TNBC; ER-Negative PR-Negative HER2/Neu-Negative Breast Cancer; HR-/HER2- Breast Cancer
Triple-negative breast cancer is a kind of breast cancer that does not have any of the receptors that are commonly found in breast cancer. This makes it aggressive and harder to treat. Learn more about this kind of breast cancer and what treatments might work.
Breast Cancer
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Summary
A lab-based study suggests a new therapeutic approach for hard-to-treat cancers like triple-negative breast cancer.
Image by National Cancer Institute
A lab-based study suggests a new therapeutic approach for hard-to-treat cancers like triple-negative breast cancer.
Image by National Cancer Institute
What Is Triple-Negative Breast Cancer?
Triple-negative breast cancer is a kind of breast cancer that does not have any of the receptors that are commonly found in breast cancer.
Think of cancer cells as a house. The front door may have three kinds of locks, called receptors—
One is for the female hormone estrogen.
One is for the female hormone progesterone.
One is a protein called human epidermal growth factor (HER2).
If your cancer has any of these three locks, doctors have a few keys (like hormone therapy or other drugs) they can use to help destroy the cancer cells.
But if you have triple-negative breast cancer, it means those three locks aren’t there. So doctors have fewer keys for treatment. Fortunately, chemotherapy is still an effective option.
Think of a cancer cell as a house. To get inside to destroy the cancer, we must bypass three locks on the front door: estrogen, progesterone, and HER2.
If your cancer tests positive for these three locks, which are known as receptors, then doctors have a few keys they can use to get inside the cell to destroy it.
If you have triple-negative breast cancer, those locks aren't there. So the keys doctors usually use won't work. But chemotherapy is still an effective option.
Source: Centers for Disease Control and Prevention (CDC)
Additional Materials (25)
Breast Cancer: treatment for triple negative breast cancer
U.S. Air Force Capt. Candice Adams reacts to the effects of a chemotherapy treatment Jan. 25, 2011 at Walter Reed Army Medical Center. Adams was diagnosed with triple negative breast cancer at age 29. (U.S. Air Force photo by Staff Sgt. Russ Scalf)
Hurricane in a Cell - This image shows a polyploid giant cancer cell (PGCC) from triple-negative breast cancer.
This image shows a polyploid giant cancer cell (PGCC) from triple-negative breast cancer. PGCCs, a subtype of cancer cell, appear in a variety of solid tumors and appear to help the tumor invade surrounding tissues and migrate to other areas of the body (metastasis). Researchers would like to better understand how PGCCs form and function with the goal of improving treatments. Actin is red; mitochondria are green; nuclear DNA is blue.
Image by National Cancer Institute \ Univ. of Pittsburg Cancer Institute / Wei Qian
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Model of Small Molecule Drug - c-terminal binding protein (CtBP) expression is shown in triple negative breast cancer
In this illustration, c-terminal binding protein (CtBP) expression is shown in triple negative breast cancer with a computer model of a molecule that can inhibit CtBP activity.
See also http://home.ccr.cancer.gov/connections/2013/Vol7_No1/news_3.asp.
Image by National Cancer Institute (NCI) / Kevin Gardner, M.D., Ph.D., NCI Center for Cancer Research
Dividing Breast Cancer Cell
This image shows a triple-negative breast cancer cell (MDA-MB-231) in metaphase during cell division. Tubulin in red; mitochondria in green; chromosomes in blue. A better understanding of how mitochondria play roles in tumor cell division may provide new therapeutic targeting strategies to stop tumor cell growth.
This image was originally submitted as part of the 2016 NCI Cancer Close Up project. This image is part of the NCI Cancer Close Up 2016 collection.
Image by National Cancer Institute \ Univ. of Pittsburgh Cancer Institute / Wei Qian
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Dividing Breast Cancer Cells
This image shows a triple-negative breast cancer cell (MDA-MB-231) in metaphase during cell division. Tubulin in red; mitochondria in green; chromosomes in blue. A better understanding of how mitochondria play roles in tumor cell division may provide new therapeutic targeting strategies to stop tumor cell growth.
This image was originally submitted as part of the 2016 NCI Cancer Close Up project. This image is part of the NCI Cancer Close Up 2016 collection.
See also https://visualsonline.cancer.gov/closeup2016.
Image by National Cancer Institute \ Univ. of Pittsburgh Cancer Institute / Wei Qian
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Nanoparticles in Breast Cancer Metastases
Targeting receptors that are overexpressed by cancer cells has been a successful precision oncology approach, but not all cancer cells in the same tumor overexpress the same receptors. Drugs capable of targeting multiple receptors have the potential to be even more effective. This image shows metastatic triple-negative breast cancer cells (green) that overexpress two receptors (EGFR, blue, and αVβ3 integrin, red) that play different roles in cancer development. Researchers linked molecules (ligands) that target each of these receptors to one nanoparticle. These dual-ligand nanoparticles were capable of binding to the majority of metastatic breast cancer cells in a mouse's lung.
This image is part of the following collections:
NCI Cancer Close Up 2017
Nanotechnology Image Library
Image by National Cancer Institute \ Case Western Reserve University / Felicia He, William Schiemann, Pubudu Peiris, Efstathios Karathanasis
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Treating Triple-Negative Breast Cancer Cell
This image shows a triple-negative breast cancer cell undergoing retraction and apoptosis (cell death) after treatment with a combination of the chemotherapy drug cisplatin and a mitochondrial division inhibitor drug called mdivi-1. Actin in red; mitochondria in green; nuclei in blue. Understanding how drugs work at the molecular level contributes to better cancer treatments.
Image by National Cancer Institute \ Univ. of Pittsburgh Cancer Institute / Wei Qian
Breast Cancer in Women: Know the Subtype
There are different subtypes of women's breast cancer. Knowing which subtype is important for guiding treatment and predicting survival.
Image by National Cancer Institute (NCI)
Triple negative breast cancer - Mammography cancer
Triple negative breast cancer
Image by libre/Wikimedia
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Heterogeneity in Triple-Negative Breast Cancer
Across different cancer types, and even within the same tumor, cancer cells exhibit a wide variety of molecular structures and characteristics. This so-called heterogeneity poses difficult challenges to researchers trying to find better ways of managing the disease. This sample of clinical triple-negative breast cancer is stained for bone morphogenetic protein-11 (red); the Golgi marker GM130 (green); glycosylated proteins (white); and nuclei (blue), illustrating profound molecular heterogeneity. Widefield fluorescence microscopy was used to obtain the image.
This image was originally submitted as part of the 2016 Cancer Close Up project. This image is part of the NCI Cancer Close Up 2016 collection.
See also https://visualsonline.cancer.gov/closeup2016.
Image by National Cancer Institute \ Univ. of Virginia Cancer Center / Kevin Janes
Progesterone 3D Molecule
The major progestational steroid that is secreted primarily by the CORPUS LUTEUM and the PLACENTA. Progesterone acts on the UTERUS, the MAMMARY GLANDS and the BRAIN. It is required in EMBRYO IMPLANTATION; PREGNANCY maintenance, and the development of mammary tissue for MILK production. Progesterone, converted from PREGNENOLONE, also serves as an intermediate in the biosynthesis of GONADAL STEROID HORMONES and adrenal CORTICOSTEROIDS.
Image by StoryMD
Talk to Linda about Triple-Negative Breast Cancer
Video by Centers for Disease Control and Prevention (CDC)/YouTube
Triple Negative Breast Cancer: What You Need to Know
Video by Demystifying Medicine/YouTube
Risk factors for developing triple-negative breast cancer
Video by Roche/YouTube
Breast Cancer Sub-types - Triple Negative Breast Cancer
Video by Dr. Susan Love Foundation/YouTube
What is triple negative breast cancer and how is it treated?
Video by You and Breast Cancer/YouTube
In situ hybridization of the Her2 gene (unamplified)
The image shows nuclei of neoplastic cells of a breast cancer with a normal number of copies of the Her2 gene (red signals) (in green, centromere labeling signals). Technique: in situ hybridization of interphase nuclei obtained from paraffin-embedded material from breast cancer.
Image by Manuel Medina Pérez/Wikimedia
Triple-Negative Breast Cancer: What You Need to Know
Video by American Cancer Society/YouTube
What is triple-negative breast cancer? | Dana-Farber Cancer Institute
Video by Dana-Farber Cancer Institute/YouTube
How a triple-negative breast cancer survivor became cancer-free
Video by MD Anderson Cancer Center/YouTube
Beyond The Shock - Chapter 5 - Types & Stages - Triple Negative Breast Cancer
Video by National Breast Cancer Foundation/YouTube
Triple Negative Breast Cancer: What you need to know
Video by Breast Cancer School for Patients/YouTube
What Makes Triple Negative Breast Cancer Aggressive?
Video by SHARE Cancer Support/YouTube
At 32, She Faced Rare Triple-Negative Breast Cancer: ‘My Story can Help a Lot of People’
Video by BaptistHealthSF/YouTube
Metastatic Triple Negative Breast Cancer
Video by Susan G. Komen®/YouTube
Breast Cancer: treatment for triple negative breast cancer
Hurricane in a Cell - This image shows a polyploid giant cancer cell (PGCC) from triple-negative breast cancer.
National Cancer Institute \ Univ. of Pittsburg Cancer Institute / Wei Qian
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Model of Small Molecule Drug - c-terminal binding protein (CtBP) expression is shown in triple negative breast cancer
National Cancer Institute (NCI) / Kevin Gardner, M.D., Ph.D., NCI Center for Cancer Research
Dividing Breast Cancer Cell
National Cancer Institute \ Univ. of Pittsburgh Cancer Institute / Wei Qian
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Dividing Breast Cancer Cells
National Cancer Institute \ Univ. of Pittsburgh Cancer Institute / Wei Qian
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Nanoparticles in Breast Cancer Metastases
National Cancer Institute \ Case Western Reserve University / Felicia He, William Schiemann, Pubudu Peiris, Efstathios Karathanasis
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Treating Triple-Negative Breast Cancer Cell
National Cancer Institute \ Univ. of Pittsburgh Cancer Institute / Wei Qian
Breast Cancer in Women: Know the Subtype
National Cancer Institute (NCI)
Triple negative breast cancer - Mammography cancer
libre/Wikimedia
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Heterogeneity in Triple-Negative Breast Cancer
National Cancer Institute \ Univ. of Virginia Cancer Center / Kevin Janes
Progesterone 3D Molecule
StoryMD
0:39
Talk to Linda about Triple-Negative Breast Cancer
Centers for Disease Control and Prevention (CDC)/YouTube
4:55
Triple Negative Breast Cancer: What You Need to Know
Demystifying Medicine/YouTube
3:05
Risk factors for developing triple-negative breast cancer
Roche/YouTube
3:40
Breast Cancer Sub-types - Triple Negative Breast Cancer
Dr. Susan Love Foundation/YouTube
1:50
What is triple negative breast cancer and how is it treated?
You and Breast Cancer/YouTube
In situ hybridization of the Her2 gene (unamplified)
Manuel Medina Pérez/Wikimedia
2:02
Triple-Negative Breast Cancer: What You Need to Know
American Cancer Society/YouTube
3:41
What is triple-negative breast cancer? | Dana-Farber Cancer Institute
Dana-Farber Cancer Institute/YouTube
1:59
How a triple-negative breast cancer survivor became cancer-free
MD Anderson Cancer Center/YouTube
1:04
Beyond The Shock - Chapter 5 - Types & Stages - Triple Negative Breast Cancer
National Breast Cancer Foundation/YouTube
10:06
Triple Negative Breast Cancer: What you need to know
Breast Cancer School for Patients/YouTube
30:41
What Makes Triple Negative Breast Cancer Aggressive?
SHARE Cancer Support/YouTube
2:39
At 32, She Faced Rare Triple-Negative Breast Cancer: ‘My Story can Help a Lot of People’
BaptistHealthSF/YouTube
3:10
Metastatic Triple Negative Breast Cancer
Susan G. Komen®/YouTube
Symptoms
Signs & Symptoms
Image by TheVisualMD
Signs & Symptoms
Image by TheVisualMD
What Are the Symptoms of Breast Cancer?
Breast pain can be a symptom of cancer. If you have any symptoms that worry you, be sure to see your doctor right away.
Different people have different symptoms of breast cancer. Some people do not have any signs or symptoms at all.
Some warning signs of breast cancer are—
New lump in the breast or underarm (armpit).
Thickening or swelling of part of the breast.
Irritation or dimpling of breast skin.
Redness or flaky skin in the nipple area or the breast.
Pulling in of the nipple or pain in the nipple area.
Nipple discharge other than breast milk, including blood.
Any change in the size or the shape of the breast.
Pain in any area of the breast.
Keep in mind that these symptoms can happen with other conditions that are not cancer.
If you have any signs or symptoms that worry you, be sure to see your doctor right away.
What Is a Normal Breast?
No breast is typical. What is normal for you may not be normal for another woman. Most women say their breasts feel lumpy or uneven. The way your breasts look and feel can be affected by getting your period, having children, losing or gaining weight, and taking certain medications. Breasts also tend to change as you age. For more information, see the National Cancer Institute’s Breast Changes and Conditions.
What Do Lumps in My Breast Mean?
Many conditions can cause lumps in the breast, including cancer. But most breast lumps are caused by other medical conditions. The two most common causes of breast lumps are fibrocystic breast condition and cysts. Fibrocystic condition causes noncancerous changes in the breast that can make them lumpy, tender, and sore. Cysts are small fluid-filled sacs that can develop in the breast.
Source: Centers for Disease Control and Prevention (CDC)
Additional Materials (10)
Cancer signs and symptoms
Symptoms of Cancer : The symptoms of cancer depend on the type of cancer, its location, the size of the tumor, and how much it affects nearby organs or tissues. If a cancer has metastasized, symptoms may appear in different parts of the body. Some cancers may be asymptomatic (have no symptoms at all) or be asymptomatic until the cancer has reached an advanced stage. Pancreatic cancer, for example, may not cause symptoms until the cancerous cells have grown around nearby nerves. Symptoms that are commonly seen with different forms of cancer include chills, fever, malaise, night sweats, unexplained weight loss, pain, loss of appetite, and change in bowel habits or bladder function.
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Breast cancer - Early Signs - Overview
Early signs of possible breast cancer
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Breast with Inverted Nipple, Symptom of Breast Cancer
Photograph of woman's right breast showing inverted nipple, a possible symptom of breast cancer. Signs and symptoms of breast cancer are not always lumps or swelling.
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Breast with Rough, Scaly Skin, Symptom of Breast Cancer
Photograph of woman's breast showing scaly, rough skin, a possible symptom of breast cancer. Signs and symptoms of breast cancer are not always lumps or swelling.
Image by TheVisualMD
How to Catch Cancer Early
Video by PatientEdChannel/YouTube
How Cancer Starts
Video by PatientEdChannel/YouTube
Is Nipple Discharge a Sign of Breast Cancer? - UF Health Breast Center – Jacksonville
Video by UF Health Jacksonville/YouTube
How to Check Your Breasts for Lumps - Signs Of Breast Cancer Symptoms
Video by WaysAndHow/YouTube
Breast Cancer 101: Our Oncologists Answer Questions On Breast Cancer
Video by Michigan Medicine/YouTube
How to Check for the Signs of Male Breast Cancer | Lorraine
Video by Lorraine/YouTube
Cancer signs and symptoms
TheVisualMD
Breast cancer - Early Signs - Overview
Raphseck
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Breast with Inverted Nipple, Symptom of Breast Cancer
TheVisualMD
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Breast with Rough, Scaly Skin, Symptom of Breast Cancer
TheVisualMD
2:46
How to Catch Cancer Early
PatientEdChannel/YouTube
2:37
How Cancer Starts
PatientEdChannel/YouTube
1:13
Is Nipple Discharge a Sign of Breast Cancer? - UF Health Breast Center – Jacksonville
UF Health Jacksonville/YouTube
4:15
How to Check Your Breasts for Lumps - Signs Of Breast Cancer Symptoms
WaysAndHow/YouTube
58:50
Breast Cancer 101: Our Oncologists Answer Questions On Breast Cancer
Michigan Medicine/YouTube
3:01
How to Check for the Signs of Male Breast Cancer | Lorraine
Lorraine/YouTube
Diagnosis
Diagnosing Breast Cancer
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Diagnosing Breast Cancer
If a woman has symptoms of breast cancer (such as a lump), or if a suspicious area is found in an imaging exam, the next step is to physically examine the breasts by noting any changes in their appearance and palpating the breast and the underarm region. A complete physical exam may be done as well. If symptoms or results of these exams suggest cancer might be present, then further tests will be done. (Note: The following diagnostic procedures are common to the US; procedures may vary in other countries.)
Image by TheVisualMD
How Is Breast Cancer Diagnosed?
Doctors often use additional tests to find or diagnose breast cancer. They may refer women to a breast specialist or a surgeon. This does not mean that she has cancer or that she needs surgery. These doctors are experts in diagnosing breast problems.
Breast ultrasound. A machine that uses sound waves to make detailed pictures, called sonograms, of areas inside the breast.
Diagnostic mammogram. If you have a problem in your breast, such as lumps, or if an area of the breast looks abnormal on a screening mammogram, doctors may have you get a diagnostic mammogram. This is a more detailed X-ray of the breast.
Magnetic resonance imaging (MRI). A kind of body scan that uses a magnet linked to a computer. The MRI scan will make detailed pictures of areas inside the breast.
Biopsy. This is a test that removes tissue or fluid from the breast to be looked at under a microscope and do more testing. There are different kinds of biopsies (for example, fine-needle aspiration, core biopsy, or open biopsy).
Staging
If breast cancer is diagnosed, other tests are done to find out if cancer cells have spread within the breast or to other parts of the body. This process is called staging. Whether the cancer is only in the breast, is found in lymph nodes under your arm, or has spread outside the breast determines your stage of breast cancer. The type and stage of breast cancer tells doctors what kind of treatment you need. For more information, visit Stages of Breast Cancer.
Source: Centers for Disease Control and Prevention (CDC)
Additional Materials (18)
Breast MRI
Title MRI of Breast Description Color-enhancement show magnetic resonance image (MRI) of individual breast.
Image by Dr. Steven Harmes. Baylor University Medical Center, Dallas Texas / NCI
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Screening for Cancer
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Dividing Breast Cancer Cell
This image shows a triple-negative breast cancer cell (MDA-MB-231) in metaphase during cell division. Tubulin in red; mitochondria in green; chromosomes in blue. A better understanding of how mitochondria play roles in tumor cell division may provide new therapeutic targeting strategies to stop tumor cell growth.
This image was originally submitted as part of the 2016 NCI Cancer Close Up project. This image is part of the NCI Cancer Close Up 2016 collection.
Image by National Cancer Institute \ Univ. of Pittsburgh Cancer Institute / Wei Qian
Ultrasound Guided Breast Biopsy 1 / Ultrasound Guided Breast Biopsy 2
Breast Cancer - Ultrasound Guided Breast Biopsy
Ultrasound image of possible breast tumor before biopsy. The procedure is performed by a radiologist and sonographer. A local anesthetic is injected into the breast. The transducer is pressed to the breast and the suspicious area is located. The biopsy needle is inserted in the breast and guided in realtime by watching its movement through the breast on a computer monitor. The tissue sample is taken and the needle is removed.
Interactive by TheVisualMD
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Nanoclusters in Breast Tumor
Nanoclusters are made when different nanoparticles and agents are linked together. Gold nanoparticles were linked to a short protein (DAPTA peptide) that binds to C-C chemokine receptor type 5 (CCR5), as well as a PET imaging agent, 64Cu. CCR5 has been identified as a biomarker for triple-negative breast cancer. This PET/CT image of the targeted gold nanocluster (64Cu-AuNCs-DAPTA) was acquired 24 hours after intravenous injection in a mouse model of triple-negative breast cancer. The image shows specific tumor accumulation of the nanoclusters (left side, contrast area).
This image is part of the following collections:
NCI Cancer Close Up 2017
Nanotechnology Image Library
Image by National Cancer Institute \ Washington University in St. Louis / Yongjian Liu, Samuel Achilefu
Lymph Nodes
Lymph Nodes
Lymph Nodes
Lymph Nodes
1
2
3
4
Breast Lymph Nodes
Lymph vessels form a network in each breast, draining into lymph nodes in the underarm and along the breast bone. Cancer cells may break away from the main tumor and spread to other parts of the body through the lymphatic system.
Interactive by TheVisualMD
Mammography
Mammogram: Normal Vs. Cancerous Comparison
Image by NIH
Screening for Cancer
Common Screening Tests and American Cancer Society Recommendations Breast cancer
Mammography: Women 40 and older should have a mammogram every year.
Clinical breast exam (breast exam performed by a medical professional): Women age 20-40 should have one every 3 years. Women 40 and older should have one every year.
Breast self-exam: Women age 20 and older should perform one each month (considered optional).
If you have a family history of breast cancer, talk to your healthcare professional about what type of screening you should have, and how often.
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Breast Cancer and family history
Image by acousticsoul215/Pixabay
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Spread of Breast Cancer
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Breast cancer incidence by anatomical site (females)
The largest proportion of breast cancer cases occur in the upper-outer quadrant of the breast, with much smaller proportions in the upper-inner, lower-outer and lower-inner quadrants, and the central portion of the breast (2010-2012).
Based on a Cancer Research UK graphic published in 2016.
http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer/incidence-invasive#heading-Five
Original sources: cruk.org, 2016; Data provided on request - ONS 2014; ISD Scotland, 2014; Welsh Cancer Intelligence and Surveillance Unit, Northern Ireland Cancer Registry, 2014
Image by Cancer Research UK uploader/Wikimedia
Breast MRI with Axillay Lymph Nodes axial cross section
Breast MRI image, axial cross section, of the female thorax at the level of the 4th-5th thoracic vertebrae. The breasts are prominently shown along with the axillary lymph nodes sandwiched between the pectoralis major and minor muscles in the front and the muscles of the upper arm and scapula in the back. The arch of the aorta is located in the center of the image with the lungs on either side. Breast cancer often travels from the breast tissue through the lymph vessels to the axillary lymph nodes.
Image by TheVisualMD
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Cancer and Wellness
Voyage deep inside your body to see, on a cellular level, why 1 in 2 men and 1 in 3 women will be diagnosed with cancer during their lifetime. Watch a cell reproducing normally and a breast cancer cell dividing out of control. Dr. Jeremy Geffen, oncologist, and Dr. Kevin Gardner of the National Cancer Institute explain that damaged DNA causes cancer-and every cell in your body undergoes 10,000 DNA damage events each day. Dr. Candace Pert, neuroscientist, and Dr. Mark Liponis of Canyon Ranch talk about why cancer represents an immune system failure. Most of your risk for cancer is due to lifestyle factors. Watch as fat cells balloon in size and learn how they secrete cancer-inducing chemicals. View breast and colon cancer inside the body. Find out how you can dramatically decrease your risk of cancer.
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Prophylactic Mastectomy
types of mutations on BRCA2
Image by NCI
Early signs of breast cancer.
Early signs of breast cancer.
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When Things Go Wrong
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When Things Go Wrong
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Breast MRI (VIDEO)
Dr. Nora Jaskowiak of The University of Chicago Medical Center explains why Magnetic Resonance Imaging, or MRI, is a critical tool in her role as breast surgeon.
Image by TheVisualMD
Breast MRI
Dr. Steven Harmes. Baylor University Medical Center, Dallas Texas / NCI
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Screening for Cancer
TheVisualMD
Dividing Breast Cancer Cell
National Cancer Institute \ Univ. of Pittsburgh Cancer Institute / Wei Qian
Breast Cancer - Ultrasound Guided Breast Biopsy
TheVisualMD
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Nanoclusters in Breast Tumor
National Cancer Institute \ Washington University in St. Louis / Yongjian Liu, Samuel Achilefu
Breast Lymph Nodes
TheVisualMD
Mammography
NIH
Screening for Cancer
TheVisualMD
Breast Cancer and family history
acousticsoul215/Pixabay
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Spread of Breast Cancer
TheVisualMD
Breast cancer incidence by anatomical site (females)
Cancer Research UK uploader/Wikimedia
Breast MRI with Axillay Lymph Nodes axial cross section
TheVisualMD
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Cancer and Wellness
TheVisualMD
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Prophylactic Mastectomy
NCI
Early signs of breast cancer.
Morning2k
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When Things Go Wrong
TheVisualMD
When Things Go Wrong
TheVisualMD
Breast MRI (VIDEO)
TheVisualMD
Breast Biopsy
Breast Biopsy
Also called: Biopsy of the Breast, Breast Biopsy
A breast biopsy is a test that can confirm or rule out breast cancer. It is used if other breast tests or a physical exam show you might have breast cancer. There are three main types of breast biopsy procedures: fine-needle aspiration, core needle biopsy, and surgical biopsy.
Breast Biopsy
Also called: Biopsy of the Breast, Breast Biopsy
A breast biopsy is a test that can confirm or rule out breast cancer. It is used if other breast tests or a physical exam show you might have breast cancer. There are three main types of breast biopsy procedures: fine-needle aspiration, core needle biopsy, and surgical biopsy.
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Use the slider below to see how your results affect your
health.
Your result is Normal.
A normal biopsy means that no cancer or abnormal cells were found.
Related conditions
A breast biopsy is a procedure that removes a sample of breast tissue so that it can be checked for signs of disease. A doctor called a pathologist looks at the tissue under a microscope to diagnose breast cancer and other breast diseases.
Breast cancer is cancer that forms in the milk ducts (tubes that carry milk to the nipple) and the lobules (the small lobes of breast tissue that make milk). Breast cancer is much more common in women, but men can get it, too. Not much is known about breast cancer risk in transgender people. If you are transgender, talk with your provider about your risk.
There are different ways to do a breast biopsy. Some methods remove breast tissue with a needle and others use a small incision (cut) in your skin to remove part or all of the suspicious tissue.
Most people who need a breast biopsy don't have cancer.
Other names: core needle biopsy; core biopsy, breast; fine-needle aspiration; open surgery biopsy
A breast biopsy is the only way to find out whether a suspicious change in your breast is cancer. You may have a biopsy after other breast tests, such as a physical breast exam or a mammogram, show signs that could be breast cancer.
You may need a breast biopsy if:
You or your health care provider felt a lump, thickening, or other change in your breast.
A mammogram, ultrasound, or MRI test shows a lump, calcium deposits, or other signs that might mean cancer.
The skin on your breast or nipple is red, scaly, or swollen, or your nipple is pulled inward.
You have a discharge of abnormal fluid coming from your nipple.
If your provider suggests that you have a breast biopsy, it doesn't mean you have breast cancer. Most breast lumps and other changes that are checked with biopsies turn out to be benign, which means they are not cancer.
There are three main types of breast biopsy procedures. They are usually done on an outpatient basis, which means you go home the same day:
Fine needle aspiration biopsy uses a very thin needle to remove a sample of breast cells or fluid. The biopsy takes about 15 minutes.
Core needle biopsy uses a wide needle to remove one or more small tissue samples about the size of a grain of rice. Sometimes a small vacuum probe is used instead of a needle. The device gently suctions some tissue and removes it with a small rotating blade. A core needle biopsy takes between 15 minutes and an hour, depending on how it's done.
Surgical biopsy (or open biopsy) is surgery to remove all or part of a lump. The biopsy usually takes about an hour.
Biopsies are often done using mammography, ultrasound, MRI, or x-rays to help see exactly where to take the tissue sample. Your procedure will vary depending on which method is used to guide the biopsy, but the general steps are usually the same.
For a fine needle aspiration biopsy or a core needle biopsy:
Your provider will clean the skin on your breast and give you a shot of medicine to numb the area, so you won't feel any pain. The shot may sting briefly.
You may be sitting or lying down. If images are used to guide the biopsy, you may lie on your side, back, or belly with your breast over an opening on the table.
For a fine needle aspiration biopsy, your provider will insert the needle into the biopsy site and remove a sample of cells or fluid. For a core biopsy, a tiny cut may be made to insert a wide needle or a vacuum device. You may feel a little pressure when the sample or samples are removed.
Pressure will be applied to area until the bleeding stops.
Your provider will cover the biopsy site with a sterile bandage. If you had a small incision, small strips of medical tape may be used to close the wound.
For a surgical biopsy:
You'll lie on an operating table. You may have an IV (intravenous line) in your arm or hand that may be used to give you medicine to relax. The skin over the biopsy area will be cleaned.
To prevent pain, you'll have either:
A shot of medicine to numb your breast. The shot may sting briefly.
General anesthesia, which is medicine given through an IV to make you sleep.
When you are numb or asleep, the surgeon will make a small cut in your breast tissue to remove part or all of the lump. In certain cases, tissue around the lump may also be removed. This may help avoid the need for more surgery if cancer cells are found in the lump.
The cut in your skin will be closed with small strips of medical tape or stitches and covered with a sterile bandage.
The type of biopsy you have will depend on:
The size and location of the suspicious tissue in your breast
How many areas of your breast are involved
How abnormal the tissue looks on a mammogram or other image
Your general health and preferences
Ask your provider about why you need a biopsy and which type is right for you.
Your provider will give you instructions for how to prepare for your biopsy. If you take any blood thinners, including aspirin, you may need to stop taking them before your biopsy. Tell your provider about all the medicines and supplements you take. Don't stop or start taking anything without talking with your provider first.
If you're having general anesthesia, you will probably need to fast (not eat or drink) for several hours before surgery. If you have general anesthesia or medicine to relax, you may be groggy after the procedure, so plan to have someone take you home.
It's common to have some bruising and temporary discomfort after a breast biopsy. Possible risks include:
Infection, which can be treated with antibiotics
Bleeding
Your provider will give you instructions for how to care for biopsy area and manage any discomfort. If you're having general anesthesia, talk with your provider about how it may affect you. General anesthesia is very safe even for most people with other health conditions.
It may take several days to a week to get your biopsy results. The results are called a pathology report. The report is written for your provider and will include a lot of medical terms. Your provider can explain what your report means.
The most important part of your report will be the diagnosis. In general, your results will be one of these categories:
Normal. No cancer or abnormal cells were found.
Abnormal breast changes that aren't cancer and don't increase your risk for breast cancer. Some of these conditions often get better on their own and others may need treatment.
Abnormal breast changes that increase your risk for breast cancer. These cells are not cancer, but if you have them, you are more likely to develop cancer.
If you had a needle biopsy that diagnosed a condition that increases your breast cancer risk, you may need a surgical biopsy to remove all the abnormal tissue. To find out what you can do to reduce your breast cancer risk, you will likely see a doctor who specializes in breast cancer.
Breast cancer. If your biopsy finds cancer cells, your report will include details about how fast the cancer cells are growing, how much they look like normal cells, and other information to help plan the most effective treatment for your type of cancer. Usually, a doctor who specializes in breast cancer will provide your care.
Breast Biopsy: MedlinePlus Medical Test [accessed on Mar 22, 2022]
Having a Breast Biopsy | Effective Health Care (EHC) Program [accessed on Mar 22, 2022]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (13)
PreOp® Breast Biopsy Wire Guide Patient Education - Patient Engagement
Video by PreOp.com Patient Engagement - Patient Education/YouTube
How a core breast biopsy is taken
Video by Bupa Health UK/YouTube
Stereotactic Biopsies for Breast Evaluation | UPMC Magee-Womens Hospital
Video by UPMC/YouTube
What It’s Like to Get a Breast Biopsy
Video by RAYUS Radiology™/YouTube
Ultrasound-guided core-needle breast biopsy
Video by Institute for Cancer Genetics and Informatics/YouTube
Having a breast biopsy. A review of the research for women and thier families (2016 report)
This information is right for you if: -- You are a woman. The information in this summary is from
research on women. -- Your doctor has found a breast lump or shadow on your mammogram and has recommended a breast biopsy.
Document by effectivehealthcare.ahrq.gov
Ultrasound Guided Breast Biopsy 1
Ultrasound image of possible breast tumor before biopsy. The procedure is performed by a radiologist and sonographer. A local anesthetic is injected into the breast. The transducer is pressed to the breast and the suspicious area is located. The biopsy needle is inserted in the breast and guided in realtime by watching its movement through the breast on a computer monitor. The tissue sample is taken and the needle is removed.
Image by TheVisualMD
Ultrasound Guided Breast Biopsy 2
Ultrasound image of possible breast tumor showing core needle penetrating suspicious breast lesion during biopsy. The procedure is performed by a radiologist and sonographer. A local anesthetic is injected into the breast. The transducer is pressed to the breast and the suspicious area is located. The biopsy needle is inserted in the breast and guided in realtime by watching its movement through the breast on a computer monitor. The tissue sample is taken and the needle is removed.
Image by TheVisualMD
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Needle Biopsy
Adult Black female breast visible. Physician's hands are seen performing a needle biopsy to determine nature of lump either fluid-filled cyst or solid tumor.
Image by National Cancer Institute / Linda Bartlett (Photographer)
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Biopsy
A Caucasian woman patient is being operated on. Her nipple is being incised by the surgeon. The male surgeon and an operating room attendant are visible. A surgical biopsy is being performed to determine exact nature of solid tumor.
Image by National Cancer Institute / Linda Bartlett (Photographer)
Breast Biopsy
Image Caption : Needle Breast Biopsy
Image by BruceBlaus
Mammotome
Mammotome probe - biopsy
Image by Waglione/Wikimedia
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Breast Cancer Biopsy
If a woman has symptoms of breast cancer (such as a lump), or if a suspicious area is found in an imaging exam, the next step is to physically examine the breasts by noting any changes in their appearance and palpating the breast and the underarm region. A complete physical exam may be done as well. If symptoms or results of these exams suggest cancer might be present, then further tests will be done. (Note: The following diagnostic procedures are common to the US; procedures may vary in other countries.)
Video by TheVisualMD
2:22
PreOp® Breast Biopsy Wire Guide Patient Education - Patient Engagement
Stereotactic Biopsies for Breast Evaluation | UPMC Magee-Womens Hospital
UPMC/YouTube
3:57
What It’s Like to Get a Breast Biopsy
RAYUS Radiology™/YouTube
1:29
Ultrasound-guided core-needle breast biopsy
Institute for Cancer Genetics and Informatics/YouTube
Having a breast biopsy. A review of the research for women and thier families (2016 report)
effectivehealthcare.ahrq.gov
Ultrasound Guided Breast Biopsy 1
TheVisualMD
Ultrasound Guided Breast Biopsy 2
TheVisualMD
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Needle Biopsy
National Cancer Institute / Linda Bartlett (Photographer)
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Biopsy
National Cancer Institute / Linda Bartlett (Photographer)
Breast Biopsy
BruceBlaus
Mammotome
Waglione/Wikimedia
0:56
Breast Cancer Biopsy
TheVisualMD
Sentinel Lymph Node Biopsy
Sentinel Lymph Node Biopsy
Also called: SLNB, Biopsy of the Sentinel Lymph Node, Lymph Node Biopsy, Sentinel Node Biopsy, Sentinel Lymph Node Mapping and Biopsy, Sentinel Lymph Node Biopsy
A sentinel lymph node biopsy is a test that checks lymph nodes for cancer cells. Some cancers, such as breast cancer and melanoma, can spread through the lymphatic system. The sentinel lymph node is the first node where a cancer usually spreads. The test can show whether your cancer is likely to spread.
Sentinel Lymph Node Biopsy
Also called: SLNB, Biopsy of the Sentinel Lymph Node, Lymph Node Biopsy, Sentinel Node Biopsy, Sentinel Lymph Node Mapping and Biopsy, Sentinel Lymph Node Biopsy
A sentinel lymph node biopsy is a test that checks lymph nodes for cancer cells. Some cancers, such as breast cancer and melanoma, can spread through the lymphatic system. The sentinel lymph node is the first node where a cancer usually spreads. The test can show whether your cancer is likely to spread.
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Use the slider below to see how your results affect your
health.
Your result is Negative.
If your results are negative, it means no cancer cells were found, and it's unlikely that the cancer has spread. You will not need to have any more lymph nodes removed.
Related conditions
Breast cancer
Melanoma
Penile cancer
Endometrial cancer
A sentinel lymph node biopsy (SLNB) is a surgical procedure that checks your lymph nodes for cancer cells. An SLNB is only done if you have already been diagnosed with cancer. This procedure finds, removes, and checks the sentinel lymph node to determine the stage of your cancer. Cancer staging is usually based on the size of your tumor and whether the cancer has spread (metastasized) to nearby areas, lymph nodes, or other parts of your body. Knowing the stage of your cancer can help your health care provider plan the best treatment for you.
Your lymph nodes are located throughout your body, including your underarms, neck, chest, abdomen (belly), and groin. They are part of the lymphatic system, which helps to protect you from illness and maintain healthy fluid levels in your body.
Your lymphatic system is part of your body’s immune system. Your lymph fluid carries fluid and cells throughout your body to help fight infections. It may also filter cancer cells (if there are any). But sometimes, with certain cancers such as breast cancer and melanoma (the most serious type of skin cancer), some cancer cells may spread to your lymph nodes.
Cancers spread when cells break off from the original (primary) tumor and are carried by the lymphatic system to other parts of your body. The sentinel lymph node is the first lymph node where these types of cancers are most likely to spread. It’s usually located near the original tumor site and may receive drainage from the tumor. Your provider tests your sentinel lymph node to see if your cancer has spread. Sometimes, you may have more than one sentinel lymph node.
Other names: lymph node biopsy, sentinel node biopsy, sentinel lymph node mapping and biopsy
A sentinel lymph node biopsy is used to find out whether an early-stage cancer has spread through your lymphatic system to your lymph nodes or other parts of your body. It’s most often used for people who have breast cancer or melanoma and is usually done when the tumor is being removed.
You may need this test if you've been diagnosed with breast cancer, melanoma, or certain other types of cancer. It can show whether your cancer is spreading and help your provider create the best treatment plan for you.
A sentinel lymph node biopsy may be done in a hospital or an outpatient surgical center. The procedure usually includes a special type of imaging test called lymphoscintigraphy. Lymphoscintigraphy may also be called lymph node mapping. It is the process of taking pictures of your lymphatic system to locate the sentinel lymph node. The procedure includes the following steps:
Your provider will apply medicine to numb the skin over the procedure area.
You will be injected with a small amount of a radioactive substance called a tracer near the tumor. The tracer will travel and collect in the sentinel lymph node, or nodes. You may also be injected with a blue dye that stains the lymph node, making it easier to see.
You will be given general anesthesia. General anesthesia is a medicine that makes you unconscious. It makes sure you won't feel any pain during the surgery. A specially trained doctor called an anesthesiologist will give you this medicine.
Once you’re unconscious, a camera will take images of the area. The camera finds and records the location of the tracer, which will have settled in the sentinel node.
The node will be removed and sent to a lab, where it will be checked for cancer cells. This part of the test is known as a biopsy.
The original tumor is also usually removed during the procedure.
You will probably need to fast (not eat or drink) for several hours before the test. You may also need to stop taking blood thinners, such as aspirin, for a certain time before your test. Your provider will let you know when you need to stop taking your medicine and anything else to do to prepare for the test.
In addition, be sure to arrange for someone to take you home. You may be groggy and confused after you wake up from the procedure.
You may have a little bleeding, pain, or bruising at the biopsy site.
There is also a small risk of infection, which can be treated with antibiotics.
Allergic reactions to the tracer are rare and usually mild.
If only the sentinel lymph node is removed, there is a low risk of lymphedema (swelling, usually of the arms or legs) from the lymph fluid. The risk increases with the number of lymph nodes removed.
There is very little exposure to radiation in a sentinel lymph node biopsy. While radiation exposure from the tracer in a sentinel lymph node biopsy is safe for most adults, it can be harmful to a developing baby. So be sure to tell your provider if you are pregnant or think you may be pregnant.
The results will be given as positive or negative.
If your results are positive, it means cancer was found in the sentinel lymph node and may have spread to nearby lymph nodes and/or other organs. Your provider may recommend removing and testing more lymph nodes to check for cancer cells.
If your results are negative, it means no cancer cells were found in the sentinel lymph node, and it's unlikely that the cancer has spread. You will not need to have any more lymph nodes removed.
If you have questions about your results, talk to your provider.
While sentinel lymph node biopsies are mostly used to stage breast cancer or melanoma, it is sometimes used for penile and uterine cancer. It is also being studied for use with other types of cancer, including:
Colon cancer
Stomach cancer
Thyroid cancer
Non-small cell lung cancer
Sentinel Lymph Node Biopsy: MedlinePlus Medical Test [accessed on Oct 18, 2024]
Sentinel Lymph Node Biopsy - NCI. National Cancer Institute. Jun 25, 2019 [accessed on Feb 03, 2024]
Melanoma: Tests After Diagnosis - Health Encyclopedia - University of Rochester Medical Center [accessed on Feb 03, 2024]
Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."
Additional Materials (50)
Sentinel Lymph Node Biopsy of the Breast
Sentinel lymph node biopsy of the breast. The first of three panels shows a radioactive substance and/or blue dye injected near the tumor; the middle panel shows that the injected material is followed visually and/or with a probe that detects radioactivity to find the sentinel nodes (the first lymph nodes to take up the material); the third panel shows the removal of the tumor and the sentinel nodes to check for cancer cells.
Sentinel lymph node biopsy of the breast. A radioactive substance and/or blue dye is injected near the tumor (first panel). The injected material is detected visually and/or with a probe that detects radioactivity (middle panel). The sentinel nodes (the first lymph nodes to take up the material) are removed and checked for cancer cells (last panel).
Sentinel Lymph Node & Axillary Lymph Node Procedures for Breast Cancer - Mayo Clinic
Video by Mayo Clinic/YouTube
Surgery for Melanoma Patients: Sentinel Lymph Node Biopsy and Complete Lymph Node Dissection
Video by American Cancer Society/YouTube
Sentinel Node Biopsy: Breast Cancer Lymph Node Surgery
Video by Breast Cancer School for Patients/YouTube
Sentinel Lymph Node Mapping for Gynecologic Cancers
Video by Memorial Sloan Kettering/YouTube
Introduction to the Lymphatic System
Video by Osmosis/YouTube
Lymphatic System, Part 2
Video by Tammy Moore/YouTube
The Lymphatic System, Part 1
Video by Tammy Moore/YouTube
The lymphatic system's role in immunity | Lymphatic system physiology | NCLEX-RN | Khan Academy
Video by khanacademymedicine/YouTube
lymphatic system
Diagram of the lymphatic system.
Image by Cancer Research UK / Wikimedia Commons
Lymphatic System
Lymphatic System
Image by NIH
Lymph Node of Head and Neck
3D visualization reconstructed from scanned human data of male revealing lymphatic structures (lacrimal glands, tonsils, salivary glands, thymus, subclavian veins axillary nodes, stomach, cisterna chyli). The lymphatic system works in concert with the immune system. It can be described as an extensive network of vessels that shuttle molecular waste-filled fluid (lymph) through purifiying centers called lymph nodes.
Image by TheVisualMD
Lymphatic, circulatory and nervous systems
The systems of the human body consist of: circulatory, digestive, endocrine, immune/lymphatic, integumentary, muscular, reproductive, skeletal, urinary. This image depicts the circulatory, endocrine, immune/lymphatic, nervous
Image by TheVisualMD
Babies Sitting Showing Respiratory Lymphatic Circulatory and Skeletal Systems
One of the most obvious ways that we notice the overall immune health of a baby is through the presence or absence of respiratory infections. Respiratory illness is the leading cause of hospitalization among young children. Lymph nodes and vessels are a direct component of the immune system. Lymph nodes are encapsulated bundles of lymph tissue found throughout the body especially in the neck, axillae, groin, and thoracic regions. Lymph tissue aids the immune system by collecting and breaking down toxins and other waste products of the body. Lymph vessels transport lymph, a clear fluid derived from intercellular spaces around the body, eventually back into the blood. An infant's circulatory system will face an olympian job over the course of the individual's lifetime; the heart will beat 2.5 billion times and pump millions of gallons of blood through the body's vast network of arteries and veins. An infant's heart doubles in size the first year of life. Nutrition plays a key role in the development and maintenance of a healthy circulatory system by providing building blocks such as iron needed for red blood cell production.
Image by TheVisualMD
Lymphatic System
Lymphatic Trunks and Ducts System
Image by OpenStax College
Babies Sitting Showing Respiratory Lymphatic Circulatory and Skeletal Systems
One of the most obvious ways that we notice the overall immune health of a baby is through the presence or absence of respiratory infections. Respiratory illness is the leading cause of hospitalization among young children. Lymph nodes and vessels are a direct component of the immune system. Lymph nodes are encapsulated bundles of lymph tissue found throughout the body especially in the neck, axillae, groin, and thoracic regions. Lymph tissue aids the immune system by collecting and breaking down toxins and other waste products of the body. Lymph vessels transport lymph, a clear fluid derived from intercellular spaces around the body, eventually back into the blood. An infant's circulatory system will face an olympian job over the course of the individual's lifetime; the heart will beat 2.5 billion times and pump millions of gallons of blood through the body's vast network of arteries and veins. An infant's heart doubles in size the first year of life. Nutrition plays a key role in the development and maintenance of a healthy circulatory system by providing building blocks such as iron, needed for red blood cell production.
Image by TheVisualMD
In Defense of You: Your Immune System
Image by TheVisualMD
Lymph Node and Lymph interstitial fluid
Lymph Node and Vasculature: The image shows a human lymph node and its vasculature (blood vessels). Lymph nodes are encapsulated bundles of lymph tissue found throughout the body, especially in the neck, armpit, groin, lung, and aortic areas. These aggregations of lymph tissue aid the immunological system by collecting and breaking down toxins and other waste products of the body.
Image by TheVisualMD
Lymph Node with Vasculature
Computer generated illustration of a human lymph node and its vasculature. Lymph nodes are encapsulated bundles of lymph tissue found throughout the body especially in the neck, axillae, groin, lung and aortic areas. These aggregations of lymph tissue aid the immunological system by collecting and breaking down toxins and other waste products of the body.
Image by TheVisualMD
Immune System and Autoimmune Diseases
Normally, an individual's immune system learns to identify and ignore all of the distinctive little structures found on that individual's own cells. Sometimes, however, it will make a mistake and identify its own body as foreign. If that happens, the immune system produces antibodies that attempt to destroy the body's own cells in the same way it would try to destroy a foreign invader.
Lymph Node Biopsy : When breast cancer spreads beyond the primary tumor site, it usually spreads first to the sentinel lymph node or nodes, the first lymph nodes to receive drainage from a cancer-containing area of the breast. From there, breast cancer generally spreads to the axillary lymph nodes under the arm. So an important part of the breast cancer staging process is to determine whether the cancer has spread from the primary tumor to the sentinel lymph node, and from there into the axillary lymph nodes.
Image by TheVisualMD
Lymph Node Biopsy
Lymph Node Biopsy : When breast cancer spreads beyond the primary tumor site, it usually spreads first to the sentinel lymph node or nodes, the first lymph nodes to receive drainage from a cancer-containing area of the breast. From there, breast cancer generally spreads to the axillary lymph nodes under the arm. So an important part of the breast cancer staging process is to determine whether the cancer has spread from the primary tumor to the sentinel lymph node, and from there into the axillary lymph nodes.
Image by TheVisualMD
Lymph Node Biopsy
Lymph Node Biopsy : When breast cancer spreads beyond the primary tumor site, it usually spreads first to the sentinel lymph node or nodes, the first lymph nodes to receive drainage from a cancer-containing area of the breast. From there, breast cancer generally spreads to the axillary lymph nodes under the arm. So an important part of the breast cancer staging process is to determine whether the cancer has spread from the primary tumor to the sentinel lymph node, and from there into the axillary lymph nodes.
Image by TheVisualMD
Sentinel Lymph Node Biopsy
This is a picture of the first radio-guided sentinel lymph node biopsy using real-time imaging by means of a portable gamma camera (Sentinella) in a patient with colon cancer
The lobes and ducts of the breast, and nearby lymph nodes (above) are areas that cancer can attack. The temporary inconvenience of a mammogram can save you from troublesome and costly treatment and surgery by catching breast cancer early, when it is easiest to treat.
Image by NIH
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Breast Cancer Surgery
Breast surgeon Dr. Nora Jaskowiak of The University of Chicago Medical Center explains how far mastectomies and other breast surgeries have come and the impact on the patient's life.
Image by TheVisualMD
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Mastectomy (Simple)
Title Mastectomy (Simple) Description Treatment for breast cancer - removal of breast and a sample of underarm lymph nodes.
Image by National Cancer Institute / Linda Bartlett (Photographer)
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Mastectomy
Total (simple) Mastectomy Description Total (simple) mastectomy; drawing shows removal of the breast and lymph nodes. The dotted line shows where the entire breast is removed. Some lymph nodes under the arm may also be removed.
Image by National Cancer Institute
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Radical Mastectomy
Mastectomy (Radical) Description Halsted radical mastectomy. Removal of the entire breast and chest muscles, as well as lymph nodes in underarm area for the treatment of breast cancer.
Image by National Cancer Institute / Linda Bartlett (Photographer)
Front view of the breast
Diagram showing the front view of the breast.
Image by Centers for Disease Control and Prevention (CDC)
Side view of the breast
Diagram showing the side view of the breast.
Image by Centers for Disease Control and Prevention (CDC)
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Breast and adjacent lymph nodes
Illustration of Breast and Adjacent Lymph Nodes Description: The female breast along with lymph nodes and vessels. An inset shows a close-up view of the breast with the following parts labeled: lobules, lobe, ducts, nipple, areola, and fat.
Image by National Cancer Institute, Don Bliss (Illustrator)
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Breast and Adjacent Lymph Nodes
The female breast (nipple, areola, ducts, lobes, lobules, and fatty tissue) and adjacent lymph nodes and lymph vessels (no labels appear in the illustration).
Image by National Cancer Institute (NCI) / Don Bliss (Illustrator)
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Human Epidermal Growth Factor Receptor 2 (HER2): Aggressive Breast Cancers
Most breast cancers begin in the lobules or ducts of the breast, which produce breast milk and carry it to the nipples after pregnancy. Invasive cancers spread outside of the lobules and ducts and penetrate into the surrounding breast tissue. From there, cancer cells may travel to lymph nodes in the armpit area. In stage IV breast cancer, cancer cells have spread into other parts of the body, such as the lungs or bones. HER2-positive breast cancer is aggressive and is likely to spread quickly. It is also resistant to hormone therapy. However, treatment with the drugs trastuzumab and/or lapatinib may help women who test positive for HER2.
Image by TheVisualMD
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Metastatic Breast Cancer in Pleural Fluid
Image by Ed Uthman/Flickr
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Diagram showing the network of lymph nodes in and around the breast.
Diagram showing the network of lymph nodes in and around the breast.
Image by Cancer Research UK / Wikimedia Commons
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Breast lobes and ducts
Diagram showing the lobes and ducts of a breast.
Image by Cancer Research UK / Wikimedia Commons
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Breast
Breast and Adjacent Lymph Nodes Description The female breast along with lymph nodes and vessels. An inset shows a close-up view of the breast with the following parts labeled: lobules, lobe, ducts, nipple, areola, and fat.
Image by National Cancer Institute
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Breast Anatomy
Breast Anatomy; observe lobes, lobules, ducts, areola, nipple, fat, lymph nodes and lymphatic vessels.
Image by National Cancer Institute / Don Bliss (Illustrator)
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External and Internal Anatomy of Breast
The breast is made up of a variety of tissues and structures, including fat, blood vessels, lymph vessels, ligaments, and nerves. The mammary gland is embedded in the breast's fatty tissue and contains 15-20 lobes, each of which is subdivided into smaller lobules. The breast milk that is produced drains from the lobes into the nipple via the lactiferous ducts.
Image by TheVisualMD
Lymph Nodes
Lymph Nodes
Lymph Nodes
Lymph Nodes
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Breast Lymph Nodes
Lymph vessels form a network in each breast, draining into lymph nodes in the underarm and along the breast bone. Cancer cells may break away from the main tumor and spread to other parts of the body through the lymphatic system.
Interactive by TheVisualMD
Sentinel Lymph Node Biopsy of the Breast
Sentinel lymph node biopsy of the breast. The first of three panels shows a radioactive substance and/or blue dye injected near the tumor; the middle panel shows that the injected material is followed visually and/or with a probe that detects radioactivity to find the sentinel nodes (the first lymph nodes to take up the material); the third panel shows the removal of the tumor and the sentinel nodes to check for cancer cells.
Sentinel lymph node biopsy of the breast. A radioactive substance and/or blue dye is injected near the tumor (first panel). The injected material is detected visually and/or with a probe that detects radioactivity (middle panel). The sentinel nodes (the first lymph nodes to take up the material) are removed and checked for cancer cells (last panel).
Biomarker testing is used to find out whether breast cancer cells have certain receptors.
Healthy breast cells, and some breast cancer cells, have receptors (biomarkers) that attach to the hormones estrogen and progesterone. These hormones are needed for healthy cells, and some breast cancer cells, to grow and divide. To check for these biomarkers, samples of tissue containing breast cancer cells are removed during a biopsy or surgery. The samples are tested in a laboratory to see whether the breast cancer cells have estrogen or progesterone receptors.
Another type of receptor (biomarker) that is found on the surface of all breast cancer cells is called HER2. HER2 receptors are needed for the breast cancer cells to grow and divide.
For breast cancer, biomarker testing includes the following:
Estrogen receptor (ER). If the breast cancer cells have estrogen receptors, the cancer cells are called ER positive (ER+). If the breast cancer cells do not have estrogen receptors, the cancer cells are called ER negative (ER-).
Progesterone receptor (PR). If the breast cancer cells have progesterone receptors, the cancer cells are called PR positive (PR+). If the breast cancer cells do not have progesterone receptors, the cancer cells are called PR negative (PR-).
Human epidermal growth factor type 2 receptor (HER2/neu or HER2). If the breast cancer cells have larger than normal amounts of HER2 receptors on their surface, the cancer cells are called HER2 positive (HER2+). If the breast cancer cells have a normal amount of HER2 on their surface, the cancer cells are called HER2 negative (HER2-). HER2+ breast cancer is more likely to grow and divide faster than HER2- breast cancer.
Sometimes the breast cancer cells will be described as triple negative or triple positive.
Triple negative. If the breast cancer cells do not have estrogen receptors, progesterone receptors, or a larger than normal amount of HER2 receptors, the cancer cells are called triple negative.
Triple positive. If the breast cancer cells do have estrogen receptors, progesterone receptors, and a larger than normal amount of HER2 receptors, the cancer cells are called triple positive.
It is important to know the estrogen receptor, progesterone receptor, and HER2 receptor status to choose the best treatment. There are drugs that can stop the receptors from attaching to the hormones estrogen and progesterone and stop the cancer from growing. Other drugs may be used to block the HER2 receptors on the surface of the breast cancer cells and stop the cancer from growing.
Source: PDQ® Adult Treatment Editorial Board. PDQ Breast Cancer Treatment. Bethesda, MD: National Cancer Institute.
Additional Materials (4)
Hormone Receptor Positive Breast Cancer
Video by Dr. Susan Love Foundation/YouTube
Breast Cancer Sub-types - Triple Negative Breast Cancer
Video by Dr. Susan Love Foundation/YouTube
What Are Tumor Markers for Breast Cancer?
Video by Breast Cancer Answers®/YouTube
HER2-Positive
Video by Dr. Susan Love Foundation/YouTube
2:57
Hormone Receptor Positive Breast Cancer
Dr. Susan Love Foundation/YouTube
3:40
Breast Cancer Sub-types - Triple Negative Breast Cancer
Dr. Susan Love Foundation/YouTube
2:42
What Are Tumor Markers for Breast Cancer?
Breast Cancer Answers®/YouTube
3:39
HER2-Positive
Dr. Susan Love Foundation/YouTube
ER/PR Testing
Estrogen and Progesterone Receptor Tests
Also called: Breast Cancer Hormone Receptor Status, ER/PR Testing, ER/PR IHC Testing, ERPR, Hormone Receptor (HR) Status, ER/PR Status, Estrogen Receptor Status, Progesterone Receptor Status
Receptors are proteins that attach to certain substances. Estrogen receptor/progesterone receptor tests look for receptors that attach to the hormones estrogen and/or progesterone in breast cancer cells. Breast cancers that have these receptors often respond well to some types of treatments.
Estrogen and Progesterone Receptor Tests
Also called: Breast Cancer Hormone Receptor Status, ER/PR Testing, ER/PR IHC Testing, ERPR, Hormone Receptor (HR) Status, ER/PR Status, Estrogen Receptor Status, Progesterone Receptor Status
Receptors are proteins that attach to certain substances. Estrogen receptor/progesterone receptor tests look for receptors that attach to the hormones estrogen and/or progesterone in breast cancer cells. Breast cancers that have these receptors often respond well to some types of treatments.
{"label":"ER\/PR status reference range","description":"This test measures the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If there are more estrogen and progesterone receptors than normal, the cancer is called estrogen and\/or progesterone receptor positive. This type of breast cancer may grow more quickly. Test results are reported as ER\/PR-positive or -negative.","scale":"lin","step":0.25,"items":[{"flag":"negative","label":{"short":"ER\/PR\u2013","long":"Negative","orientation":"horizontal"},"values":{"min":0,"max":1},"text":"An ER\/PR-negative (also called a hormone receptor-negative or HR-) result means that your breast tumor does not have receptors for either estrogen (ER) or progesterone (PR). This means that you are not likely to benefit from treatment with hormonal therapy. About 25% of breast cancers have no hormone receptors.","conditions":[]},{"flag":"positive","label":{"short":"ER\/PR+","long":"Positive","orientation":"horizontal"},"values":{"min":1,"max":2},"text":"An ER\/PR-positive (also called a hormone receptor-positive or HR+) result means that your breast tumor has receptors for estrogen (ER) and\/or progesterone (PR). Therefore, you are likely to benefit from treatment with hormonal therapy. About 65% of breast cancers are both ER\/PR-positive.","conditions":["Hormone therapy for breast cancer"]}],"hideunits":true,"value":0.5}[{"negative":0},{"positive":0}]
Use the slider below to see how your results affect your
health.
Your result is Negative.
An ER/PR-negative (also called a hormone receptor-negative or HR-) result means that your breast tumor does not have receptors for either estrogen (ER) or progesterone (PR). This means that you are not likely to benefit from treatment with hormonal therapy. About 25% of breast cancers have no hormone receptors.
Related conditions
{"label":"ER status reference range","description":"This test measures the amount of estrogen receptors (proteins to which estrogen will bind) in cancer tissue. The result is reported as a percentage that tells you how many cells out of 100 stain positive for estrogen receptors \u2014 a number between 0% (none have receptors) and 100% (all have receptors). This may affect how the cancer is treated.","scale":"lin","step":1,"items":[{"flag":"normal","label":{"short":"Negative","long":"Negative","orientation":"horizontal"},"values":{"min":0,"max":1},"text":"A negative or normal result means that none or less than 1% of the cells stained positive for estrogen receptors. Cancers that have estrogen receptors are called ER-negative (or ER-) cancers. This result generally means that hormonal therapy will not be helpful in treating the cancer.","conditions":[]},{"flag":"borderline","label":{"short":"Low positive","long":"Low positive","orientation":"horizontal"},"values":{"min":1,"max":10},"text":"A low positive result means that less than 10% of the cells \u2014 or fewer than 1 in 10 \u2014 stained positive for estrogen receptors. These cancers may or may not respond to hormonal therapy.","conditions":[]},{"flag":"abnormal","label":{"short":"Positive","long":"Positive","orientation":"horizontal"},"values":{"min":10.1,"max":100},"text":"A positive or elevated result means that more than 10% \u2014 or more than 1 in 10 \u2014 stained positive for estrogen receptors. About 70%\u201380% of breast cancers in women and 90% in men are ER-positive (or ER+). This result generally means that hormonal therapy will be helpful in treating the cancer.","conditions":["Hormone therapy for breast cancer"]}],"units":[{"printSymbol":"%","code":"%","name":"percent"}],"hideunits":false,"value":0}[{"normal":0},{"borderline":0},{"abnormal":0}]
Use the slider below to see how your results affect your
health.
%
1
10
Your result is Negative.
A negative or normal result means that none or less than 1% of the cells stained positive for estrogen receptors. Cancers that have estrogen receptors are called ER-negative (or ER-) cancers. This result generally means that hormonal therapy will not be helpful in treating the cancer.
Related conditions
{"label":"PR status reference range","description":"This test measures the amount of progesterone receptors (proteins to which progesterone will bind) in cancer tissue. The result is reported as a percentage that tells you how many cells out of 100 stain positive for progesterone receptors \u2014 a number between 0% (none have receptors) and 100% (all have receptors). This may affect how the cancer is treated.","scale":"lin","step":1,"items":[{"flag":"normal","label":{"short":"Negative","long":"Negative","orientation":"horizontal"},"values":{"min":0,"max":1},"text":"A negative or normal result means that none or less than 1% of the cells stained positive for progesterone receptors. Cancers that have progesterone receptors are called PR-negative (or PR-) cancers. This result generally means that hormonal therapy will not be helpful in treating the cancer.","conditions":[]},{"flag":"abnormal","label":{"short":"Positive","long":"Positive","orientation":"horizontal"},"values":{"min":1,"max":100},"text":"A positive or elevated result means that more than 10% \u2014 or more than 1 in 10 \u2014 stained positive for progesterone receptors. Cancers that have progesterone receptors are called PR-positive (or PR+) cancers. This result generally means that hormonal therapy will be helpful in treating the cancer.","conditions":[]}],"units":[{"printSymbol":"%","code":"%","name":"percent"}],"hideunits":false,"value":0}[{"normal":0},{"abnormal":0}]
Use the slider below to see how your results affect your
health.
%
1
Your result is Negative.
A negative or normal result means that none or less than 1% of the cells stained positive for progesterone receptors. Cancers that have progesterone receptors are called PR-negative (or PR-) cancers. This result generally means that hormonal therapy will not be helpful in treating the cancer.
Related conditions
Estrogen receptor/progesterone receptor (ER/PR) tests are done on samples of your tissue that contain breast cancer cells. The tests check if your cancer cells have estrogen and progesterone receptors (proteins that estrogen and progesterone attach to). The results of the tests are used to help guide breast cancer treatment.
Receptors are special proteins inside or on the surface of cells. They can attach to certain substances in your blood, including estrogen and progesterone. Estrogen and progesterone are hormones (chemical messengers in your bloodstream that control the actions of certain cells or organs). These hormones play key roles in a woman's sexual development and reproductive functions. Men also have these hormones, but in much smaller amounts.
Breast cancer can affect both women and men. If a receptor attaches to estrogen and/or progesterone, the receptor may use that hormone to trigger certain breast cancer cells to grow.
ER/PR tests will show whether there are ER and/or PR receptors on your breast cancer cells. Test results are frequently referred to as the hormone receptor status. The different statuses include:
ER-positive (ER+): Cancers that have estrogen receptors (ER). Most breast cancers are ER-positive.
PR-positive (PR+): Cancers that have progesterone receptors (PR)
Hormone receptor-positive (HR+): Cancers with one or both receptor types.
HR-negative (HR-): Cancers without ER or PR receptors.
If your hormone receptor status shows you have one or both receptors on your cancer cells, you may respond well to certain treatments.
Other names: ER/PR IHC testing, hormone receptor status, hormone receptor test, ER/PR test
ER/PR tests are used to guide treatment for breast cancer patients.
You may need this test if you've been diagnosed with breast cancer. Knowing your hormone receptor status will help your health care provider decide how to treat it. If you have ER-positive, PR-positive, or HR-positive cancer, medicines that lower hormone levels or stop the hormones from helping cancer to grow can be very effective. If you have HR-negative cancer, these types of medicines won't work for you.
Your provider will need to take a sample of your breast tissue in a procedure called a breast biopsy. There are may ways to do a biopsy:
There are three main types of breast biopsy procedures. They are usually done on an outpatient basis, which means you go home the same day:
Fine needle aspiration biopsy uses a very thin needle to remove a sample of breast cells or fluid. The biopsy takes about 15 minutes.
Core needle biopsy uses a wide needle to remove one or more small tissue samples about the size of a grain of rice. Sometimes a small vacuum probe is used instead of a needle. The device gently suctions some tissue and removes it with a small rotating blade. A core needle biopsy takes between 15 minutes and an hour, depending on how it's done.
Surgical biopsy (or open biopsy) is surgery to remove all or part of a lump. The biopsy usually takes about an hour.
Biopsies are often done using mammography, ultrasound, MRI, or x-rays to help see exactly where to take the tissue sample. Your procedure will vary depending on which method is used to guide the biopsy, but the general steps are usually the same.
For a fine needle aspiration biopsy or a core needle biopsy:
Your provider will clean the skin on your breast and give you a shot of medicine to numb the area, so you won't feel any pain. The shot may sting briefly.
You may be sitting or lying down. If images are used to guide the biopsy, you may lie on your side, back, or belly with your breast over an opening on the table.
For a fine needle aspiration biopsy, your provider will insert the needle into the biopsy site and remove a sample of cells or fluid. For a core biopsy, a tiny cut may be made to insert a wide needle or a vacuum device. You may feel a little pressure when the sample or samples are removed.
Pressure will be applied to area until the bleeding stops.
Your provider will cover the biopsy site with a sterile bandage. If you had a small incision, small strips of medical tape may be used to close the wound.
For a surgical biopsy:
You'll lie on an operating table. You may have an IV (intravenous line) in your arm or hand that may be used to give you medicine to relax. The skin over the biopsy area will be cleaned.
To prevent pain, you'll have either:
A shot of medicine to numb your breast. The shot may sting briefly.
General anesthesia, which is medicine given through an IV to make you sleep.
When you are numb or asleep, the surgeon will make a small cut in your breast tissue to remove part or all of the lump. In certain cases, tissue around the lump may also be removed. This may help avoid the need for more surgery if cancer cells are found in the lump.
The cut in your skin will be closed with small strips of medical tape or stitches and covered with a sterile bandage.
The type of biopsy you have will depend on:
The size and location of the suspicious tissue in your breast
How many areas of your breast are involved
How abnormal the tissue looks on a mammogram or other image
Your general health and preferences
Ask your provider about why you need a biopsy and which type is right for you.
Your provider will give you instructions for how to prepare for your biopsy. If you take any blood thinners, including aspirin, you may need to stop taking them before your biopsy. Tell your provider about all the medicines and supplements you take. Don't stop or start taking anything without talking with your provider first.
If you're having general anesthesia, you will probably need to fast (not eat or drink) for several hours before surgery. If you have general anesthesia or medicine to relax, you may be groggy after the procedure, so plan to have someone take you home.
It's common to have some bruising and temporary discomfort after a breast biopsy. Possible risks include:
Infection, which can be treated with antibiotics
Bleeding
Your provider will give you instructions for how to care for biopsy area and manage any discomfort. If you're having general anesthesia, talk with your provider about how it may affect you. General anesthesia is very safe even for most people with other health conditions.
The results will show whether you have a hormone receptor-positive or negative type of cancer.
If your hormone receptor status is positive:
At least 1% of the cells in your sample have estrogen and/or progesterone receptors.
The cancer is using either estrogen or progesterone to grow. The higher the levels of receptors, the more effective certain medicines may be in treating your cancer.
These results may also be called hormone-sensitive, hormone receptor-positive, or HR-positive.
If your hormone receptor status is negative:
Less than 1% of the cells in your sample have receptors, so those medicines will not be effective.
These results may also be called hormone insensitive, receptor-negative, or HR-negative.
If you have questions about your results, talk to your provider. They may want to do other tests before making a diagnosis and planning the best treatment for you.
HER2 testing is often done at the same time as ER/PR testing to help guide treatment. HER2 is a protein involved in normal cell growth. It also helps certain types of cancer cells grow quickly. Cancers with large amounts of HER2 protein tend to grow quickly and spread to other parts of the body. Breast cancer cells with higher-than-normal levels of HER2 are called HER2-positive. Certain medicines, called HER2 targeted therapy, can block or slow HER2 proteins and help control these cancers. But these medicines won’t help cancers that don’t have high levels of HER2 proteins. So, HER2 tumor marker testing is necessary to find out if targeted therapy will be helpful.
Estrogen Receptor, Progesterone Receptor Tests: MedlinePlus Medical Test [accessed on Dec 22, 2023]
Breast Cancer Treatment - NCI. National Cancer Institute. Dec 6, 2023 [accessed on Dec 22, 2023]
Estrogen Receptor and Progesterone Receptor Test | Testing.com. Dec 3, 2021 [accessed on Dec 22, 2023]
Breast Cancer Hormone Receptor Status [accessed on Dec 22, 2023]
Immunohistochemical Test for Estrogen and Progesterone Receptors - Health Encyclopedia - University of Rochester Medical Center [accessed on Dec 22, 2023]
Additional Materials (6)
Hormone Receptor Positive Breast Cancer
Video by Dr. Susan Love Foundation/YouTube
Introduction to Cancer Biology (Part 1): Abnormal Signal Transduction
Video by Mechanisms in Medicine/YouTube
Breast cancer cells
Breast cancer cells typically have some combination of the estrogen receptor (ER), progesterone receptor (PR), and overexpressed HER2. But triple-negative breast cancer (TNBC) cells lack all three of these.
Image by National Cancer Institute
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Estrogen Receptor Assay
A culture dish containing frozen breast tissue. A technician's hands and test instruments are visible as well. This is used for analysis in estrogen receptor assay test. Results suggest whether removal of ovaries or use of antiestrogen drugs are likely to be effective.
Image by National Cancer Institute / Linda Bartlett (Photographer)
Using FFNP to “Light Up” Tumors
A new imaging test takes advantage of the fact that progesterone receptor levels in estrogen receptor-positive tumors go up in response to estrogen if the estrogen receptor is active. The test involves a PET scan that uses a radioactive tracer called FFNP, which binds specifically to progesterone receptors. When more progesterone receptors are present, the amount of FFNP taken up by tumor cells is greater and the signal from FFNP on a PET scan is stronger.
Image by National Cancer Institute
Circulating Progesterone May Increase Breast Cancer Risk
Research found that postmenopausal women with higher circulating progesterone levels experience a 16% increased risk of breast cancer. Additionally, associated risk from progesterone seemed to be modified by estradiol concentrations. Further research is needed to examine the relationship between progesterone and estradiol in breast cancer etiology and to validate these findings in diverse populations.
Image by National Cancer Institute (NCI)
2:57
Hormone Receptor Positive Breast Cancer
Dr. Susan Love Foundation/YouTube
7:47
Introduction to Cancer Biology (Part 1): Abnormal Signal Transduction
Mechanisms in Medicine/YouTube
Breast cancer cells
National Cancer Institute
Sensitive content
This media may include sensitive content
Estrogen Receptor Assay
National Cancer Institute / Linda Bartlett (Photographer)
Using FFNP to “Light Up” Tumors
National Cancer Institute
Circulating Progesterone May Increase Breast Cancer Risk
National Cancer Institute (NCI)
HER2 Testing
HER2 Tumor Marker Testing
Also called: Human Epidermal Growth Factor Receptor 2, HER2, HER2 Gene, ERBB2 Amplification, HER2 Overexpression, HER2/neu Tests, HER2/Neu Gene Status
HER2 genes there are and how much HER2 protein is made in a sample of tissue. These tests can help guide treatment choices for certain cancers of the breast, stomach, and esophagus.
HER2 Tumor Marker Testing
Also called: Human Epidermal Growth Factor Receptor 2, HER2, HER2 Gene, ERBB2 Amplification, HER2 Overexpression, HER2/neu Tests, HER2/Neu Gene Status
HER2 genes there are and how much HER2 protein is made in a sample of tissue. These tests can help guide treatment choices for certain cancers of the breast, stomach, and esophagus.
{"label":"HER2 overexpression reference range","description":"This test measures how much HER2 protein is made in a sample of tissue. IHC (immunohistochemistry staining assay) test results for cancer of the breast, stomach, or esophagus show the amount of HER2 protein as a score. The test is used to determine whether you can benefit from treatment with HER2-targeted drugs.","scale":"lin","step":1,"items":[{"flag":"negative","label":{"short":"HER2-negative","long":"HER2-negative","orientation":"horizontal"},"values":{"min":0,"max":2},"text":"0 (zero) or 1+ means that your cancer cells don't have too much HER2 protein. Your cancer is HER2-negative and will not respond to HER2-targeted therapy. Your provider will discuss other treatment options.","conditions":[]},{"flag":"borderline","label":{"short":"Equivocal","long":"Equivocal","orientation":"horizontal"},"values":{"min":2,"max":3},"text":"2+ means that the amount of HER2 protein is borderline. This may be reported as \"equivocal.\" It means the test result is not clear. You may need to have a different type of HER2 tumor marker test. The test may be done on the same tissue sample, or you may need to provide a new sample.","conditions":[]},{"flag":"positive","label":{"short":"HER2-positive","long":"HER2-positive","orientation":"horizontal"},"values":{"min":3,"max":5},"text":"3+ means that your cancer cells have too much HER2 protein. Your cancer is HER2-positive and is likely to respond to HER2-targeted therapy.","conditions":["HER2-targeted therapy"]}],"units":[{"printSymbol":"score","code":"{score}","name":"score"}],"hideunits":false,"value":1}[{"negative":0},{"borderline":0},{"positive":0}]
Use the slider below to see how your results affect your
health.
score
2
3
Your result is HER2-negative.
0 (zero) or 1+ means that your cancer cells don't have too much HER2 protein. Your cancer is HER2-negative and will not respond to HER2-targeted therapy. Your provider will discuss other treatment options.
Related conditions
{"label":"HER2\/neu gene status reference range","description":"This test checks for extra copies of <em>HER2<\/em> genes in cancer cells using the FISH (fluorescence in situ hybridization) technique. Results are reported as either positive (detected) or negative (not detected) for HER2 gene amplification. The test is used to determine whether you can benefit from treatment with HER2-targeted drugs.","scale":"lin","step":0.25,"items":[{"flag":"negative","label":{"short":"Negative","long":"Negative","orientation":"horizontal"},"values":{"min":0,"max":1},"text":"A negative or not detected result means that you don't have too many <em>HER2<\/em> genes in your cancer cells. HER2-targeted therapy won't help your cancer, so your provider will discuss other treatment options.","conditions":[]},{"flag":"positive","label":{"short":"Positive","long":"Positive","orientation":"horizontal"},"values":{"min":1,"max":2},"text":"A positive or detected result means that your cancer cells have too many <em>HER2<\/em> genes. HER2-targeted therapy is likely to help your cancer.","conditions":["HER2-targeted therapy"]}],"hideunits":true,"value":0.5}[{"negative":0},{"positive":0}]
Use the slider below to see how your results affect your
health.
Your result is Negative.
HER2 genes in your cancer cells. HER2-targeted therapy won't help your cancer, so your provider will discuss other treatment options.
Related conditions
Tumor marker tests look for substances, called tumor markers, that are often made by cancer cells or normal cells in response to cancer. The test results can provide important information, such as how fast a cancer may grow and which treatments are most likely to work.
HER2 is a type of tumor marker. It stands for human epidermal growth factor receptor 2. It's also called HER2/neu. HER2 is a protein involved in normal cell growth. Some types of cancer cells make larger than normal amounts of HER2, including certain cancers of the breast, stomach, and esophagus.
Cancers with large amounts of HER2 protein tend to grow quickly and spread to other parts of the body. Certain medicines, called HER2 targeted therapy, can block or slow HER2 proteins and help control these cancers. But these medicines won't help cancers that don't have high levels of HER2 proteins. So, HER2 tumor marker testing is necessary to find out if targeted therapy will be helpful.
A HER2 tumor marker test usually uses a sample of tumor tissue to measure either:
The amount of HER2 protein on the surface of cancer cells
How many copies of the HER2 gene are inside the cancer cells
Genes are parts of DNA in your cells that you inherit from your parents. HER2 genes have instructions for making the HER2 protein. Normally, you have two HER2 genes in each cell, one from each parent. But certain cancers have extra copies of the HER2 gene, which leads to too much HER2 protein on the cancer cells.
A HER2 tumor marker test looks to see whether certain cancers are:
HER2 positive, which means the cancer has high levels of the HER2 protein or HER2 genes. These cancers are likely to respond to HER2 targeted therapy.
HER2 negative, which means your cancer cells have little to no HER2 protein or a normal number of HER2 genes. This type of cancer may grow more slowly than HER2-positive cancer. It is also less likely to come back after treatment or spread to other parts of the body. HER2 targeted therapy will not work for this type of cancer, but other treatment options may help.
There are different HER2 tumor marker tests for checking HER2 proteins and HER2 genes. Usually, a protein test is done first because those tests are faster and less expense. Blood tests to measure HER2 usually aren't recommended. That's because it's not clear how blood test results can plan cancer treatment.
HER2 tumor marker tests are mostly used to find out whether certain cancers are HER2 positive or negative. This information shows how fast cancer may grow and whether medicine to target HER2 proteins may be helpful.
HER2 tumor marker testing is mainly used for cancers that start in the:
Breast (most common)
Stomach
Esophagus
Ovaries
Bladder
Pancreas
You may need HER2 tumor marker testing to help guide cancer treatment decisions if you have:
Breast cancer that has:
Just been diagnosed and is growing in the normal breast tissue around the tumor. This is called "invasive" cancer.
Spread beyond your breast and is growing in other parts of your body. This is called metastatic cancer. The cancer growing outside of your breast should be tested to see if it's HER2 positive, even if your breast tumor was already tested.
Come back after treatment, usually after a period of time when no cancer could be found in your body. This is called recurrent cancer. The new tumor should be tested to see if it's HER2 positive even if your first tumor was tested. That's because cancer cells can change over time.
Stomach or esophageal cancer that:
Can't be removed using surgery.
Has come back after treatment.
Cancer of the pancreas, bladder, ovaries, or certain other cancers that may have high levels of HER2 which may be treated with medicines that target HER2.
Most HER2 testing uses a sample of tumor tissue. The tissue will be removed during a procedure called a biopsy. There are many ways to do a biopsy. The type of biopsy you have depends on where the tumor is located. In general, a biopsy may be done using:
A hollow needle inserted through your skin. Imaging tests, such as ultrasound, may be used to guide the needle:
A fine needle aspiration biopsy uses a very thin needle to remove a sample of cells and/or fluid.
A core needle biopsy uses a larger needle to remove a sample.
Surgery. A surgeon may remove a sample of the tumor (incisional biopsy) or the entire tumor (excisional biopsy).
Endoscopy. This procedure uses a scope to look inside your body. Special tools may be used with a scope to remove a tissue sample. An endoscopy may be used for a biopsy of a tumor in your stomach or esophagus.
Preparations for your test depend on how your tissue sample will be taken. Ask your health care provider how to prepare for your test.
If you are getting medicine to relax or sleep during the procedure, you will probably need to fast (not eat or drink) for several hours before surgery. You will also need to have someone take you home, because you may be sleepy after the procedure.
Risks depend on how your tissue sample is taken. In general, if you are having a biopsy, you may have a little bruising or bleeding where the tissue was removed. Ask your provider to explain any risks from the test you're having.
The results of HER2 tumor marker tests are reported differently, depending on the type of test you had. The main HER2 tumor marker tests are:
IHC (immunohistochemistry staining assay) to measure the amount of HER2 protein on cancer cells
FISH (fluorescence in situ hybridization) to check for extra copies of HER2 genes in cancer cells
IHC test results for cancer of the breast, stomach, or esophagus show the amount of HER2 protein as a score:
0 (zero) or 1+ means that your cancer cells don't have too much HER2 protein. Your cancer is HER2 negative and will not respond to HER2 targeted therapy. Your provider will discuss other treatment options.
2+ means that the amount of HER2 protein is borderline. This may be reported as "equivocal." It means the test result is not clear. You may need to have a different type of HER2 tumor marker test. The test may be done on the same tissue sample, or you may need to provide a new sample.
3+ means that your cancer cells have too much HER2 protein. Your cancer is HER2 positive and is likely to respond to HER2 targeted therapy.
FISH results for cancer of the breast, stomach, or esophagus will be reported as either:
HER2 negative, which means that you don't have too many HER2 genes in your cancer cells. HER2 targeted therapy won't help your cancer, so your provider will discuss other treatment options.
HER2 positive, which means that your cancer cells have too many HER2 genes. HER2 targeted therapy is likely to help your cancer.
Talk with your provider to learn what your results mean for your treatment.
HER2 Tumor Marker Test: MedlinePlus Medical Test [accessed on Dec 22, 2023]
Breast Cancer Treatment - NCI. National Cancer Institute. Dec 6, 2023 [accessed on Dec 22, 2023]
Additional Materials (6)
This browser does not support the video element.
Diagnosing Breast Cancer
Breast imaging and early detection of breast cancer have evolved immensely over the last 25 years, leading to increased survival rates and improved quality of life for millions of women with breast cancer. This video takes you through the process of screening and diagnosis using various imaging modalities, including mammogram, ultrasound and MRI.
Video by TheVisualMD
DNA Methylation and Cancer
Video by Armando Hasudungan/YouTube
How to Recognize Breast Cancer Symptoms
Video by Howcast/YouTube
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Human Epidermal Growth Factor Receptor 2 (HER2): Aggressive Breast Cancers
Most breast cancers begin in the lobules or ducts of the breast, which produce breast milk and carry it to the nipples after pregnancy. Invasive cancers spread outside of the lobules and ducts and penetrate into the surrounding breast tissue. From there, cancer cells may travel to lymph nodes in the armpit area. In stage IV breast cancer, cancer cells have spread into other parts of the body, such as the lungs or bones. HER2-positive breast cancer is aggressive and is likely to spread quickly. It is also resistant to hormone therapy. However, treatment with the drugs trastuzumab and/or lapatinib may help women who test positive for HER2.
Image by TheVisualMD
Human Epidermal Growth Factor Receptor 2 (HER2): Her2/neu Receptors on Cell Surface
HER2 is a cell surface receptor that responds to chemicals called growth factors. Normally, there are few HER2 receptors on the surface of the cell. But when a mutated gene causes the overproduction of HER2, it can spur the growth of tumors. The test called immunohistochemistry (IHC) measures the amount of HER2 protein present and can help with determining the patient's prognosis.
Image by TheVisualMD
Human Epidermal Growth Factor Receptor 2 (HER2): Breast Cancer and HER2
In about one out of five breast cancers, a protein called human epidermal growth factor receptor 2 (HER2) is overproduced due to a gene mutation. High levels of HER2 on cell surfaces spur the growth of cancerous tumors and also make the cancer less responsive to hormone therapy. This type of breast cancer usually occurs in younger women.
Image by TheVisualMD
4:47
Diagnosing Breast Cancer
TheVisualMD
5:17
DNA Methylation and Cancer
Armando Hasudungan/YouTube
3:01
How to Recognize Breast Cancer Symptoms
Howcast/YouTube
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Human Epidermal Growth Factor Receptor 2 (HER2): Aggressive Breast Cancers
TheVisualMD
Human Epidermal Growth Factor Receptor 2 (HER2): Her2/neu Receptors on Cell Surface
TheVisualMD
Human Epidermal Growth Factor Receptor 2 (HER2): Breast Cancer and HER2
Often, patients first need to have the lump removed (a lumpectomy) or the entire breast removed (a mastectomy). Then they have chemotherapy treatments to target any cancer cells that can’t be seen—cells remaining in the breast or that may have spread into other parts of the body. Sometimes doctors recommend chemotherapy before surgery to shrink the cancer.
Lumpectomy
With lumpectomy, a surgeon removes the lump from your breast. He or she also removes nearby lymph nodes (the little oval-shaped organs that are part of your immune system) to see if the cancer has spread. The surgery takes an hour or two. Most women spend the day at the hospital and usually do not need to stay overnight.
Mastectomy
For a mastectomy, your surgeon removes the breast and nearby lymph nodes to see if the cancer has spread. Some women choose to have breast reconstruction during the same surgery.
Radiation
Lumpectomies are usually followed by radiation therapy. This is where high-energy radiation is given to your breast to kill any remaining cancer cells. It usually takes about 20 minutes per day. Most women go in four to five days a week for about six weeks. You’ll see a radiation doctor to have this done.
Chemotherapy
Cells from the cancerous lump may have spread somewhere else in your body. The goal of chemotherapy is to kill those cancer cells wherever they may be. Chemotherapy lowers the chance that your cancer will grow or come back.
Source: Centers for Disease Control and Prevention (CDC)
Additional Materials (15)
Lumpectomy
Breast Anatomy Post Lumpectomy Structures of the breast post lumpectomy (breast conserving surgery). as well as the space where the tumor was removed are visible in a Breast MRI: Lumpectomy section removed Nipple Breast tissue Fat Suspensory ligaments Ducts Chest wall muscle
Image by TheVisualMD
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Mastectomy
Total (simple) Mastectomy Description Total (simple) mastectomy; drawing shows removal of the breast and lymph nodes. The dotted line shows where the entire breast is removed. Some lymph nodes under the arm may also be removed.
Image by National Cancer Institute
Lumpectomy
Colorized MR of Breasts After Breast Conserving Surgery or Lumpectomy : Colorized breast MR of breasts, axial slice (horizontal view, as though seen from above). The breast on the right side of the image has had breast-conserving surgery, also called lumpectomy. This type of surgery removes the tumor, some breast tissue, and some lymph nodes, but preserves the chest muscles. The aim of the surgery is to take only as much tissue as is necessary to keep the chance of recurrence low, but to keep the breast looking as normal as possible.
Image by TheVisualMD
Radiation for Breast Cancer
Radiation therapy is a common treatment for breast cancer. Here, breast surgeon Dr. Nora Jaskowiak explains standard prescription of radiation therapy in conjunction with lumpectomy surgery. Then dosimetrist Carla Rash walks you through part of a high-tech radiation treatment planning session. A dosimetrist is a member of the radiation oncology team who specializes in the physics behind radiation therapy treatment.
Image by TheVisualMD
Breast Cancer: treatment for triple negative breast cancer
U.S. Air Force Capt. Candice Adams reacts to the effects of a chemotherapy treatment Jan. 25, 2011 at Walter Reed Army Medical Center. Adams was diagnosed with triple negative breast cancer at age 29. (U.S. Air Force photo by Staff Sgt. Russ Scalf)
Centers for Disease Control and Prevention (CDC)/YouTube
10:06
Triple Negative Breast Cancer: What you need to know
Breast Cancer School for Patients/YouTube
2:02
Triple-Negative Breast Cancer: What You Need to Know
American Cancer Society/YouTube
1:59
How a triple-negative breast cancer survivor became cancer-free
MD Anderson Cancer Center/YouTube
Becoming Well
TheVisualMD
0:39
Talk to Linda about Triple-Negative Breast Cancer
Centers for Disease Control and Prevention (CDC)/YouTube
1:26
First immunotherapy success for triple-negative breast cancer
QMULOfficial/YouTube
7:59
What You Need To Know About Triple Negative Breast Cancer
Mount Sinai Health System/YouTube
1:59
Triple-negative breast cancer: a potential new treatment is now in sight
Garvan Institute of Medical Research/YouTube
4:55
Triple Negative Breast Cancer: What You Need to Know
Demystifying Medicine/YouTube
Pembrolizumab (Keytruda)
Pembrolizumab 5DK3
Image by Fvasconcellos (talk · contribs)/Wikimedia
Pembrolizumab 5DK3
Space-filling model of pembrolizumab. False-colored to more easily distinguish heavy and light chains. Style made to resemble the Protein Data Bank's "Molecule of the Month" series, illustrated by Dr. David S. Goodsell of the Scripps Research Institute.Created using QuteMol (http://qutemol.sourceforge.net). Optimized with OptiPNG.
Image by Fvasconcellos (talk · contribs)/Wikimedia
Pembrolizumab Improves Survival in Advanced Triple-Negative Breast Cancer
August 9, 2022, by Edward Winstead
Adding the immunotherapy drug pembrolizumab (Keytruda) to chemotherapy can help some patients with advanced triple-negative breast cancer live longer than if they received chemotherapy alone, new results from a clinical trial show.
In the trial, KEYNOTE-355, overall survival improved only among patients whose tumors had relatively high levels of the PD-L1 protein—a PD-L1 combined positive score of at least 10.
Among patients with this combined positive score, median overall survival was 23.0 months for those who received pembrolizumab and chemotherapy versus 16.1 months for those who received chemotherapy alone. These results are based on a median follow-up of 44 months.
Javier Cortés, M.D., Ph.D., of the International Breast Cancer Center, Barcelona, Spain, and his colleagues reported their findings July 21 in the New England Journal of Medicine.
In an earlier analysis of interim data from the trial, Dr. Cortés and his colleagues had reported that among patients with a PD-L1 combined positive score of at least 10, the combination of pembrolizumab and chemotherapy improved progression-free survival compared with chemotherapy alone.
Based on those results, in 2020 the Food and Drug Administration (FDA) approved the combination therapy for patients with advanced triple-negative breast cancer whose tumors have a PD-L1 combined score of at least 10.
The approval covers patients with cancer that cannot be removed surgically (unresectable), that has spread to tissue near the breast but not to other parts of the body (locally advanced), or that has spread to other parts of the body (metastatic).
The new KEYNOTE-355 results confirm that pembrolizumab is a “breakthrough” treatment for triple-negative breast cancer, wrote Xavier Pivot, M.D., Ph.D., of the Institute of Cancerology Strasbourg, Strasbourg, France, in an accompanying editorial.
New treatments needed for advanced triple-negative breast cancer
Triple-negative breast cancer tends to be more aggressive, harder to treat, and more likely to recur than other forms of the disease, such as hormone receptor–positive or HER2-positive breast cancers.
Conventional chemotherapy drugs have not been effective against triple-negative breast cancer, and new treatment options are needed, said Jung-Min Lee, M.D., of the Women’s Malignancies Branch in NCI’s Center for Cancer Research.
In the KEYNOTE-355 trial, 847 patients with advanced (unresectable, locally advanced, or metastatic) triple-negative breast cancer were randomly assigned to receive chemotherapy plus placebo or chemotherapy plus pembrolizumab.
The study assessed the amount of time before the disease worsened (progression-free survival) and overall survival in all patients, in those with PD-L1 combined positive scores of 1 or more, and in those with combined positive scores of 10 or more. The trial was funded by Merck, the manufacturer of pembrolizumab.
The PD-L1 combined positive score is essentially a measure of the extent to which cells in a tumor produce PD-L1, the immune checkpoint protein that pembrolizumab targets. By blocking immune checkpoints, pembrolizumab and other immune checkpoint inhibitors unleash the immune system against cancer cells.
Among patients with a combined PD-L1 score of more than 1, pembrolizumab did not improve median overall survival, which was 17.6 months in the pembrolizumab–chemotherapy group and 16.0 months in the chemotherapy-alone group.
Among patients with a combined PD-L1 score of 10 or more, at 18 months after starting treatment, about 58% of patients in the combination-treatment group were still alive, compared with about 45% of those in the chemotherapy-alone group.
The incidence of treatment-related side effects, including serious side effects, was similar between the two groups of patients in the study.
The most common side effects in both groups were a drop in red blood cells, a lower-than-normal number of white blood cells, and nausea. These side effects are typically associated with chemotherapy, and adding pembrolizumab to chemotherapy did not increase the incidence of side effects among patients, the study authors wrote.
Research progress and future questions
After the 2020 approval of the combination of pembrolizumab and chemotherapy for advanced triple-negative breast cancer, FDA approved the combination therapy for people with early-stage disease in 2021.
That approval was based on results from a different trial, KEYNOTE-522. In that study, patients with high-risk, early-stage triple-negative breast cancer benefited from pembrolizumab given with chemotherapy before surgery, and then continued as a single agent as an additional, or adjuvant, treatment after surgery.
“This is an exciting time” for research on triple-negative breast cancer, said Dr. Lee. “We have now seen a benefit from an immune checkpoint inhibitor and chemotherapy” in a subgroup of patients in both the advanced and early stages of the disease.
Dr. Lee cautioned, however, that more than half of all patients with triple-negative breast cancer have PD-L1 combined positive scores of less than 10, so more work is needed to find effective treatments for these patients.
In his editorial, Dr. Pivot noted that people diagnosed with triple-negative breast cancer are not a homogeneous group. Future studies, he added, will try to identify which individuals are more or less likely to benefit from pembrolizumab.
Source: Cancer Currents: An NCI Cancer Research Blog. August 9, 2022, by Edward Winstead.
Additional Materials (9)
Chemo and immunotherapy together may help triple-negative breast cancer patients
Video by CBS Mornings/YouTube
First immunotherapy success for triple-negative breast cancer
Video by QMULOfficial/YouTube
Immunotherapy and Triple Negative Breast Cancer - Mayo Clinic
Video by Mayo Clinic/YouTube
How immunotherapy might be effective for triple-negative breast cancer
Video by Dana-Farber Cancer Institute/YouTube
Encouraging developments in triple negative breast cancer immunotherapy
Video by VJOncology/YouTube
Immunotherapy Means Life: Karen’s Breast Cancer Story
Video by Cancer Research Institute/YouTube
Immunotherapy Keytruda Shows Benefit in Early Triple-Negative Breast Cancer
Video by Breastcancer.org/YouTube
Role of Immunotherapy inTriple Negative Breast Cancer
Video by Max Healthcare/YouTube
KEYNOTE-355: pembrolizumab in triple-negative breast cancer
Video by VJOncology/YouTube
2:48
Chemo and immunotherapy together may help triple-negative breast cancer patients
CBS Mornings/YouTube
1:26
First immunotherapy success for triple-negative breast cancer
QMULOfficial/YouTube
5:04
Immunotherapy and Triple Negative Breast Cancer - Mayo Clinic
Mayo Clinic/YouTube
2:21
How immunotherapy might be effective for triple-negative breast cancer
Dana-Farber Cancer Institute/YouTube
1:39
Encouraging developments in triple negative breast cancer immunotherapy
VJOncology/YouTube
1:00
Immunotherapy Means Life: Karen’s Breast Cancer Story
Cancer Research Institute/YouTube
1:29
Immunotherapy Keytruda Shows Benefit in Early Triple-Negative Breast Cancer
Breastcancer.org/YouTube
1:34
Role of Immunotherapy inTriple Negative Breast Cancer
Max Healthcare/YouTube
2:07
KEYNOTE-355: pembrolizumab in triple-negative breast cancer
VJOncology/YouTube
Treatment Side Effects
Hair loss from Chemotherapy
Image by cristhianelouback0
Hair loss from Chemotherapy
Hair loss from Chemotherapy
Image by cristhianelouback0
What Are Some Common Side Effects of Triple-Negative Breast Cancer Treatment?
Hair Loss
You may lose some or all of your hair within about two to four weeks of starting chemotherapy. New treatments may help with hair loss, so ask your doctor about that if it’s a big concern for you. Your hair will grow back starting around four to six weeks after your last chemotherapy treatment.
Nausea
Most women feel sick and exhausted for a day or two after each chemotherapy treatment. It’s different for everybody, and you have to try the first round or so of chemotherapy before you know for sure. If you feel queasy, your doctor can give you a prescription for medicine to treat the nausea.
Tiredness
You may feel tired or have problems with thinking and remembering things after chemotherapy and radiation therapy. Most of those side effects go away a few weeks after therapy ends.
Lymphedema
If you have lymph nodes removed during surgery, or if you receive radiation treatment to your lymph nodes, the lymph fluid may not be able to drain properly. This may cause the fluid to build up under your skin and cause part of your body to swell. This condition is called lymphedema.
Skin Changes
On or around the skin where you’ve been treated with radiation, you may get some redness or peeling, kind of like a sunburn. Your doctor will tell you the best way to treat these skin changes.
Source: Centers for Disease Control and Prevention (CDC)
Additional Materials (1)
Chemotherapy side effects | The side effects for Angie | Cancer Research UK
Video by Cancer Research UK/YouTube
1:03
Chemotherapy side effects | The side effects for Angie | Cancer Research UK
Cancer Research UK/YouTube
Genetic Counseling
How Do Genetic Changes Affect Cancer Treatment?
Image by National Cancer Institute (NCI)
How Do Genetic Changes Affect Cancer Treatment?
Each person's cancer has a unique combination of genetic changes. Specific genetic changes may make a person's cancer more or less likely to respond to certain treatments.
Image by National Cancer Institute (NCI)
Do I Need Genetic Counseling and Testing for Triple-Negative Breast Cancer?
Your doctor may recommend that you see a genetic counselor. That’s someone who talks to you about any history of cancer in your family to find out if you have a higher risk for getting breast cancer. For example, people of Ashkenazi Jewish heritage have a higher risk of inherited genetic changes (mutations) that may cause breast cancers, including triple-negative breast cancer. The counselor may recommend that you get a genetic test.
If you have a higher risk of getting breast cancer, your doctor may talk about ways to manage your risk. You may also have a higher risk of getting other cancers such as ovarian cancer, and your family may have a higher risk. That’s something you would talk with the genetic counselor about.
Source: Centers for Disease Control and Prevention (CDC)
Additional Materials (5)
Oncology genetic counseling and testing
Video by AAMCNews/YouTube
Genetic Testing for Cancer — AMITA Health | NBC Chicago Ask the Doc
Video by AMITA Health/YouTube
Genetic Counseling
Video by FetalTreatment/YouTube
Risk factors for developing triple-negative breast cancer
Video by Roche/YouTube
NCCN Animation for Patients: Overview of Triple-Negative Breast Cancer (TNBC)
Video by NCCN/YouTube
5:18
Oncology genetic counseling and testing
AAMCNews/YouTube
1:31
Genetic Testing for Cancer — AMITA Health | NBC Chicago Ask the Doc
AMITA Health/YouTube
3:32
Genetic Counseling
FetalTreatment/YouTube
3:05
Risk factors for developing triple-negative breast cancer
Roche/YouTube
3:38
NCCN Animation for Patients: Overview of Triple-Negative Breast Cancer (TNBC)
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Triple-Negative Breast Cancer
Triple-negative breast cancer is a kind of breast cancer that does not have any of the receptors that are commonly found in breast cancer. This makes it aggressive and harder to treat. Learn more about this kind of breast cancer and what treatments might work.