From My Pathology Report

Tumor size at removal: slightly over 1.5cm
Cancer type: actually there were 2 types found; Invasive Ducal Carcinoma and Ductal carcinoma in situ (DCIS)
Stage: T1
Grade: between 2 and 3
Estrogen and progesterone receptors: Positive
HER2/neu Factor: Positive

Explanation of Pathology Report

Types of breast cancer: The tissue removed during the biopsy is examined in the lab to see whether the cancer is in situ (not invasive) or invasive. The biopsy is also used to determine the cancer's type. These types of breast cancer are defined in the section on "What Is Breast Cancer?." The most common types, invasive ductal and invasive lobular cancer, are treated the same way. In some cases, special breast cancer types that tend to have a more favorable prognosis (medullary, tubular, and mucinous cancers) are treated differently. For example, hormonal therapy or chemotherapy may be recommended for small stage I cancers with unfavorable microscopic features but not for small cancers of the types associated with a more favorable prognosis.

Grades of breast cancer: A pathologist looks at the tissue sample under a microscope and then assigns a grade to it. The grade helps predict the patient's prognosis because cancers that closely resemble normal breast tissue tend to grow and spread more slowly. In general, a lower grade number indicates a slower-growing cancer while a higher number indicates a faster-growing cancer.

Histologic tumor grade (sometimes called its Bloom-Richardson grade, Scarff- Bloom-Richardson grade, or Elston-Ellis grade) is based on the arrangement of the cells in relation to each other, as well as features of individual cells. Grade 1 cancers have relatively normal-looking cells that do not appear to be growing rapidly and are arranged in small tubules. Grade 3 cancers, the highest grade, lack these features and tend to grow and spread more aggressively. Grade 2 cancers have features between grades 1 and 3. Grade 1, 2, and 3 cancers are sometimes referred to as well differentiated, moderately differentiated, and poorly differentiated. This system of grading is used for invasive cancers but not for in situ cancers.

Ductal carcinoma in situ (DCIS) is sometimes given a nuclear grade, which describes how abnormal the cancer cells appear. The presence or absence of necrosis (areas of degenerating cancer cells) is also noted. Some researchers have suggested combining information about the nuclear grade and necrosis together with information about the surgical margin (how close the cancer is to the edge of the lumpectomy specimen) and the size (amount of breast tissue affected by DCIS). The researchers have proposed assigning a score to each of these features and adding them together. This sum is called the Van Nuys Prognostic Index. In situ cancers with high nuclear grade, necrosis, cancer at or near the edge of the lumpectomy sample, and large areas of DCIS tend to be more likely to come back after lumpectomy.

Estrogen and progesterone receptors: Receptors are molecules that are a part of cells. They recognize certain substances such as hormones that circulate in the blood. Normal breast cells and some breast cancer cells have receptors that recognize estrogen and progesterone. These two hormones play an important role in the development, growth, prognosis, and treatment of breast cancer. An important step in evaluating a breast cancer is to test for the presence of these receptors. This is done on a portion of the cancer removed at the time of biopsy or initial surgical treatment. Breast cancers that contain estrogen and progesterone receptors are often referred to as ER-positive and PR-positive tumors. These cancers tend to have a better prognosis than cancers without these receptors and are much more likely to respond to hormonal therapy ("See How Is Breast Cancer Treated?").

HER2/neu testing: About one third of breast cancers have too much of a growth-promoting protein called HER2/neu and too many copies of the gene that instructs the cells to produce that protein. In other cases, a normal number of HER2/neu genes are present, but they are too active in instructing the cells to produce HER2/neu protein. These cancers tend to grow and spread more aggressively than other breast cancers. They can be treated with a drug called Herceptin that prevents the HER2/neu protein from stimulating breast cancer cell growth (See section on breast cancer treatment for information on this drug). Studies also suggest that breast cancers with too much HER2/neu are more effectively treated by chemotherapy combinations containing anthracycline drugs (such as doxorubicin or epirubicin) than by combinations that do not include these drugs. HER2/neu testing is done on thin slices of the biopsy sample that are treated with special antibodies that identify the HER2/neu protein or with pieces of DNA that identify the HER2/neu gene. The test that uses antibodies to detect HER2/neu protein is called immunohistochemistry. The DNA test for extra copies of the HER2/neu gene is called fluorescent in situ hybridization (usually called FISH for short).

Stage 0: Ductal carcinoma in situ (DCIS) is the earliest form of breast cancer. In DCIS, cancer cells are located within a duct and have not invaded into the surrounding fatty breast tissue.

Lobular carcinoma in situ (LCIS), also called lobular neoplasia, is sometimes classified as stage 0 breast cancer, but is believed by most oncologists not to be a true breast cancer. In lobular carcinoma in situ, abnormal cells grow within the lobules or milk-producing glands, but they do not penetrate through the wall of these lobules. Most breast cancer specialists think that LCIS itself does not usually become an invasive cancer, but that women with this condition are at increased risk of later developing an invasive breast cancer elsewhere in the same breast or in the opposite breast. This later cancer may be either invasive ductal or invasive lobular.

Stage I: The tumor is 2.0 cm (about 4/5 inches) or less in diameter and does not appear to have spread beyond the breast.

Stage II: The tumor is larger than 2.0 cm in diameter and/or it has spread to the axillary (underarm) lymph nodes on the same side as the breast cancer. In stage II breast cancer, the lymph nodes are not stuck to one another or to the surrounding tissues.

Stage III: The tumor is either larger than 5 cm (2 inches) in diameter or has spread to lymph nodes that are fixed (attached) to one another or to surrounding tissue. The cancer is also Stage III if both of these findings are present. Breast cancers of any size that have spread to the skin, the chest wall, or the internal mammary lymph nodes (located beneath the breast and inside the chest) are also included in this stage. Patients with stage III cancer show no signs that the cancer has spread to distant organs or bones, or to lymph nodes that are not near the breast, such as those above the collarbone. Inflammatory breast cancer is classified as stage III, unless it has spread to distant organs or lymph nodes that are not near the breast, in which case it would be stage IV.

Stage IV: The cancer, regardless of its size, has metastasized to distant organs such as bones or lungs or to lymph nodes not near the breast.

 

BREAST CANCER STAGE GROUPING
	T (Tumor)	N (Nodes)	M (Metastasis)
Stage 0	Tis	N0	M0
Stage 1	T1	N0	M0
Stage IIA	T0	N1	M0
	T1	N1	M0
	T2	N0	M0
Stage IIB	T2	N1	M0
	T3	N0	M0
Stage IIIA	T0	N2	M0
	T1	N2	M0
	T2	N2	M0
	T3	N2	M0
	T3	N1, N2	M0
Stage IIIB	T4	Any N	M0
	Any T	N3	M0
Stage IV	Any T	Any N	M1

 

Breast cancer survival by stage
Stage	5-year relative survival rate
0	100%
I	98%
IIA	88%
IIB	76%
IIIA	56%
IIIB	49%
IV	16%

Explanation of Pathology Report from The American Cancer Society website.