How to Read Immunohistochemistry Results - Just Menong

 

It doesn’t feel like the experience of suffering from breast cancer experienced by my mother has stepped into the third year. The story that used to be experienced is now a story for all of us. There are still many stories that have not been shared for Menong friends who are still struggling, including how to read the results of immunohistochemistry or CPI that Mom lived.

Early Breast Cancer

In November 2019, the mother felt a lump in the left breast. Because the lump got bigger and started to feel painful, Mommy finally said her complaint, which I immediately followed by taking my mother to Hermina Arcamanik Hospital Bandung.

The surgeon, Dr. Richard SHL. Tobing, is instructing for biopsy surgery.

Absolutely, the results of the biopsy stated that the lump was a carcinoma, or cancer. Mastectomy was carried out immediately at Ujungberung Hospital Bandung and continued with chemotherapy at Santosa Bandung Hospital for as many as 6 cycles or 6x for 1 package of chemotherapy.

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Post-chemotherapy, onk neurosurgeon, Dr. Yusuf Heryadi, SpB(K), instructed to exercise control every month. Because the condition of the mother is good and without complaints, there are no further actions such as radiation or others. Every month the doctor only gives a prescription for Sancoidan, an herb to increase the endurance of the body of cancer patients.

Doctor Yusuf also suggested that we conduct an immunostochemical examination to ensure the type of cell and the origin of the cancer cell that the mother has. To shorten the time, I also had the initials to make a self-payment of 2 million rupiah so as not to have to queue for a long time when compared to BPJS facilities that must be done at Hasan Sadikin Hospital Bandung.

Mastectomy Sediment

The mastectomy sediment that will be examined comes from Ujungberung Hospital Bandung, where the mastectomy is carried out. By bringing a cover letter from the Anatomical Pathology Laboratory, we get a masectomy sediment that we deliver directly for inspection.

After a few days, the lab attendant called me and told me to go back to Santosa Kopo Hospital. Officers explained that immunostochemical examinations could not be done on the sediment that I brought from Ujungberung Hospital because in the sample there are no more cancer cells left. Officers suggested that we bring biopsy results that are still stored in the laboratory of anatomical pathology in Hermina Arcamanik Hospital.

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Officers also explained the possibility of why in the mastectomy sediment there are no more cancer cells. The cause could be that at the time of the biopsy (first surgery) by Doctor Richard, all the cancer cells had been lifted.

We went back to Hermina Arcamanik Hospital, where the biopsy operation was, with a cover letter from Santosa Kopo Hospital.

Results of immunostochemistry

The results of our immunostochemical examination were obtained within 6 weeks. After getting the results, we again consulted with Doctor Yusuf at the oncology surgical clinic.

Immunohistochemical examination, or CPIS, is an examination to detect various proteins contained in the cells of various diseases, including malignant tumors or cancer. CPIS testing is used to help the prognosis (prediction of the development of a disease), drugs, and advanced therapy.

In the case of cancer, each tumor/cancer cell produces various types of proteins that form their temperament and aggressiveness. Despite suffering from the same type of cancer, each individual sufferer will have a different tumor behavior.

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International standards in breast cancer must examine at least four types of protein, including:

• Receptor estrogen (ER) determines the presence of receptors against the hormone estrogen
• Progester receptor (PR) determines the presence of receptors against the hormone progesterone
• Human Epidemal Growth Factor Receptor 2, or HER2, determines the presence or absence of receptors against Human Epidermal Growth Factor. These receptors help control cell development normally and how those cells repair themselves. In 25% of breast cancer cases, these receptors increase, which causes cancer cells to develop abnormally and uncontrollably.
• Ki67, the protein contained in the surface of the cell, is used to determine the speed of cell division related to the speed of growth or aggressiveness of tumor cells/cancer.

The results of IHK ER and PR positive showed the type of cancer that reacted to the hormones estrogen and progesterone, which means the cancer suffered by the patient, including hormonal cancer and breast cancer, is associated with the activity of the hormones estrogen and progesterone, which serve as the main female reproductive hormones.

Positive HER2 results indicate cancer cells develop uncontrollably.

The higher the results of Ki67, the more they signify the development of cancer cells that are increasingly aggressive.

This combination of four-protein immunoactivity can help doctors know the type of cancer and estimate the possible development of cancer suffered by the mother. (source: rsupwahidin.com, www.alododokter.com and www.unpad.ac.id)

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Alhamdulillah, from the immunohistochemical examination, there are 3 examinations that show negative results, namely ER-negative, PR-negative, and HER2-negative, or what is known as Triple Negative Breast Cancer (TNBC). D. Octer stated that the results were good so that, God willing, the condition of the mother was fine and there was no further therapy.

Although it has been conveyed by the doctor, I also studied how to read immunostochemical results to better understand the condition of the mother.

Monthly Control

With the results of a good immunohistochemical examination, finally the mother is only required to control every month. Sometimes, out of pity with you who have to wait for the old queue, finally doctors and nurses offer an option so that you are only given a Sancoidan prescription without having to meet directly with the doctor.

For some time, we ended up just coming in the control hours to take and make up for the recipe because of the normal condition of the mother's normal activity as usual. Nurses also diligently ask if there are any complaints or not.

After getting the results of an IHK examination, I also began to learn how to read immunostochemical results or read the results of CPHK. The next step, in July 2022, I had the initiative to meet with Doctor Yusuf to ask for further examination even though my mother's condition remained in normal circumstances. The doctor also approved post-chemotherapy; the patient must still be controlled with various examinations, including the stomach ultrasound and chest X-rays.