Tuesday, December 20, 2011

Pathology Report in a Nutshell

I asked Dr. Haley to explain my pathology report so that I could use the little abbreviations other breast cancer patients use with their name on all the community boards and forums. So, in case you are interested (LOL), here is mine:

Diagnosis:7/22/2011, ILC, 8cm, Stage 2b, Grade 3, 0/3 nodes, ER+/PR+, HER2-

ILC:   I had Invasive or Infiltrating Lobular Carcinoma in my left breast. This type of cancer counts for 10% of breast cancer frequency. It is more common in women who have taken hormone replacement therapy, which I did for about 12 years until the study in 2002 stated the risk of breast cancer. A lobular cancer has about a 20% risk or occurring in the other breast in your lifetime - an increased risk, but not an overwhelming one.

8 cm Size:   Lobular cancers tend to grow larger in size, with the average being 5 cm. My little monster was 8 cm!!! And to think it didn't show up on the mammogram & my internist upon giving me a breast exam said it was just dense breast tissue! I felt the cancer in the inner upper quadrant of my breast & to make me happy the internist ordered a sonogram. The radiologist at the imaging clinic immediately burst into my dressing room & said I needed a biopsy the next day. Which I had - & the results were indeed breast cancer. A self breast exam saved me - plus my insistance that something was not right! I no longer go to that internist, needless to say!
Stage 2b:  Pathologists "stage" breast cancers based on the tumor, node involvement, & metastisis (if the cancer has spread). I received a Stage 2b based on the size of my tumor. I had no node involvement & no metastisis (thank the good Lord), but any tumor over size 5 cm (mine was 8 cm) is automatically classified as stage 2b.

Grade 3:  Pathologists usually grade on a scale of 1 to 3, with the higher number being the worst.  The score is based on three features:  degree of tubule formation (well-formed tubules are better than poorly formed ones, as mine were), nuclear grade (regularity in the size, shape, & staining character of the nuclei, with small being better than large, & nitotic activity (no or few mitoses are good and many mitoses are not as good.  Each of these gets a score of 1, 2, or 3, with the higher number reflecting poor tubules, large nuclei, & high mitotic rate.  The scores are added up:  3-5 is grade 1, 6-7 is grade 2, 8-9 (my score) is grade 3.  Grade 3 is the highest & supposedly the most aggressive.  My grade of 3 justified my chemotherapy treatment.

0/3 Nodes:  Pathologists look at lymph nodes because they are a good window into what is going on in the rest of the body.  If they don't show cancer cells, it means there is a lower probability of cancer cells in other parts of the body.  In my case, none of the 3 nodes taken & evaluated had cancer cells, even though 2 showed "isolated tumor cells" - which still gets a negative rating.  Even if lymp nodes are negative, it does not mean that the cancer has not spread - 20-30 percent of breast cancers with negative lymph nodes have spread elsewhere.  At least we're starting off on the right path!

ER+PR+:  My tumor was sensitive to estrogen & progesterone receptors, making it both Estrogen Receptor Positive & Progesterone Receptor Positive.  The implications of the hormone receptor tests are both prognostic & predictive.  In general, tumors that are sensitive top hormones - that have receptors - are slightly slower growing & have a slightly better prognosis than tumors that aren't. 

Her2-:  Another biomarker is overexpression (too many copies) of the Her-2/neu oncogene.  Her2/new is one of the dominant oncogenes that contribute to cancer by telling cells to grow.  This is a prognostic indicator & an indicator of the best treatment.  Thankfully, my tumor was Her2 negative.