
Incisional biopsy : The removal of part of a
lump or a sample of tissue.
Cont.
Core biopsy : The removal of tissue using
a wide needle.
Fine-needle aspiration (FNA) biopsy : The
removal of tissue or fluid, using a thin
needle.
Types of treatment
1. Surgery is the primary method of
treatment and few patients elect to bypass
this option as it is considered necessary to
stop cancer progression.
2. Radiation therapy is the next step,
which uses x-rays and other radioactive
materials to damage DNA and cell
membranes of cancer cells.
Cont.
3. Chemotherapy is the third step, which is
the use of chemical agents that destroy
dividing cells or stop their division.
One of the most popularly used
chemotherapeutic agents is cisplatin, which
in general is a systemic treatment.
Inflammatory Breast
Cancer
Fixation
Staining
Processing
Methodology
Sectioning
Embedding
sample in
wax
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