Tests

Uncertainty, especially under the circumstances of a cancer diagnosis, is one of most stressful experiences. I recommend exercise, meditation, and relaxation exercises as ways to cope with stress during this time. Check out this book by Dr. Michael Antoni, one of the leading researchers in this area: http://www.amazon.com/Stress-Management-Intervention-Breast-Cancer/dp/1557989419/ref=sr_1_2?s=books&ie=UTF8&qid=1332591278&sr=1-2 I also highly recommend finding online social networks, like on http://www.PatientsLikeMe.com to find and connect with others going through what you are going through. Even though family and friends may be supportive, it can be so helpful to talk to people who have been through or are going through what you are going through. Only they can truly understand your fears and concerns. And, because the people you meet in online social networks are not close family and friends, you may actually be able to speak more freely about your thoughts, feelings and challenges, especially to the extent that some of the challenges involve family and friends reactions to your cancer. Uncertainty, especially under the circumstances of a cancer diagnosis, is one of most stressful experiences. I recommend exercise, meditation, and relaxation exercises as ways to cope with stress during this time. Check out this book by Dr. Michael Antoni, one of the leading researchers in this area: http://www.amazon.com/Stress-Management-Intervention-Breast-Cancer/dp/1557989419/ref=sr_1_2?s=books&ie=UTF8&qid=1332591278&sr=1-2 I also highly recommend finding online social networks, like on http://www.PatientsLikeMe.com to find and connect with others going through what you are going through. Even though family and friends may be supportive, it can be so helpful to talk to people who have been through or are going through what you are going through. Only they can truly understand your fears and concerns. And, because the people you meet in online social networks are not close family and friends, you may actually be able to speak more freely about your thoughts, feelings and challenges, especially to the extent that some of the challenges involve family and friends reactions to your cancer.

When you’re given drugs that can cause cardiac damage, your heart is carefully monitored so that if damage occurs that outweighs the benefit of the drugs, your oncologist can change your treatment. I was given two drugs—Adriamycin and Herceptin—that are known to cause heart damage in some people.

In my case, the test used to monitor my heart function was the MUGA (short for Multi Gated Acquisition Scan), which provides a very accurate, real-time image of your beating heart and shows how efficiently your left ventricle is pumping blood. I was given a baseline MUGA before I began Adriamycin, and a follow-up every three months until I finished Herceptin over a year later.

The test isn’t particularly difficult or painful, but it’s time-consuming: a couple of hours from start to finish. First a small amount of your blood is drawn, mixed with a radioactive substance, and injected back into your bloodstream. Then you lie on a table under a special camera that records the movement of the radioactive blood through your beating heart. The technician measures the percentage of blood pumped through the left ventricle with each heartbeat. This figure is called the Left Ventricular Ejection Fraction or LVEF. Each time you go for a MUGA, your LVEF is compared with your previous LVEF and your baseline LVEF so that changes can be noted.

My heart function dropped slowly throughout my treatment, and I was afraid I might have to stop or delay the rest of my scheduled Herceptin infusions. But it didn’t drop so fast or so low that my oncologist felt the risk outweighed the benefit of continuing treatment.

The only disturbing thing about the MUGA was the piece of paper I was given to carry with me for 24 hours after the test in case I set off any alarms at, say, an airport. I was also instructed not to hug or hold babies during that time.

My advice: Drink enough water to be well hydrated for the blood draw. And bring a book or your knitting; there’s a fair amount of downtime between the initial blood draw and the actual scan.
When you’re given drugs that can cause cardiac damage, your heart is carefully monitored so that if damage occurs that outweighs the benefit of the drugs, your oncologist can change your treatment. I was given two drugs—Adriamycin and Herceptin—that are known to cause heart damage in some people.

In my case, the test used to monitor my heart function was the MUGA (short for Multi Gated Acquisition Scan), which provides a very accurate, real-time image of your beating heart and shows how efficiently your left ventricle is pumping blood. I was given a baseline MUGA before I began Adriamycin, and a follow-up every three months until I finished Herceptin over a year later.

The test isn’t particularly difficult or painful, but it’s time-consuming: a couple of hours from start to finish. First a small amount of your blood is drawn, mixed with a radioactive substance, and injected back into your bloodstream. Then you lie on a table under a special camera that records the movement of the radioactive blood through your beating heart. The technician measures the percentage of blood pumped through the left ventricle with each heartbeat. This figure is called the Left Ventricular Ejection Fraction or LVEF. Each time you go for a MUGA, your LVEF is compared with your previous LVEF and your baseline LVEF so that changes can be noted.

My heart function dropped slowly throughout my treatment, and I was afraid I might have to stop or delay the rest of my scheduled Herceptin infusions. But it didn’t drop so fast or so low that my oncologist felt the risk outweighed the benefit of continuing treatment.

The only disturbing thing about the MUGA was the piece of paper I was given to carry with me for 24 hours after the test in case I set off any alarms at, say, an airport. I was also instructed not to hug or hold babies during that time.

My advice: Drink enough water to be well hydrated for the blood draw. And bring a book or your knitting; there’s a fair amount of downtime between the initial blood draw and the actual scan.

The most basic would be a metabolic panel (sometimes called a chem 7 or basic chemistry). It basically is a picture of the electrolyte balance in your body and kidney function. With this test the bicarbonate level will give your doctor an idea of any acid-base problems. The other way to directly measure blood pH is an arterial blood gas. Here blood is taken directly from the artery (usually the radial artery in the wrist) and information about the level of oxygen and carbon dioxide in your blood helps direct your care—usually ventilator settings (yep, this is the “in the intensive care unit” scenario). The most basic would be a metabolic panel (sometimes called a chem 7 or basic chemistry). It basically is a picture of the electrolyte balance in your body and kidney function. With this test the bicarbonate level will give your doctor an idea of any acid-base problems. The other way to directly measure blood pH is an arterial blood gas. Here blood is taken directly from the artery (usually the radial artery in the wrist) and information about the level of oxygen and carbon dioxide in your blood helps direct your care—usually ventilator settings (yep, this is the “in the intensive care unit” scenario).

Currently micrometastases are detected with the microscope using both standard H&E staining of slices of the sentinel lymph node as well as with melanoma specific imunostains (immuno-histo-chemistry or IHC). There are techniques to evaluate sentinel lymph nodes by PCR (polymerase chain reaction) that detect submicroscopic deposits of melanoma cells in the lymph nodes; however they are only experimental at this time. Currently micrometastases are detected with the microscope using both standard H&E staining of slices of the sentinel lymph node as well as with melanoma specific imunostains (immuno-histo-chemistry or IHC). There are techniques to evaluate sentinel lymph nodes by PCR (polymerase chain reaction) that detect submicroscopic deposits of melanoma cells in the lymph nodes; however they are only experimental at this time.

Extracapsular extension is usually only seen under the microscope by the pathologist examining the involved lymph node. Rarely, extracapsular extension can be so extensive that the lymph nodes 'grow together' or become matted - this is ominous and denotes a very aggressive melanoma. Extracapsular extension is usually only seen under the microscope by the pathologist examining the involved lymph node. Rarely, extracapsular extension can be so extensive that the lymph nodes 'grow together' or become matted - this is ominous and denotes a very aggressive melanoma.

Most commonly this is done with a high sensitivity c-reactive protein (hs CRP in medspeak), IL-6 (usually limited to research studies), and serum amyloid A was measured in the study by Pierce, et al. (noted here: http://talkabouthealth.com/what-is-meant-by-the-term-inflammation-in-the-context-of-cancer-and-integrative-medicine) but I’m not as familiar with it. Most likely your insurance won’t cover a hs CRP unless you have heart disease. Most commonly this is done with a high sensitivity c-reactive protein (hs CRP in medspeak), IL-6 (usually limited to research studies), and serum amyloid A was measured in the study by Pierce, et al. (noted here: http://talkabouthealth.com/what-is-meant-by-the-term-inflammation-in-the-context-of-cancer-and-integrative-medicine) but I’m not as familiar with it. Most likely your insurance won’t cover a hs CRP unless you have heart disease.

Many surgical oncologists will make sure the melanoma has not spread elsewehere in the body by doing several scans. The most widely used is the PET/CT scan for checking everything (except the brain) including the lungs, liver, and bones - all places to which the melanoma could spread. The brain is often scanned with either a CT scan or MRI - unfortunately the brain is one place to which the melanoma can metastasize. Some oncologists are more selective, only scanning the patients with more extensive melanoma - either very thick (>4mm) , thinner (>2mm) with ulceration, or those with lymph node spread. Many surgical oncologists will make sure the melanoma has not spread elsewehere in the body by doing several scans. The most widely used is the PET/CT scan for checking everything (except the brain) including the lungs, liver, and bones - all places to which the melanoma could spread. The brain is often scanned with either a CT scan or MRI - unfortunately the brain is one place to which the melanoma can metastasize. Some oncologists are more selective, only scanning the patients with more extensive melanoma - either very thick (>4mm) , thinner (>2mm) with ulceration, or those with lymph node spread.

Genetic mutations play a key role in NSCLC. Identifying certain, key mutations can help select targeted therapy. The two most important mutations in lung cancer right now are the EGFR and EML-4ALK mutation and are found in the subtype of lung cancer called adenocarcinoma. These mutations are more commonly found in female, asian, non-smokers. However, they are also found in smokers and males, but to a lesser degree.

Patients with the EGFR mutation are generally treated with a drug (pill) called Tarceva as first line treatment, rather than chemotherapy. Similarly, patients with the EML-4 ALK mutation are treated with a recently approved drug (pill) called Xalqori (Crizotinib). Generally patients with these mutations who are treated with the appropriate drug do very well when compared to patients who don't have the mutation and are treated with chemotherapy

Due to the dramatic responses with the use of these drugs when a mutation is identified, it is important to test for these mutation at diagnosis. Generally, when the initally biopsy is done, I make sure that there is enough material left over to send for molecular testing. It takes roughly 2 weeks to get the results back, so based on patient preference, I may start the patient on chemotherapy until the results come back.

To note, the testing of these mutations should routinely be performed in patients with stage IV NSCLC, not in patients with stage I-III (yet). Outside of a clinical trial, there is just not enough evidence yet on how to use these molecular markers in stage I to III NSCLC although this may change very soon. Genetic mutations play a key role in NSCLC. Identifying certain, key mutations can help select targeted therapy. The two most important mutations in lung cancer right now are the EGFR and EML-4ALK mutation and are found in the subtype of lung cancer called adenocarcinoma. These mutations are more commonly found in female, asian, non-smokers. However, they are also found in smokers and males, but to a lesser degree.

Patients with the EGFR mutation are generally treated with a drug (pill) called Tarceva as first line treatment, rather than chemotherapy. Similarly, patients with the EML-4 ALK mutation are treated with a recently approved drug (pill) called Xalqori (Crizotinib). Generally patients with these mutations who are treated with the appropriate drug do very well when compared to patients who don't have the mutation and are treated with chemotherapy

Due to the dramatic responses with the use of these drugs when a mutation is identified, it is important to test for these mutation at diagnosis. Generally, when the initally biopsy is done, I make sure that there is enough material left over to send for molecular testing. It takes roughly 2 weeks to get the results back, so based on patient preference, I may start the patient on chemotherapy until the results come back.

To note, the testing of these mutations should routinely be performed in patients with stage IV NSCLC, not in patients with stage I-III (yet). Outside of a clinical trial, there is just not enough evidence yet on how to use these molecular markers in stage I to III NSCLC although this may change very soon.

Mainly blood tests that look at the bone marrow function and kidney function and liver function. Mainly blood tests that look at the bone marrow function and kidney function and liver function.

Symptoms our often our main clue. We use a variety of imaging : plain xrays, bone scans, CT scans, PET scans. Which one is used is dependent on the problem that we are investigating. Tumor markers (from the blood) can be helpful in some cases. Symptoms our often our main clue. We use a variety of imaging : plain xrays, bone scans, CT scans, PET scans. Which one is used is dependent on the problem that we are investigating. Tumor markers (from the blood) can be helpful in some cases.

The tests that generally used to determine is lung cancer has travelled to other parts of the body (metastasized) is either a CT scan of the chest, abdomen and pelvis or more commonly a PET scan. A PET scan in a cancer scan of the whole body that picks up tumor growth. Generally, a PET scan is considered the standard of care for patients in the initial workup of their cancer. However, if a patient has already been diagnosed and treated, either a CT scan of chest/abdomen/pelvis or a PET scan can be used. Finally, a brain MRI is generally done as well to make sure the cancer has not moved to the brain. The tests that generally used to determine is lung cancer has travelled to other parts of the body (metastasized) is either a CT scan of the chest, abdomen and pelvis or more commonly a PET scan. A PET scan in a cancer scan of the whole body that picks up tumor growth. Generally, a PET scan is considered the standard of care for patients in the initial workup of their cancer. However, if a patient has already been diagnosed and treated, either a CT scan of chest/abdomen/pelvis or a PET scan can be used. Finally, a brain MRI is generally done as well to make sure the cancer has not moved to the brain.

Cancers produce novel proteins that can suggest, though not diagnose, a source of the tumor. The original blood tests included CEA, known to occur in many adenocarcinomas including lung, gastrointestinal and breast. CA 27-29 and CA15-3 have been most closely associated with breast cancers. CA 125 is the marker for ovarian as is HE4, a more recently developed test. PSA and prostatic acid phosphatase are used in prostate cancer. CA 19-9 is associated with pancreatic cancer. Germ cell tumors can produce B-HCG and AFP. AFP is also associated with hepatocellular cancer. Despite all of this, some tumors express no markers while other tumors express markers not generally associated with that disease type. This is part of the reason why markers are not promoted for general use at academic centers. Cancers produce novel proteins that can suggest, though not diagnose, a source of the tumor. The original blood tests included CEA, known to occur in many adenocarcinomas including lung, gastrointestinal and breast. CA 27-29 and CA15-3 have been most closely associated with breast cancers. CA 125 is the marker for ovarian as is HE4, a more recently developed test. PSA and prostatic acid phosphatase are used in prostate cancer. CA 19-9 is associated with pancreatic cancer. Germ cell tumors can produce B-HCG and AFP. AFP is also associated with hepatocellular cancer. Despite all of this, some tumors express no markers while other tumors express markers not generally associated with that disease type. This is part of the reason why markers are not promoted for general use at academic centers.

It is certainly not too late to be tested. BRCA 1 and 2 testing can be done on DNA extracted for a blood sample or from a buccal swab. NCCN guidelines for who should be offered testing were updated in April 2011. Generally if the guidelines are followed, insurance will cover the testing.

Myriad will provide testing kits to a doctor's office to facilitate the sample being sent in. I'm not a doctor but I do know you CAN be tested even though you already had a mastectomy. The BRCA gene is tested using blood (not tissue sample). There are other things that can be determined only with tissue (ER/PR status of tumor) but BRCA only requires a blood draw and it can be done at any time on anyone.

AnneMarie

Oncotype DX is a test designed for women with an early stage breast cancer, negative lymph nodes, and estrogen receptor positive breast cancer. The purpose of Oncotype DX is to determine whether seemingly low risk women, per their diagnosis, would benefit from chemotherapy.
If a person has a more advanced stage of breast cancer, positive lymph nodes, triple negative breast cancer, or another factor that would require chemotherapy then the oncologist does not order Oncotype DX because they already know the person requires chemotherapy.
So in your case I think you do not need the Oncotype DX because you are already having chemotherapy.
You may want to read more about Oncotype DX at the Genomics website...
http://www.genomichealth.com/en-US/OncotypeDX.aspx

Thanks,
Heather Oncotype DX is a test designed for women with an early stage breast cancer, negative lymph nodes, and estrogen receptor positive breast cancer. The purpose of Oncotype DX is to determine whether seemingly low risk women, per their diagnosis, would benefit from chemotherapy.
If a person has a more advanced stage of breast cancer, positive lymph nodes, triple negative breast cancer, or another factor that would require chemotherapy then the oncologist does not order Oncotype DX because they already know the person requires chemotherapy.
So in your case I think you do not need the Oncotype DX because you are already having chemotherapy.
You may want to read more about Oncotype DX at the Genomics website...
http://www.genomichealth.com/en-US/OncotypeDX.aspx

Thanks,
Heather

There are several different tests that can be performed on breast cancer tissue removed during breast biopsy/surgery. The general goal of the tests is to obtain detailed genetic information about the cancer cells. The results can help to a) predict response to particular treatments, b) predict the likelihood of recurrence of the cancer. By looking for changes in a carefully selected group of genes, it is possible to make these types of predictions. The tests (Mammaprint, Oncotype DX, etc.) look at different sets of genes and may be hard to compare directly. A site where you can learn more: http://labtestsonline.org/understanding/analytes/breast-genex?start=2. There are several different tests that can be performed on breast cancer tissue removed during breast biopsy/surgery. The general goal of the tests is to obtain detailed genetic information about the cancer cells. The results can help to a) predict response to particular treatments, b) predict the likelihood of recurrence of the cancer. By looking for changes in a carefully selected group of genes, it is possible to make these types of predictions. The tests (Mammaprint, Oncotype DX, etc.) look at different sets of genes and may be hard to compare directly. A site where you can learn more: http://labtestsonline.org/understanding/analytes/breast-genex?start=2.

I am doing mammaprint on all patients with tumor 1cm or greater.

Mammaprint is a 70 gene assay that can be used determine if a breast cancer is high risk or low risk for recurrence. Additionally it allows for tumor subtyping so that we can know if the tumor is luminal, basal or her2neu over-expressing. This can be very helpful for helping patients make decisions about the potential benefit of chemotherapy as well as helping to decide which medications are most effective. This assay can only be done on fresh tumor tissue either obtained at the time of core biopsy or during surgery. I am doing mammaprint on all patients with tumor 1cm or greater.

Mammaprint is a 70 gene assay that can be used determine if a breast cancer is high risk or low risk for recurrence. Additionally it allows for tumor subtyping so that we can know if the tumor is luminal, basal or her2neu over-expressing. This can be very helpful for helping patients make decisions about the potential benefit of chemotherapy as well as helping to decide which medications are most effective. This assay can only be done on fresh tumor tissue either obtained at the time of core biopsy or during surgery.

Immunohistochemistry (IHC) is a way to stain for a particluar protein on or in a cell. They are a combination of an antibody to a portion of the protein hooked to a colored stain. If the protein is there, the stain will appear a certain color - typically brown and if it is not then there will be an absence of color. Immunohistochemistry is used in breast cancer to see if the cells have estrogen receptors, progesterone receptors, epidermal growth factor receptors (such as Her2/neu). IHC stains are also used to look for cancer cells in sentinel nodes (staining for cytokeratin - a protein that is on breast cancer and other types of cancer cells).
Immunohistochemistry (IHC) is a way to stain for a particluar protein on or in a cell. They are a combination of an antibody to a portion of the protein hooked to a colored stain. If the protein is there, the stain will appear a certain color - typically brown and if it is not then there will be an absence of color. Immunohistochemistry is used in breast cancer to see if the cells have estrogen receptors, progesterone receptors, epidermal growth factor receptors (such as Her2/neu). IHC stains are also used to look for cancer cells in sentinel nodes (staining for cytokeratin - a protein that is on breast cancer and other types of cancer cells).

What happens next if mammogram is abnormal?
If an abnormality is found, it may or may not be something that needs treatment. The next step would be another "imaging" test like an ultrasound. This is a painless test that will allow the radiologist to better understand what was seen on the mammogram. Another imaging test that is used is an MRI. If the radiologist feels that the abnormality needs further study, a biopsy may be recommended. A mammogram is an x-ray of the breasts. It is used for both breast cancer screening and diagnostic purposes.

For screening, it may detect breast cancer before it can be felt in a physical examination. Two views are usually taken for a screening mammogram.

For diagnosis, multiple views of the breast are taken to determine the size and location of the abnormality as well as learn more about the surrounding tissue and lymph nodes.

Not sure, but as a Caregiver, I know that it is really difficult to balance. Not sure, but as a Caregiver, I know that it is really difficult to balance.