Hormone receptor tests
Hormone receptor tests are diagnostic procedures primarily used to evaluate breast tumors for the presence of estrogen and progesterone receptors. These receptors, which are proteins on the surface of normal cells, play a crucial role in regulating cell growth and can significantly influence tumor behavior. The test helps classify tumors as hormone receptor positive or negative, which is vital for determining appropriate treatment options for breast cancer. If a tumor is hormone receptor positive, it typically responds well to hormonal therapies aimed at lowering estrogen levels or blocking its effects.
The testing process begins with a biopsy to obtain tissue samples, which can be performed through various methods such as fine needle aspiration or surgical biopsy. The choice of biopsy technique often depends on the tumor's size and location. Following the procedure, tissue samples are analyzed in a laboratory to assess hormone receptor status. The results guide treatment decisions, with higher receptor levels indicating a more favorable response to therapies like antiestrogens, such as tamoxifen or aromatase inhibitors. Overall, understanding hormone receptor status is essential for tailoring effective breast cancer treatment, potentially improving patient prognosis.
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Hormone receptor tests
Other names: Estrogen receptor/progesterone receptor (ER/PR) test
DEFINITION: The hormone receptor test determines if a breast tumor is hormone receptor positive. Hormone receptors, proteins present on the surfaces of normal cells, bind to hormones such as estrogen and progesterone to regulate normal cell growth. Many tumors express more of these receptors, making them more responsive to hormone-dependent cell growth. The tumor may use this method to grow faster than usual. The hormone receptor test analyzes tissue from a breast biopsy for the number of receptors present and will classify the tumor as hormone receptor positive or negative. This information is used to decide the method of treatment for breast cancer.
Cancer diagnosed: Breast cancer
Why performed: If symptoms and screening tests, such as a mammogram, suggest the likelihood of breast cancer, then a biopsy will be performed to determine if the disease is present, the stage of the cancer, and whether the tumor is hormone receptor positive. If the cancer is estrogen receptor (ER) positive or progesterone receptor (PR) positive, it will typically respond well to hormonal therapy. Hormonal therapy will either reduce the levels of estrogen present in the body or prevent the binding of estrogen to the receptors.
Patient preparation: Depending on the type of biopsy planned, the patient may be asked to refrain from eating or drinking the night before any type of surgical procedure. If a needle biopsy is done, then it is advisable to eat lightly prior to the procedure.
Steps of the procedure: A biopsy of the suspicious lump will be further analyzed to determine whether the lump is or malignant, the stage of the tumor, and whether it is hormone receptor positive. Tissue samples can be obtained by fine needle biopsy, core (large-needle) biopsy, or open surgical biopsy. The procedure used depends on the size of the tumor, with more invasive methods providing the most conclusive diagnosis and the least invasive method providing more false negatives. A commonly used technique is fine needle aspiration, in which a thin hollow needle is used to take out a small portion of the tumor. Vacuum-assisted or large-gauge needles are used to remove multiple pieces of the tumor. The needle is guided to the tumor using ultrasound imaging, guaranteeing that tissue is removed only from the suspicious region. Needle biopsies are minimally invasive and can be performed in the physician’s office with local anesthesia.
Surgical biopsies include incisional biopsies, which remove a small piece of tissue, and excisional biopsies, which remove the entire area of suspected cancer. Surgical biopsies provide the most conclusive diagnosis, with fewer false negatives, but are far more invasive and require a longer recovery time. Once the tissue is removed, it is sent to the laboratory for analysis, where the number of hormone receptors present will be determined.
After the procedure: For a needle biopsy, the opening is very small and little care is needed. It is covered with a small bandage for one to two days, and usual activity can be resumed immediately. If a surgical biopsy was performed, then care of the will require coverage with a bandage that can be removed in one or two days. If general anesthesia was used, a friend or relative should drive the patient home. Normal activities can be resumed in one to three days and stitches removed in about one week.
Risks: There is little risk involved in having a biopsy, but the main risk is infection in the area of biopsy, indicated by redness or swelling. A (collection of blood) may also occur and requires drainage.
Results: The laboratory test will take a few days, after which the physician will discuss whether the suspicious lump is benign or malignant, the stage of the tumor, and the hormone receptor status. About 80 percent of all biopsies in the United States are benign. The results of the hormone receptor test determine whether the tumor will be declared hormone receptor positive. In some practices, a number between 0 and 8 is also given. A higher score means more receptors were found, which means they were easy to see in the sample. A score of 0 means hormonal therapy will not be helpful while a score of 8 means it is hormone receptor positive and will respond to treatment. If the tumor has a large number of receptors present, then it is hormone dependent, and hormonal therapies such as antiestrogens will be used. Antiestrogen therapies include tamoxifen and aromatase inhibitors (Arimides, Aromasin, and Femara). Tamoxifen is generally given for premenopausal women, while aromatase inhibitors work better in postmenopausal women. Women whose tumors are hormone receptor positive generally respond very well to antiestrogen therapies and have a better prognosis than those whose tumors are not hormone dependent.
Bibliography
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