Role of E2,P2 & HER2 in cancer breast

Role of E2,P2 & HER2 in cancer breast

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  Role of ER,PR,HER2in Cancer Breast Dr. Laxmi Shrikhande Consultant - Shrikhande Hospital, Nagpur https://facebook.com/laxmi.shrikhande | https://.linkedin.com/in/dr-laxmi-agrawal-shrikhande
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  Dr. Laxmi Shrikhande- MD; FICOG; FICMU;FICMCH • Medical Director-Shrikhande Fertility Clinic, Nagpur • Chairperson Designate Indian College of OB/GY ICOG • National Corresponding Editor-The Journal of Obstetrics &Gynecology of India • Senior Vice President FOGSI 2012 • Patron & President -Vidarbha Chapter ISOPARB • Received Nagpur Ratan Award at the hands of Union Minister Shri Nitinji Gadkari • Received Bharat excellence Award for women’s health • Received Mehroo Dara Hansotia award for Best Committee of FOGSI • National Governing Council member ICOG 2012-2017 • National Governing Council Member ISAR 2014-2019 • National Governing Council Member IAGE for 3 terms • Chairperson-HIV/AIDS Committee, FOGSI (2007-09) • President Nagpur OB/GY Society 2005-06 • Immediate Past President Menopause Society, Nagpur • Associate member of RCOG & ESHRE • Member of European Society of Human Reproduction • Visited 96 FOGSI Societies as invited faculty • Delivered 11 orations and 450 guest lectures • Publications-Twenty National & eleven International • Presented Papers in FIGO, AICOG, SAFOG, AICC-RCOG conferences • Conducted adolescent health programme for more than 15,000 adolescent girls • Conducted health awareness programme for more than 10,000 women
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  Role of ER,PR,HER2in Cancer Breast DR LAXMI SHRIKHANDE NAGPUR
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  Overview What is theimportance of these hormone receptors ? Classification of breast cancer based on these receptors Diagnosis of receptor status Treatment of Receptor + & receptor –ve tumors Take Home message
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  INTRODUCTION Globally, breast canceris the most frequently diagnosed cancer and the leading cause of cancer death in females Breast cancer is a heterogeneous, phenotypically diverse disease composed of several biologic subtypes that have distinct behavior.
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  What are estrogenand progesterone receptors? Receptors are proteins in or on cells that can attach to certain substances in the blood. Normal breast cells and some breast cancer cells have receptors that attach to the hormones estrogen and progesterone, and depend on these hormones to grow. Breast cancer cells taken out during a biopsy or surgery will be tested for these receptors.
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  What is HER2-PositiveBreast Cancer? HER2-positive breast cancer is a type of breast cancer in which breast cancer cells have a protein receptor called HER2 (human epidermal growth factor receptor 2). Normally, this protein helps breast cells grow, divide, and repair themselves. But sometimes, something goes wrong in the gene that controls the HER2 protein and pts body creates too many of these receptors. As a result, her breast cells grow and divide uncontrollably.
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  Why is knowinghormone receptor status important? It helps in prognostication and planning treatment. Hormone therapy drugs can be used to either lower estrogen levels or stop estrogen from acting on breast cancer cells. This kind of treatment is helpful for hormone receptor-positive breast cancers, but it doesn’t work on tumors that are hormone receptor-negative (both ER- and PR-negative).
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  How to Diagnosehormone receptor status? A test called an immunohistochemistry (IHC) is used most often to find out if cancer cells have estrogen and progesterone receptors A tumor is hormone receptor-positive if at least 1% of the cells tested have estrogen and/or progesterone receptors. Otherwise the test will say the tumor is hormone receptor-negative.
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  ER and PR+ treatment Premenopausal women Tamoxifen for five years. After five years assess, menopausal status. If not yet menopausal, consider continuing on tamoxifen for five more years. If menopausal, consider staying on tamoxifen or switching to an aromatase inhibitor. Postmenopausal women Tamoxifen for 10 years or An aromatase inhibitor for five years or Tamoxifen for five years followed by an aromatase inhibitor for up to five years or Tamoxifen for two to three years followed by an AI for up to five years (Note: There is insufficient evidence to recommend taking an AI for greater than five yrs.)
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  Her2 + treatment Patientswith HER2-positive non-metastatic breast cancer generally warrant adjuvant or neoadjuvant treatment with chemotherapy and trastuzumab, though other HER2- directed agents also may play a role in management Benefits of adjuvant chemotherapy in early breast cancer have been demonstrated in a large meta-analysis
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  Her2 + treatment Trastuzumabshould be administered concomitantly with the non- anthracycline components of chemotherapy, rather than sequentially after chemotherapy. Although administration of trastuzumab sequentially after completion of all chemotherapy has demonstrated activity, it appears to be less effective than when given concurrently. Other HER2-directed agents are under investigation.
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  Take Home Message ER,PR and HER2 should be tested on surgical specimen It helps in prognostication and planning appropriate therapy for women. Triple + has better prognosis than triple –ve All Triple + don’t behave in an identical fashion because of cross talk Refer the women to Oncologist for Treatment of Ca breast
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  The Art ofLiving Anything that helps you to become unconditionally happy and loving is what is called spirituality. H. H. Sri Sri Ravishakar