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NCCN Guidelines for Patients



Breast Cancer – Metastatic (STAGE IV), Version 2.2017


Treatment planning



Cancer lab tests


A biopsy is a procedure that removes tissue or fluid

samples for testing. The methods used to remove

samples will depend on where the cancer has

spread. A biopsy is advised to confirm if the distant

site has cancer. If your doctor does not suggest a

biopsy, ask why.

If you were treated for earlier stages of breast

cancer, tissue from the breast tumor was likely

tested. Expect a biopsy of the distant site. In a small

number of cases, the biology of the tumor changes.

Such changes can greatly impact how the cancer

responds to treatments and your treatment options.

Cancer lab tests

Tissue samples from the biopsy will be sent to a

pathologist. A pathologist is a doctor who’s an expert

in testing cells to find disease. He or she will examine

the samples using a microscope.

Pathology report

All lab results are recorded in a pathology report.

A report will be written each time tissue is removed

from your body and tested for cancer. These reports

are vital to planning treatment.

Review your pathology report(s) with your doctor. Ask

questions if you don’t understand. This information

can be complex. It’s also a good idea to get a copy of

your pathology report(s) and take notes.

Histologic typing

If cancer is present, the pathologist will study the

parts of the cancer cells to classify the disease. This

is called histologic typing. The pathology report will

state if the cancer started in the breast or elsewhere.

If breast cancer is found, the subtype will be noted

in the report. The most common subtype is ductal

breast cancer. Out of every 100 breast cancers,

about 85 to 90 are ductal cancers. These cancers

started in the breast ducts. Breast cancer can also

start in the lobules. These cancers are called lobular

breast cancer.

Receptor testing

Not all breast cancer cells are alike. They can differ

by the type of receptors they have. A receptor is a

protein found in the membrane of cells or inside of

cells. Substances bind to the receptors and cause

changes within the cell.

Hormone receptor test

. Estrogen and progesterone

are hormones that are present in all women. Among

some women with breast cancer, the cancer cells

have receptors to which these hormones attach. After

hormones attach, the receptors enter the nucleus

and cause cells to grow in number.

See Figure 6.

However, the growth of cancer cells with hormone

receptors is usually slower than cancer cells without

these receptors.

Testing for hormone receptors is important. There

are drugs that can be used to stop hormones from

causing cancer growth. IHC (







is the lab test used by pathologists for hormone


IHC involves applying a stain to cells then looking

at them with a microscope. The stain shows how

many cells have hormone receptors and the amount

of hormone receptors in the cells. If at least 1 out of

every 100 cancer cells stains positive, the cancer is

called hormone receptor–positive. If fewer cancer

cells stain positive for hormone receptors, the cancer

is called hormone receptor–negative.