Lab 7: Handling and Evaluation of Breast Cancer Biopsy

El-Hindi.M. & Abdelmoneim.A.

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-receptor-negative 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

Methodology

Fixation

Processing

Embedding sample

in wax

Sectioning

Staining

Thanks a lot