HER2-Positive Breast Cancer

HER2-positive breast cancer is a specific type of breast cancer that affects a significant number of individuals. In this article, we will break down the complex medical jargon and explain everything you need to know about HER2-positive breast cancer in simple and easy-to-understand language. From what HER2-positive means to the symptoms, treatments, and lifestyle adjustments, we’ve got you covered.

HER2-positive breast cancer refers to a type of breast cancer where the cancer cells have too much of a protein called HER2 (human epidermal growth factor receptor 2). This protein normally helps cells grow and divide, but when there’s too much of it, it can make cancer cells grow and spread more rapidly. The symptoms of HER2-positive breast cancer are similar to other types of breast cancer and might include a lump in the breast or underarm, changes in the size or shape of the breast, pain, tenderness, skin changes, and nipple discharge. If you notice any of these symptoms, it’s important to see a doctor.

Types

Types of HER2-positive breast cancer in simple terms, making it easy to understand.

1. HER2-Positive Ductal Carcinoma In Situ (DCIS)This is the earliest form of HER2-positive breast cancer. It’s often referred to as a “non-invasive” cancer because it hasn’t spread beyond the milk ducts. However, it’s essential to treat DCIS to prevent it from progressing to invasive cancer. Treatment usually involves surgery or radiation therapy.
2. HER2-Positive Invasive Ductal CarcinomaIn this type, the cancer cells have broken out of the milk ducts and invaded nearby tissues in the breast. It’s the most common form of breast cancer. Treatment might involve surgery, chemotherapy, targeted therapy, and radiation therapy, depending on the extent of the spread.
3. HER2-Positive Invasive Lobular CarcinomaSimilar to invasive ductal carcinoma, this type of cancer begins in the lobules (milk-producing glands) and then spreads to surrounding tissues. It’s less common than invasive ductal carcinoma. Treatments are generally similar to those for other invasive breast cancers.
4. HER2-Positive Metastatic Breast CancerWhen HER2-positive breast cancer spreads beyond the breast to other parts of the body like bones, liver, or lungs, it’s called metastatic breast cancer. This is an advanced stage of the disease and requires a combination of treatments such as targeted therapies, chemotherapy, and sometimes surgery.
5. HER2-Positive Hormone Receptor-Positive Breast CancerThis type of cancer is both HER2-positive and hormone receptor-positive. It means the cancer cells have receptors for hormones like estrogen and progesterone. This type might require treatments that block both the HER2 protein and hormone receptors.
6. HER2-Positive Triple-Negative Breast CancerUnlike hormone receptor-positive cancers, triple-negative breast cancer lacks receptors for HER2, estrogen, and progesterone. This type tends to be more aggressive and may require a combination of treatments, including chemotherapy.
7. HER2-Positive Inflammatory Breast CancerInflammatory breast cancer is rare but aggressive. It often presents with redness, warmth, and swelling of the breast, mimicking an infection. HER2-positive inflammatory breast cancer requires intense treatment, including chemotherapy, surgery, radiation, and targeted therapy.
8. HER2-Positive Recurrent Breast CancerSometimes, cancer can return even after successful treatment. Recurrent HER2-positive breast cancer requires a personalized approach, which might involve treatments previously used or new therapies depending on the circumstances.

Causes

Possible causes of HER2-positive breast cancer in easy-to-understand terms.

1. Genetic Predisposition: Sometimes, certain genes passed down from parents can increase the risk of developing HER2-positive breast cancer.

2. Hormone Imbalances: Fluctuations in hormones, like estrogen and progesterone, can contribute to the growth of HER2-positive breast cancer cells.

3. Age: As we get older, the risk of developing HER2-positive breast cancer increases.

4. HER2 Gene Mutation: A mutation in the HER2 gene can lead to the overproduction of the HER2 protein, triggering cancer growth.

5. Family History: Having a close family member with breast cancer can elevate the risk of HER2-positive breast cancer.

6. Personal History: If you’ve had breast cancer in one breast, you’re at a higher risk for developing it in the other breast, possibly HER2-positive.

7. Gender: Though rare, men can also develop HER2-positive breast cancer.

8. Radiation Exposure: Previous exposure to high levels of radiation, like in certain medical treatments, might increase the risk.

9. Hormone Replacement Therapy (HRT): Long-term use of HRT, especially estrogen and progesterone, could elevate the risk.

10. Obesity: Carrying excess weight can disrupt hormone balance, potentially leading to HER2-positive breast cancer.

11. Alcohol Consumption: Drinking alcohol regularly might increase the likelihood of HER2-positive breast cancer.

12. Lack of Physical Activity: A sedentary lifestyle could contribute to the risk of breast cancer, including the HER2-positive subtype.

13. Environmental Factors: Exposure to certain chemicals and pollutants may play a role in cancer development.

14. High-Fat Diet: Consuming a diet rich in saturated fats might contribute to cancer growth.

15. Insulin Resistance: This condition, often linked to obesity, could promote the growth of cancer cells.

16. Early Onset of Menstruation: Starting menstruation at a young age might increase the risk of HER2-positive breast cancer.

17. Late Menopause: Experiencing menopause later in life could also be a contributing factor.

18. Reproductive History: Women who haven’t had children or had their first child after 30 may have a higher risk.

19. Benign Breast Diseases: Certain non-cancerous breast conditions could indicate a higher risk for HER2-positive breast cancer.

20. Dense Breast Tissue: Higher breast tissue density could make it harder to detect cancer early.

21. Certain Medications: Some medications might slightly increase the risk, though the connection is still being studied.

22. Lack of Breastfeeding: Not breastfeeding, especially for an extended period, could play a role.

23. Stress: While not a direct cause, chronic stress might weaken the immune system’s ability to combat cancer cells.

24. Lack of Sleep: Poor sleep patterns could affect overall health, potentially contributing to cancer development.

25. Viral Infections: Some viral infections have been linked to an increased risk of breast cancer.

26. Chemical Exposure: Contact with certain chemicals, like those found in pesticides, could be a factor.

27. Inherited Genetic Mutations: Aside from BRCA genes, other genetic mutations might raise the risk.

28. Inflammation: Chronic inflammation in the body could contribute to cancer growth.

29. Unhealthy Lifestyle: A combination of smoking, poor diet, and lack of exercise could elevate risk.

30. Estrogen Exposure: Extended exposure to estrogen, without the balancing effect of progesterone, might contribute.

Symptoms

Symptoms of HER2-positive breast cancer in plain and simple language, helping you understand the signs to watch out for.

1. Changes in Breast Appearance: One of the first signs might be changes in the breast’s appearance, such as swelling, redness, or an unusual shape.

2. Breast Pain or Discomfort: Experiencing pain, tenderness, or discomfort in the breast without any apparent reason could be a symptom.

3. Lump or Thickening: Feeling a lump or a thickened area in the breast or underarm could indicate HER2-positive breast cancer.

4. Skin Changes: Skin changes on the breast, like dimpling, puckering, or an orange-peel texture, might be a sign of this type of cancer.

5. Nipple Changes: Changes in the nipple, like inversion, scaling, or discharge, should be checked out by a doctor.

6. Swollen Lymph Nodes: Lymph nodes under the arm or around the collarbone becoming enlarged can be a symptom of breast cancer.

7. Fatigue: Unexplained fatigue or tiredness that doesn’t go away with rest might be a sign your body is fighting something.

8. Unintended Weight Loss: Losing weight without trying could be indicative of various health issues, including HER2-positive breast cancer.

9. Loss of Appetite: A sudden loss of appetite and a feeling of fullness even without eating much might be a symptom to pay attention to.

10. Shortness of Breath: If you find yourself consistently short of breath, it could indicate that the cancer has spread beyond the breast.

11. Persistent Cough: A persistent cough or hoarseness can be a symptom if the cancer has spread to the lungs or throat.

12. Bone Pain: Bone pain, especially in the back, hips, or ribs, might be a sign that the cancer has spread to the bones.

13. Headaches: Frequent and severe headaches could be a symptom of advanced HER2-positive breast cancer.

14. Abdominal Pain: Pain or discomfort in the abdomen could be a sign if the cancer has spread to the liver or other organs.

15. Neurological Symptoms: Weakness in certain body parts, numbness, or tingling might occur if the cancer affects the nervous system.

16. Vision Changes: Blurry vision or other changes in eyesight might be indicative of advanced cancer affecting various parts of the body.

17. Mood Changes: Experiencing sudden mood swings or depression that can’t be attributed to other factors could be a symptom.

18. Skin Lesions: The appearance of skin lesions or lumps could be a sign if the cancer has spread to the skin.

19. Swelling in Legs: Swelling in the legs, often accompanied by pain, might be due to cancer affecting circulation.

20. Bowel or Bladder Changes: Changes in bowel habits or urinary patterns could indicate the spread of cancer to nearby organs.

Diagnosis

Let’s break it down in simple words, focusing on its diagnosis and tests.

1. What is HER2-Positive Breast Cancer?

HER2 is a protein that can promote the growth of cancer cells. In some people, high levels of HER2 are produced in breast cells, leading to rapid growth and division of these cells. This type is known as HER2-positive breast cancer.

2. Importance of Determining HER2 Status:

Knowing the HER2 status helps doctors select the most effective treatment. HER2-targeted therapies can be beneficial for those with HER2-positive cancer.

Diagnosis and Tests for HER2-Positive Breast Cancer

3. Biopsy:

What is it? A sample of the breast tissue is taken. Why? To check for cancer cells and determine the HER2 status.

4. Immunohistochemistry (IHC) Test:

What is it? A lab test that checks for HER2 protein in cancer cells. Why? To see if the cancer is HER2-positive or HER2-negative.

5. Fluorescent in situ Hybridization (FISH) Test:

What is it? A test that checks for HER2 genes in cancer cells. Why? It can provide more detailed information about HER2 status than IHC.

6. Dual In Situ Hybridization (DISH) Test:

What is it? Similar to FISH, this test checks for multiple genes in the cancer cells. Why? It helps confirm the HER2 status.

7. Polymerase Chain Reaction (PCR):

What is it? A test that detects genetic material. Why? Used to identify the HER2 gene in breast cancer samples.

8. Blood Tests:

What is it? Drawing blood to check for signs of cancer. Why? It can provide clues about overall health and cancer’s spread.

9. Mammogram:

What is it? An X-ray of the breast. Why? To identify any lumps or abnormalities.

10. MRI (Magnetic Resonance Imaging):

What is it? Uses magnets and radio waves to create detailed images of the breast. Why? Helpful to see the size of the cancer and if it has spread.

11. CT Scan (Computerized Tomography):

What is it? Detailed X-ray to get images of the body. Why? To see if cancer has spread to other parts.

12. PET Scan (Positron Emission Tomography):

What is it? Uses a radioactive substance to look for cancer cells. Why? Helps detect if and where cancer has spread in the body.

13. Bone Scan:

What is it? A test to check the bones. Why? To find out if cancer has spread to the bones.

14. Ultrasound:

What is it? Uses sound waves to create pictures of the inside of the breast. Why? Helps differentiate between solid tumors and fluid-filled cysts.

15. Chest X-Ray:

What is it? An X-ray of the chest. Why? To see if cancer has spread to the lungs.

16. Sentinel Lymph Node Biopsy:

What is it? Removal of a few lymph nodes. Why? To check if cancer has reached the lymphatic system.

17. Axillary Lymph Node Dissection:

What is it? Removing several lymph nodes from the armpit. Why? If cancer is found in sentinel nodes, more nodes might be checked.

18. Estrogen and Progesterone Receptor Test:

What is it? Tests the cancer cells for these hormone receptors. Why? Determines if hormone therapy might be an effective treatment.

19. Tumor Grade:

What is it? Measures how abnormal the cancer cells look. Why? It can give an idea of how quickly the cancer may grow.

20. Oncotype DX:

What is it? A test that studies a set of genes in cancer cells. Why? Helps predict if cancer will return and if chemotherapy is beneficial.

21. MammaPrint:

What is it? Another gene test. Why? Used to predict the risk of cancer coming back.

Diagnoses and Tests for HER2-Positive Breast Cancer:

1. Mammogram: A mammogram is an X-ray of the breast that can detect abnormalities or masses, including HER2-positive tumors.
2. Ultrasound: This imaging technique uses sound waves to create images of the breast tissue, helping to identify the nature of any detected lumps.
3. Clinical Breast Exam: A doctor examines the breasts for any lumps or changes in texture, which might indicate the presence of HER2-positive cancer.
4. Biopsy: A biopsy involves removing a small sample of breast tissue for analysis. A pathologist examines the tissue to determine if HER2 is overexpressed.
5. Fine Needle Aspiration (FNA): A thin needle is used to extract cells from a suspicious area, which are then examined for HER2 status.
6. Core Needle Biopsy: This procedure uses a slightly larger needle to extract a small core of tissue for more detailed analysis.
7. Surgical Biopsy: In some cases, a surgeon might remove a larger piece of tissue for examination to confirm HER2 status.
8. HER2 Testing: The tissue sample obtained from a biopsy is tested for the presence and quantity of HER2 receptors on the cancer cells.
9. Immunohistochemistry (IHC): This test uses antibodies to detect HER2 proteins on the surface of cancer cells.
10. Fluorescence In Situ Hybridization (FISH): FISH detects the presence of HER2 genes by using fluorescent probes to bind to specific DNA sequences.
11. Gene Expression Profiling: Tests like Oncotype DX or Mammaprint analyze the activity of specific genes to help determine the aggressiveness of the cancer and its response to treatment.
12. Breast MRI: Magnetic Resonance Imaging provides detailed images of the breast, helping to evaluate the size and extent of HER2-positive tumors.
13. CT Scan: Computed Tomography scans provide cross-sectional images to determine if cancer has spread beyond the breast.
14. PET Scan: Positron Emission Tomography can help detect distant metastases by highlighting areas with high metabolic activity.
15. Sentinel Lymph Node Biopsy: This procedure determines if cancer has spread to the lymph nodes by examining the first nodes that cancer is likely to reach.
16. Axillary Lymph Node Dissection: In more advanced cases, multiple lymph nodes may be removed for further analysis.
17. Chest X-ray: This helps assess if the cancer has spread to the lungs.
18. Bone Scan: Detects cancer that has spread to the bones.
19. Liver Function Tests: Blood tests can assess liver health and detect potential spread to the liver.
20. Complete Blood Count (CBC): This blood test helps evaluate overall health and detect any abnormalities.
21. HER2-Targeted Therapy: Once HER2-positive status is confirmed, targeted therapies like Herceptin, Perjeta, or Kadcyla can be prescribed.
22. Chemotherapy: Often used in combination with targeted therapy to eliminate cancer cells.
23. Hormone Therapy: If HER2-positive cancer is also hormone receptor-positive, hormone-blocking drugs may be used.
24. Radiation Therapy: High-energy rays are used to target and kill cancer cells after surgery.
25. Surgery: Lumpectomy or mastectomy may be performed to remove the tumor and surrounding tissue.
26. Neoadjuvant Therapy: Treatment given before surgery to shrink tumors and make them easier to remove.
27. Adjuvant Therapy: Treatment given after surgery to reduce the risk of recurrence.
28. Clinical Trials: Participating in research studies can provide access to cutting-edge treatments.
29. Follow-Up Care: Regular check-ups, imaging, and tests to monitor for recurrence.
30. Supportive Care: Emotional, psychological, and physical support to manage the challenges of cancer treatment.

Treatment

HER2-positive breast cancer is a type of cancer that has too much HER2 protein. This protein makes cancer cells grow faster. But, the good news is there are many treatments available. Here’s a simple list of 30 treatments to understand better.

1. Surgery

What it is: Doctors remove the tumor or the whole breast. Simple Explanation: It’s like removing a bad apple from a basket.

2. Radiation Therapy

What it is: Uses high-energy rays to kill cancer cells. Simple Explanation: Imagine a powerful light beam targeting only the bad cells.

3. Chemotherapy

What it is: Uses drugs to kill cancer cells. Simple Explanation: Think of it as a medicine cocktail that targets harmful cells.

4. Hormone Therapy

What it is: Blocks hormones that fuel some breast cancers. Simple Explanation: Stops the food supply to bad cells.

5. Targeted Therapy

What it is: Drugs specifically designed for HER2 cancer cells. Simple Explanation: Like a smart missile targeting only the enemy.

6. Trastuzumab (Herceptin)

What it is: A drug targeting the HER2 protein. Simple Explanation: It’s a special medicine focused on the cause of HER2 cancer.

7. Pertuzumab (Perjeta)

What it is: Works alongside Trastuzumab. Simple Explanation: Another medicine to double the power against HER2.

8. T-DM1 (Kadcyla)

What it is: A mix of Herceptin and a chemotherapy drug. Simple Explanation: A 2-in-1 solution against HER2.

9. Lapatinib (Tykerb)

What it is: A pill that stops the growth of HER2 cancer cells. Simple Explanation: A tablet that halts bad cells in their tracks.

10. Neratinib (Nerlynx)

What it is: A drug that blocks enzymes promoting cancer growth. Simple Explanation: Stops the engines that power bad cells.

11. Fam-trastuzumab deruxtecan-nxki (Enhertu)

What it is: Targets HER2 cells and delivers chemotherapy. Simple Explanation: A smart drug that hits the target and drops a medicine bomb.

12. Bisphosphonates

What it is: Helps strengthen bones weakened by cancer. Simple Explanation: Like a health booster for your bones.

13. Ovarian Suppression

What it is: Stops ovaries from making estrogen. Simple Explanation: Switches off the estrogen factory.

14. Aromatase Inhibitors

What it is: Lowers estrogen in postmenopausal women. Simple Explanation: Reduces the food supply for some cancer cells.

15. Monoclonal Antibodies

What it is: Man-made immune system proteins. Simple Explanation: Bodyguards designed in a lab to protect you.

16. Immune Checkpoint Inhibitors

What it is: Boosts the immune system against cancer. Simple Explanation: Awakens your body’s defense team.

17. CDK4/6 Inhibitors

What it is: Stops cancer cells from dividing. Simple Explanation: Puts the brakes on harmful cells.

18. mTOR Inhibitors

What it is: Blocks a pathway that helps cancer cells survive. Simple Explanation: Cuts off a secret path used by bad cells.

19. PARP Inhibitors

What it is: Stops cancer cells repairing their DNA. Simple Explanation: Prevents harmful cells from fixing themselves.

20. Cryotherapy

What it is: Freezes off the tumor. Simple Explanation: Like using super-cold ice against bad cells.

21. Laser Therapy

What it is: Uses light to burn off or shrink tumors. Simple Explanation: Powerful light zaps the bad cells away.

22. Mastectomy

What it is: Surgical removal of one or both breasts. Simple Explanation: Removing the entire affected area to ensure safety.

23. Lumpectomy

What it is: Surgery to remove only the tumor and a small margin. Simple Explanation: Takes out only the bad spot.

24. Lymph Node Removal

What it is: Surgery to remove affected lymph nodes. Simple Explanation: Removing filters that may have trapped bad cells.

25. Sentinel Node Biopsy

What it is: Checks the first few lymph nodes for cancer. Simple Explanation: A test to see if cancer has spread.

26. Systemic Therapy

What it is: Treatments that reach cells throughout the body. Simple Explanation: A full-body approach to tackle the disease.

27. Bone-modifying Drugs

What it is: Medicines to strengthen bones. Simple Explanation: Fortifying your bones against attacks.

28. Physical Therapy

What it is: Helps restore strength and mobility. Simple Explanation: Exercises to get you back on your feet.

29. Complementary Therapies

What it is: Practices like yoga or acupuncture to support treatment. Simple Explanation: Extra help to make you feel better during treatment.

30. Clinical Trials

What it is: Research studies to find new treatments. Simple Explanation: Testing new ways to defeat cancer.

Medications

Drug treatments for HER2-positive breast cancer, explaining their details in simple terms. Whether you’re a patient, caregiver, or someone seeking information, this guide will help you understand these treatments better.

1. Herceptin (Trastuzumab)

Herceptin is a well-known drug that targets HER2-positive breast cancer cells. It blocks the HER2 protein’s signals, which can slow down or stop the growth of cancer cells. It’s often used with other treatments to improve their effectiveness.

2. Perjeta (Pertuzumab)

Perjeta works in combination with Herceptin to block HER2 signals, making the treatment even more effective. It’s particularly useful for early-stage HER2-positive breast cancer.

3. Kadcyla (T-DM1)

Kadcyla is a combination of Herceptin and a chemotherapy drug. It delivers the chemotherapy directly to the cancer cells, minimizing damage to healthy cells.

4. Tykerb (Lapatinib)

Tykerb blocks signals from both HER2 and another protein called EGFR. It’s used when cancer has spread to other parts of the body.

5. Nerlynx (Neratinib)

Nerlynx is used after initial treatment to lower the risk of cancer coming back. It blocks HER2 and other proteins that promote cancer growth.

6. Enhertu (Trastuzumab Deruxtecan)

Enhertu is used for advanced breast cancer. It delivers chemotherapy directly to cancer cells while targeting HER2.

7. Tukysa (Tucatinib)

Tukysa is used when cancer has spread to the brain. It specifically targets brain metastases in HER2-positive breast cancer.

8. Neratinib (Nerlynx)

Neratinib works by blocking signals that cause cancer cells to grow. It’s often used to reduce the risk of cancer recurrence.

9. Lapatinib (Tykerb)

Lapatinib blocks signals from both HER2 and EGFR, which can slow down cancer growth.

10. Trastuzumab Deruxtecan (Enhertu)

Trastuzumab Deruxtecan is used for advanced breast cancer and delivers chemotherapy directly to cancer cells.

11. Tucatinib (Tukysa)

Tucatinib targets brain metastases in HER2-positive breast cancer.

12. Arzerra (Ofatumumab)

Arzerra helps the immune system fight cancer cells. It’s used when cancer is resistant to other treatments.

13. Avastin (Bevacizumab)

Avastin targets blood vessels that supply cancer cells, slowing down their growth.

14. Halaven (Eribulin)

Halaven blocks cancer cell division and growth, helping to control the spread of the disease.

15. Ibrance (Palbociclib)

Ibrance targets proteins that help cancer cells grow, slowing down their progression.

16. Afinitor (Everolimus)

Afinitor inhibits proteins that promote cancer growth, helping to control the disease.

17. Abraxane (Paclitaxel Albumin-bound)

Abraxane is a chemotherapy drug that disrupts cancer cell division.

18. Xeloda (Capecitabine)

Xeloda interferes with cancer cell growth, slowing down the disease’s advancement.

19. Gemzar (Gemcitabine)

Gemzar is a chemotherapy drug that stops cancer cells from multiplying.

20. Taxotere (Docetaxel)

Taxotere disrupts cancer cell division, slowing down tumor growth.

21. Halaven (Eribulin)

Halaven blocks cancer cell division and growth, helping to control the spread of the disease.

22. Ibrance (Palbociclib)

Ibrance targets proteins that help cancer cells grow, slowing down their progression.

23. Afinitor (Everolimus)

Afinitor inhibits proteins that promote cancer growth, helping to control the disease.

24. Abraxane (Paclitaxel Albumin-bound)

Abraxane is a chemotherapy drug that disrupts cancer cell division.

25. Xeloda (Capecitabine)

Xeloda interferes with cancer cell growth, slowing down the disease’s advancement.

26. Gemzar (Gemcitabine)

Gemzar is a chemotherapy drug that stops cancer cells from multiplying.

27. Taxotere (Docetaxel)

Taxotere disrupts cancer cell division, slowing down tumor growth.

28. Navelbine (Vinorelbine)

Navelbine interferes with cancer cell division, helping to control the spread of the disease.

29. Cytoxan (Cyclophosphamide)

Cytoxan is a chemotherapy drug that targets rapidly dividing cancer cells.

30. Adriamycin (Doxorubicin)

Adriamycin damages cancer cell DNA, slowing down its growth.

Conclusion

These 30 drug treatments offer hope to individuals diagnosed with HER2-positive breast cancer. Each treatment has a unique way of targeting cancer cells, slowing down their growth, and improving patient outcomes. Remember that medical decisions should be made with your healthcare provider’s guidance. Stay informed, ask questions, and explore the best treatment options available for your specific situation.

References