When doctors confirm that you or someone close to you has breast cancer, it is difficult to put into words the fear and anxiety you feel. At the same time, when doctors talk about various tests and treatments , it can be difficult to understand those words. One test you will often hear is the IHC test. Even though the name may sound a little complicated, don't be afraid . This is a very important test that helps your doctor choose the best treatment for your cancer. Today, we will talk about this in a very simple way, in a way that you can understand.
What is the IHC test simply?
Simply put, IHC (Immunohistochemistry) is a special test that identifies the exact nature of your cancer cells. Not all breast cancers are the same. Some cancers use hormones in our bodies to grow. Others depend on other proteins to grow. So once you know exactly what factors are helping your cancer grow, your doctor can target those factors and treat them.
The IHC test mainly looks for two things:
1. Hormone Receptors : Our bodies naturally produce hormones called estrogen and progesterone. Some breast cancer cells have special places on their surface called receptors where these hormones can attach. When these hormones attach, the cancer cells receive a signal to grow. If your cancer cells have these hormone receptors, it is called "hormone receptor-positive."
2. HER2 protein: `(HER2)` is another protein that helps control cell growth. However, some breast cancer cells produce too much of this `HER2` protein. This is called "HER2-positive". This is also a reason why the cancer grows faster.
The main goal of this test is to find out exactly what factors are "feeding" your cancer, that is, what is causing it to grow. Then, we can give you medication that will stop that "feeding."
How is this IHC test done?
This test requires a sample of your cancer cells . This is usually obtained from a piece of tissue taken during a biopsy to confirm the presence of cancer or during surgery to remove the cancer.
Then this piece of tissue is sent to the laboratory, that is, to the lab. There, something very interesting happens:
- The professionals in the lab will add a special chemical to your cancer cell sample. This uses a type of protein that is specially made in the lab. These are called ``antibodies''.
- These `(antibodies)` are designed to only attach to `(Estrogen)`, `( Progesterone )` or `(HER2)` receptors. Just like a keyhole that fits a key.
- If your cancer cells have these receptors, those antibodies will go and stick to them.
- Then, when another chemical is added to this, the cells that have attached antibodies change color .
- A pathologist , or histologist, looks at the tissue under a microscope and counts whether there are any cells that have changed color and how many there are.
This is how you can find out exactly whether your cancer is `HER2-positive`, `hormone receptor-positive`, or `both negative`.
How do you understand what is in the test report?
When you get your IHC test report, it can be a little intimidating to see the numbers and words on it. But the most important thing is to sit down with your doctor and talk clearly about everything in the report . Here's how the results are usually reported:
HER2 results
`HER2` results are usually given as a number.
| Result | Meaning |
|---|---|
| 0 or 1+ | This means that your cancer is HER2-negative . This means that the cancer cells do not have HER2 receptors or have very low levels of them. |
| 2+ | This is a "borderline" or indeterminate condition. It is not possible to say for sure whether the tumor is HER2-positive or negative. In such cases, the doctor may recommend a more definitive test, called a FISH test (Fluorescence In Situ Hybridization). |
| 3+ | This means that your cancer is HER2-positive . This means that the cancer cells have too many HER2 receptors. |
Hormone Receptor (ER/PR) Results
These results can be reported in several ways:
- As a percentage (0% - 100%): The percentage of 100 cancer cells that have hormone receptors.
- A number from 0 to 3: 0 means no receptors. 1, 2, and 3 indicate low, medium, and high receptors, respectively.
- An "Allred score" (0-8): The higher this score, the greater the number of receptors and their clarity.
- "Positive" or "Negative": "Positive" means that there are receptors. Even if there are as few as 1% of receptors, it is still considered "Positive." Therefore, it is important to know the percentage or score.
Sometimes the results can be wrong. If you have any doubts, never hesitate to ask your doctor to have the report re-examined by another ``pathologist`` or to repeat the test.
How do IHC results affect your treatment?
This is the most important part. Your oncologist will determine the best treatment plan for you based on the results of the IHC test.
| Cancer type (based on IHC results) | Compatible treatments |
|---|---|
| HER2-positive | Targeted therapy, which targets the HER2 protein, is very effective for this type. |
| HER2-negative | This type may grow more slowly than HER2-positive cancer. HER2-targeted drugs do not work for this type. So your doctor may choose other treatments, such as chemotherapy or hormone therapy. |
| Hormone receptor-positive (ER+ and/or PR+) | Hormone therapy is very effective for this type of cancer. These drugs either lower the level of estrogen in the body or block the cancer cells from getting estrogen. |
| Hormone receptor-negative | These cancers usually grow rapidly. Hormone treatments cannot affect this. Therefore, other treatments, such as chemotherapy, are needed. |
| Triple-positive | This means that all three of these are positive: `(Estrogen), `(Progesterone), and `HER2.` These people can be given both hormonal therapy and HER2-targeted therapy. |
| Triple-negative | This means that all three factors are negative. These often grow rapidly. Since hormonal or HER2-targeted therapies do not work for this, things like surgery, chemotherapy, and radiation are mainly used. |
Take-Home Message
- The IHC test is a very critical test used in breast cancer treatment planning. Don't be intimidated by the name.
- This mainly determines whether your cancer is hormone-dependent (ER/PR positive) and HER2 protein-dependent (HER2 positive).
- Based on the results of this test, your doctor will be able to choose the most effective treatment for you, with the fewest side effects.
- When you receive your test report, ask your doctor to explain every word and number in it so that you understand it clearly. Never be afraid to ask questions.
- If you are unsure about the results, talk to your doctor about getting a second opinion or repeating the test. It is important that you take an active role in making decisions about your health.
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