Understanding Test Results

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1 Understanding Test Results 8 th Annual Metastatic Breast Cancer Conference September 20-21, 2014 Friday Center Chapel Hill NC Delma Armstrong, BSN, RN, OCN Nurse Navigator, UNC Breast Program

2 Types of Tests Laboratory tests on blood samples Laboratory tests on tumor tissue samples Imaging X-rays CT Scans MRI Scans Nuclear Medicine Scans

3 What are the costs of tests? $24,000 question Monetary costs can be high Insurance reimbursement can vary widely, even when ordered by the same provider, in different settings Psychological costs can also be high - Anxiety Abnormal test results may lead to more tests Additional abnormal results may lead to even more tests and/or procedures such as biopsies.

4 What are tests for? In Metastatic Breast Cancer (MBC), periodic testing is done To MONITOR disease activity To MONITOR treatment effect To INFORM treatment decisions

5 Blood Tests Chemistries Tumor Markers Liver Enzymes Sodium, Potassium BUN, Creatinine Calcium, Phosphorus Glucose CA 15.3 CA CA 125 CEA (carcinoembryonic antigen)

6 Blood Chemistries Indirectly give information on organ function Checked periodically to assess risk of treatment side effects Tests checked may depend on location of metastases and/or side effects of treatments Liver Enzymes check liver function Sodium, Potassium check hydration, liver and kidney function BUN, Creatinine check kidney function Calcium, Phosphorus check bone health Glucose check for diabetes

7 Tumor Markers in Blood Advantages Can be early indicators of disease progression Can assist in therapy decisions Are checked periodically to check response to ongoing treatment Disadvantages Not conclusive Negative result no cancer Positive result growing cancer

8 Tumor Markers in Blood Used in MBC to monitor response to therapy Decreasing tumor marker = treatment working Can help avoid costly imaging studies Increasing tumor marker not as clear MUST be used with other indicators of disease process: Physical Exam, Labs, Scans, history

9 Tumor Markers in Blood Best tests for Breast Cancer CA 15.3 CA CA 125 CEA (carcinoembryonic antigen)

10 Tumor Markers in Tissue ImmunoHistoChemistry tests ER (estrogen receptor) PR (progesterone receptor) Her2 (her2neu oncogene) FISH (Fluorescence InSitu Hybridization) Quantifies Her2, especially when IHC borderline

11 Tumor Markers in Tissue Guide treatment with targeted therapies Biologic Agents Decrease the effect of Her2neu oncogene Used when Her2neu is 3+ or overamplified Herceptin (trastuzumab) Tykerb (lapatinib) Perjeta (pertuzumab) Hormone Therapy can block estrogen/progesterone receptors slowing tumor growth

12 Imaging X-rays Bone density scan CT Scans MRI Scans Nuclear Medicine Scans Bone Scans PET Scans

13 Imaging X-rays Bone Density Scan

14 CT Scan Imaging

15 MRI Scan Imaging

16 NM Bone Scan Imaging

17 PET/CT Scan Imaging

18 Imaging Comparison Test Cost Advantage Disadvantage Limitations X-ray $ Quick, easy Radiation exposure Structures overlap CT $$ Quick, easy No structure overlap MRI $$$ Shows tissues well No radiation Contrast not likely to cause allergy Bone Scan SS Very sensitive for bone lesions PET $$$$ Identifies cancer affected areas PET,CT PET/MRI $$$$$ Combines advantaes of each More radiation IV contrast needed Studies take longer Requires IV contrast Size matters Radiation exposture Requires IV contrast Takes several hours Radiation exposure Images not detailed Radiation, Contrast, Takes a long time Positioning Must lie flat IV access Allergy? Must lie still Must lie flat IV access Claustrophobia IV access Must lie still IV access Must lie still Blood glucose must be normal

19 Test Results What is the purpose of the test? How accurate is the test? Advantages/disadvantages How long will it take? When will we know results? How will I get my result? What is the plan if result is negative? What is the plan if result is positive?

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