Confused with Oncotype Score and ER/PR, etc...

hlya

Hi,



Firstly thank you for all of your help! Sorry as a new member I still have limitation to post threads/day so I can't respond to everybody's post. Also I will be able to answer questions when I get more knowledge but for now I can only ask questions.



1) How does the Oncotype score come out? Based on ER/PR, and HER2 should be considered as well, correct? Otherwise why do they need to test ER/PR HER2?



2) On core biopsy report, do you have a kind of "Allred score"? What does that mean?



3)Where does "Grade" come from? From HER2 score?

I was told ER is important for ILC therapy, but how about PR? What's the value of this score?



4) Could the scores on final pathology report after surgery be different from biopsy report? I mean those ER/PR HER2, grade would be changed after surgery?....



I am trying to understand those things and what's happening in my body....Thanks.

hlya

Well, seems some of the questions had been discussed...hopefully my questions are not too stupid.

idaho

No question is stupid!  I will try to answer your questions the best I can.  The oncotype score is determined from different genes they test in your lumpectomy.  These genes tell the oncologist what "kind" of cells you are growing and how likely they are to respond to chemo.  I don't know what an Allred score is, I have not heard of that.  I bet it is to compare it to other cancers though.  Grade comes from a test they do on your cancer cells that tells them how fast the cells are growing.  grade 1 - they are growing slow, grade 3- they are growing fast.  HER2 is a also a test that tells them if you have a certain protein in your cells.  It used to be bad to have HER2, but now they have new meds to treat it, and it works really well.  ER+ is useful because it will tell the Doc if you should take an estrogen blocker. (ER stands for estrogen).  If you are ER+ that means your cancer is fed by estrogen.  If it is PR+ that means progesterone feeds it also.  People with ER+ cancers can take tamoxifen or other drugs to block the estrogen from feeding cancer cells.  The scores on a final path report can certainly be different from the biopsy report.  The ER-PR status will not change, but after they test your lymph nodes that could change your stage.  And they are finding that even the same lump can have different grades in it.  I hope that helps,  Don't hesitate to ask questions, we have all been in your shoes, it is like a foreign language.... Hugs- Tami

nash

1) ER/PR/HER2 receptors are determined by the pathologist, prior to Oncotype testing. Every women's tumor sample will be checked for receptor status, but not every woman will qualify for Oncotype testing. Those who are ER/PR+, HER2- will benefit from Oncotype testing to see how responsive their tumor will be to hormone therapy (vs chemo).

You can read about the test at www.oncotypedx.com. ER/PR- tumors can't be Oncotype tested, and most oncs don't bother testing HER2+ tumors because they all tend to score high on Oncotype and all need chemo because of their aggressiveness, so the Oncotype test is moot in those situations.

Every tumor is checked for ER/PR/HER status, b/c those receptors drive the adjuvant treatment decisions--hormone therapy for ER/PR+ tumors, and Herceptin for HER2+ tumors. Oncotype helps with the chemo decision by determining how hormone sensitive the tumor really is, and whether the patient will derive a larger benefit from HT or from chemo.

 2) The Allred score is a method of determining how strongly ER/PR expressive the tumor is. You can read more about it here:

http://www.breastcenter.tmc.edu/research/cores/path/services/er.htm

 3) Grade is determined by the pathologist, by looking at the tumor's characteristics under the microscope. Here is a good explanation of tumor grading:

http://www.imaginis.com/breasthealth/histologic_grades.asp

HER2 tumors tend to be grade 3, b/c the protein overexpression makes them more aggressive. 

ER+/PR- tumors tend to be slightly more aggressive than ER+/PR+ tumors, but most oncs don't pay too much attention to the PR-. The more ER/PR+ you are, the better HT is supposed to work.

4) Yes, there can be differences in grade, ER/PR scores, etc. between the biopsy path report and the surgical path report. This is because bc tumors are heterogenous. The biopsy is only looking at a small sample, while the surgical excision sample looks at the entire tumor.

My tumor was a Grade 1, ER+ 49%, PR+ 31%, HER2- at biopsy, but after sugery was a Grade 2, ER+ 60%, PR+ 50%.

There are different ways of scoring ER/PR, BTW--it seems the Allred method gives a score of between 0-8.  And I believe Oncotype now includes ER/PR scores as part of the testing, which they didn't do when I had it done.

Hope that helps--sorry I can't post live links with my browser--just cut and paste the addresses into your browser.

Anonymous

I'm fairly new here and still learning a lot from all the informative posts I've read.  I can only respond to the hormone receptor question.  After my biopsy I was told that I was triple negative and it wasn't until the addendum to my surgery path report came back that I learned things had changed.  I was then told that I was ER+72%, PR+60% and the Her2 stayed neg.  My oncologist said that this was uncommon but was happy with the change as now I could benefit from some of the other long term drugs that are given.  Thanks to everyone for all the help and knowledge they have given.  My best to all in this journey we all seem to be on together.

wallycat

Nash, one of the links for the Allred score isnot working.

And I would like to say THANK YOU NASH!!  I thought I "got and knew" all of this stuff, but the way you phrased the onco scoring gave me a great jolt of a DIFFERENT understanding!

Bless you all!

Anonymous

Ditto - thank you Nash.  You are certainly one of the bright stars on these boards.

nash

Wallycat, I tried the Allred link and it worked for me. Give it another shot, and if it still gives you fits, I'll find another article and post it.

You're very welcome, girls! I'm happy to help out where I can. Between my late Stage IV bc mom being on active treatment for 5 1/2 years and my ILC, I unfortunately know way more about bc than I ever cared to. But I figure I should put it to good use and share what I know, b/c the docs don't tell us diddly squat half the time.

hlya

Hi, I did have limitation to post threads everyday and didn't say Thank You to ALL yet.



Nash, Thanks! They are very informative. After surgery your ER/PR got higher % but why was your grade higher also? Did they ever explain to you? BTW my BS told me if there is any lymph node involved then Oncotype test won't work either as anyway chemo would be neccessary.



DENRulzBC: That's a BIG difference before/after surgery.

nash

QAnna--one reason my grade went up is because tumors are not homogenous--the same reason the ER/PR percentages can change. Also, the surgical excision gives a much larger tissue sample to work with than the core biopsy does. And also I had my biopsy and surgical path read by different pathologists at different facilities, and part of grading a tumor is subjective.

Oncotype can be used for postmenopausal women with positive nodes (I think up to 3 nodes, but I'd have to look it up). It hasn't be validated for premeno node positive women yet, though.

wallycat

My grade also changed from biopsy and lumpectomy...and larger sample was the reason.

ccbaby

My pathology report says ER 0%, unfavorable  and PR 0%, unfavorable. Does that mean I am ER negative and  PR negative? I have never thought to ask my onco about it.

Gitane

If your ER and PR are both 0% that would mean that they are negative.  It would affect treatment in that you would not take Tamoxifen or an AI when you complete your chemotherapy.  BTW looks like you are about half way through chemo.  YEA!  Hope you are doing O.K., not too many SEs.

ccbaby

Thanks so much Gitane!  Yes, half-way through and cannot wait to be all done!!  Take care!