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Breast Imaging

Baylor All Saints Medical Center at Fort Worth

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Grading Cancer 

Grading the Aggressiveness of Cancer 

Grading tells us the personality of the cancer…in other words, how aggressive is it.

Grades are:  ↓ 1 – 2 – 3 ↑

Prognostic indicators:

Oncologists look at these to help tell them about your individual cancer characteristics. 

ER/PR + -     

Her 2   + -    

Ki 67% ↑ ↓

Histologic tumor grade: based on the arrangement of the cells in relation to each other, as well as features of individual cells. Grade 1 cancers have relatively normal-looking cells that do not appear to be growing rapidly and are arranged in small tubules.

Grade 3 cancers, the highest grade, lack these features and tend to grow and spread more aggressively.

Grade 2 cancers have features between grades 1 and 3. Grade 1, 2, and 3 cancers are sometimes referred to as well differentiated, moderately differentiated, and poorly differentiated.

Estrogen and progesterone receptors: Receptors are molecules that are a part of cells.

They recognize certain substances such as hormones that circulate in the blood. Normal breast cells and some breast cancer cells have receptors that recognize estrogen and progesterone. These two hormones play an important role in the development, growth, prognosis, and treatment of breast cancer.

An important step in evaluating a breast cancer is to test for the presence of these receptors. This is done on a portion of the cancer removed at the time of biopsy or initial surgical treatment.

Breast cancers that contain estrogen and progesterone receptors are often referred to as ER-positive and PR-positive tumors. These cancers tend to have a better prognosis than cancers without these receptors and are much more likely to respond to hormonal therapy.

HER2/neu testing: About one third of breast cancers have too much of a growth-promoting protein called HER2/neu and too many copies of the gene that instructs the cells to produce that protein. In other cases, a normal number of HER2/neu genes are present, but they are too active in instructing the cells to produce HER2/neu protein.

These cancers tend to grow and spread more aggressively than other breast cancers. They can be treated with a drug called Herceptin that prevents the HER2/neu protein from stimulating breast cancer cell growth. HER2/neu testing is done on thin slices of the biopsy sample that are treated with special antibodies that identify the HER2/neu protein or with pieces of DNA that identify the HER2/neu gene.

The test that uses antibodies to detect HER2/neu protein is called immunohistochemistry. The DNA test for extra copies of the HER2/neu gene is called fluorescent in situ hybridization (usually called FISH for short).

The Ki-67 protein (also known as MKI67) is a cellular marker for proliferation. In other words, how fast is the cell dividing.  This is an important factor in assessing the grade and prognosis of breast cancer.