Topic: Here is our report, pleasetranslate into simple terms

I'm not an expert at reading pathology reports but there are some good news items in this report - 1st, the margins appear to be clear, which usually means no cancerous tissue was left behind. 2nd, IDC is the type of cancer that is most common in women and very treatable, 3rd all of the lymph nodes are negative - a big plus for your wife.  The not so good news is that the cancer cell is grade 3 - which means that they are cells that are immature and grow rapidly.  However, do not confuse Grade 3 with Stage 3 - two different things.  You need some more information, which I'm sure your surgeon and pathologist are taking care of.  You need to know the Stage (which from this report looks like it could be Stage I) and whether the cancer cells are Estrogen Receptor positive or negative and Progesterone Receptor positive or negative.  Positive is better than negative because there are more treatment options following the basic treatments of mastectomy/lumpectomy, chemo, and radiation.

The most important thing you can do right now is not panic.  Read this website for basic information and don't ever be intimidated by your doctors. Write down all your questions beforehand and ask every one of them. It's crucial for you and your wife to understand all the options and to make informed decisions. 

I wish you both lots of luck.  As someone who is just approaching two years following diagnosis, I can say that having a husband who cares and supports you makes all the difference in the world.  But remember, you will need support also.  It's a hard journey but it is doable and hopefully in about two years you or your wife will be giving the same advice on this site to another newbie.

The Husband,

Coltsneck is correct in saying that there is good news, and some bad news, in that pathology report.  Most of the report is irrelevant to your wife's diagnosis and prognosis, because the whole first part consists of a gross description of the samples and their labeleling.  That is sort of a "tracking" history, so everybody knows what tissues the path lab received.

The important part of the report starts with the word "Microscopy", since that part is the actual description of the tissue that was collected.  I'll try to translate it for you.

First, there was malignant tumor present in the sample:  infitrating (also called "invasive") ductal carcinoma.  That is the most common type of invasive breast cancer in women. The tumor cells were classified as "Grade 3", which means they were poorly differentiated (they did not resemble normal breast cells in appearance or growth characteristics).  Tumor cells are classified as Grade 1-3 in the scheme that was used in your wife's report.  Grade 1 poses the least risk of spread or recurrence; Grade 3 is the most serious.  I don't know for sure what this means:  "NST (3,2,3)."  Sometimes "NST" refers to "non-specific type"--a tumor in which the exact cells of origin were not identified.  The "3,2,3" may be the codes for the 3 features of the tumor cells that were used to calculate the tumor grade.

The diameter of the invasive part of your wife's tumor (the important part, with respect to staging) was 21 mm (2.1 cm) in its greatest dimension.  "Vascular invasion" was present, which means the pathologist did see evidence that cells from the tumor had entered into some of the blood or lymphatic vessels at the site of the tumor.  This means there was a chance that tumor cells might have escaped from the breast and gone to the lymph nodes (more about that, later).

The "margins of excision" were clear, which means the entire tumor was removed along with a band of healthy tissue around it.  The "deep margin"--the border between the invasive part of the tumor and the chest wall--was 7 mm, which I think is a reasonably wide margin of safety for a "wide excision."  Your wife's surgeon should be able to tell you for sure.  

Your wife's tumor also contained some "ductal carcinoma in-situ" (DCIS), which is breast cancer cells that are still in the duct epithelium and have not spread to the adjacent breast tissue.  I think it's fairly common for breast tumors to contain DCIS as well as invasive (IDC) components.  I don't believe the DCIS component is used to stage the tumor or determine prognosis, since it is the less serious part of the picture compared with the IDC. 

Five lymph nodes were removed, but all were "clear"--there was no evidence that the tumor had spread to the nodes. 

So, the pathological diagnosis of the tissue from the left breast "WLE" (wide local excision) was a Grade 3 infiltrating ductal carcinoma of no specific type (NST).

The tumor was staged according to the TNM staging scheme, in which "T" refers to the size of the tumor, "N" refers to the number of involved lymph nodes, and "M" refers to distant metastases.  The "p" in "pT" means the size of the tumor was measured by the pathologist, rather than being estimated by imaging.  Since the diameter of your wife's tumor was 2.1 cm, it was classified "pT2" (greater than 2.0 cm but less than 5.0 cm).  There were no lymph nodes involved, so the tumor was "pN0".  There is no "M" number because, as for many of us, the presence or absence of metastases has not been determined for sure. Based on the pT2pN0Mx status, your wife's tumor would be Stage II (greater than 2.0 cm diameter but no nodes involved).

Here's a website that talks about staging:

http://www.cancer.gov/cancertopics/pdq/treatment/breast/HealthProfessional/page4

I didn't know anything about the Nottingham prognostic index, so I Googled it.  Here's a website that supposedly explains it:

http://www.cancerbackup.org.uk/QAs/BreastcancerQAs/LivingwithcancerQAs/Prognosis/related_faqs/QAs/899 

The NPI helps to predict the prognosis.  It uses the size and grade of the tumor and the status of the lymph nodes in this formula: 

NPI = (0.2 x tumour diameter in cms) + lymph node stage + tumour grade

However, the definition of the NPI provided on that website does not correspond to the NPI of your wife's tumor (NPI = 4.2).  Maybe the formula has been changed or there is some other information I haven't found.

Anyway, I hope this helps a bit. I can understand how scary this all is.

otter 

I am still a little confused though, before my wife went down to theatre I had a quick look through her notes, and it did say there were 2 tumors the largest being 25mm, and also when the surgeon came round in the morning to see my wife he did say to her her removed 2 lumps, when I asked the surgeon he said there was only one lump, and when I asked my wife about it she said she was still dopey and maybe got it wrong. 

dear husand ,,i can feel ur confussion and worriness about ur wife,,

my DH went through the same hard times that u r having trying to understand my reports,,

all i can tell u is not so much differs from wat my other sisters said here,,,but the most important thing to be said is wat i found after finishing my treatments,,,

i found that it really dont mean anything about the survivourship ,,,we read all the statics and try to undrstand every single word in our reports ,,after all my DH questions to my surgeon and oncologist ,,,i loved what my oncologist told him...

he said that sometime the reports looks bad and worrisom but the patient staycancer free!!!!other times the reports look good and so treatable but the patient have recurrence unfortunatly...then he took my husbands hand and said ..WE SIMPLY DONT KNOW ...

he said then ,,the best thing to be done is to live every minute that u have now with ur wife,,,to love and support her through these hard times and to hope that u both will live soooooo long after that,,,,

i loved his words as they made my husband feels better,,

i thought to share these worsd with u hopping that they may help in the same way to make u feel better ..

best wishes

dera otter,,

plz look at ur diagnosis as it is just a technical information to determine the type of chemo comination that u will have ,,no more..

i learned that we r not just statistic numbers ,,we r more than that...

look at those wonderfull women who r fighting this ugly disease bravely  and win thier battles,,no matter thier path reports were saying,,

i have lost so much with my diagnosis..

i was 10 weeks in my fisrt pregnancy wen been daignosed last august,,they told me its better to be aborted to be able to start chemo as soon as possile,,

i had mastectomy and abortion and port insertion in the same day,,started chemo 3weeeks latter,,agressive treatment for 6 rounds,,then 25 rads,,

now i have finished my rads in 26th of march,,

i started excersizing again in 1st of april,,and planning to live my life as best as i can do,,

we cant change our path reports or our daignosis,,but we sure can live as best as we can ,,,

plz ,,listen to me sister,,i have learned these things through the hard way,,it was not easy at all..

but i do believe in all my surviving sisters stories that i have read in these boards which helped me alot ..

i hope i can give u a hugg now to make u feel better..

much luv

Hey Otter, I just had a look at that site about Nottingham Index,

Thanks .

Let us know when you find out!

otter 

You guys are all so wonderful explaining everything.

I have been reading through different postings and googled a lot to understand everything.

I was first dx with breastcancer in Sept 02, IDC, Triple neg.

Had a Lumpectomy, radiation and Chemo.

Things went well for 5 1/2 years and we found another lump.

I just had a bilateral mastectomy with transflap and having a hard time healing.

Dx is the same as last time, so I am looking at Chemo again.

Right now my worries are, that I can't take my Chemo treatment any time soon,because my wounds are not healing.

Reading you alls postings is helping me understand a lot more about all the big words the doctors through at you and gives me a lot more courage to go back and ask more questions.

The first time around I think I was to much in denial and just went with whatever the doctors said. I did not think this would come back, but now I am ready to ask questions and make sure I know what they are doing to me every step of the way.

Ok went to see the oncologist, not a lot to tell really, we are going to be starting chemo in around 3 to 4 weeks, they called it FEC. 6 rounds apparently followed by radiotherapy and hormone treatment, I asked about ER and was told my wife was

ER positive 7whatever that means, they said it was good?????

TX66, one thing I've found that is really inspiring about these BCO boards is the willingness of peope to welcome others into their midst, no matter what the circumstances might be.  I remember a BCO regular who said she would be starting chemo again after a disease-free interval, and wanted to join a monthly chemo group.  However, because her BC was Stage IV, she was concerned that her presence might make the early-stage participants uncomfortable.  As far as I can tell, they welcomed her with open arms.

I can sure understand why you might hesitate to post on the Triple Negative topic, but I think you will find those women to be as generous and attentive as anywhere on the BCO boards. I'm pretty sure most of them understand what "triple-negative" means in terms of treatment options and risk of recurrence.

Another option you might try is to visit the other sections of the boards that deal with recurrence or with 2nd or 3rd cancers. There is lots of support there from women who are dealing with the same issues you are facing.

I cannot imagine how frustrating and sad and scary it must be, to have thought you'd beaten this monster ... only to have it reappear after 5-1/2 years.  I hope you find comfort here, and I hope your docs have a strategy that will set your BC back again.

otter 

@ Otter

Thank you so much I will go check it out.

My moods are up and down right now and I am not sure anymore if it is the cancer or the fact that they did take my last ovary at the same time they did the mastectomy...lol....I guess missing hormones can do that to...

THank you

@ Raine,

Thanks for letting me know. I guess going through this the first time is bad enough, just after you have such high hopes as the years go by, that the cancer is not coming back and just when you get to the point and think it is gone it hits you again. I am just a little crushed right now. I guess I thought it wasn't coming back, btu it did. At first I was wondering why I had to do CHemo, because did took both breasts off, now after reading through so many postings I can't wait to get started on it to make no cancer cells escaped anywhere else.

THe worries start all over again.

Thank you so much for yur help.

ER Positive score 7

Can anyone explain what this means?

Just to add to what MAMHOP said, being ER+ means that the tumor needs estrogen to grow. As MAMHOP said, it responds to hormone therapy--after chemo, your wife can take tamoxifen or one of the newer aromatase inhibitors, which will block the estrogen and lower the chances of recurrence. So, yes, being ER+ is good!!

Barbara,

Actually, it's a really simple question, with an answer you probably won't want to hear.  The short answer to your question is, no.  I can't do short answers, though, so here's the long answer:

Just as background:  Most of the time (according to dogma, whoever he is), BC cells metastasize via the lymphatic drainage system.  That's good, because it's the basis of using SNB and ALND to detect their spread.  I'm not sure why they tend to travel that way.  I suppose I learned it somewhere along the line, but I don't recall.

To get into the lymphatic system, the cancer cells at the site of the original tumor have to actually invade the lymphatic vessels ("lymphovascular invasion").  They are already called "invasive" once they leave the duct system; that's when DCIS becomes IDC.  This is different.  The BC cells use enzymes, adhesion factors, and other stuff, to "digest" and crawl through the wall of a lymphatic vessel to get to the lumen.  Once they're through the wall into the lumen, they might remain stuck there; or they might break free and pass with the lymphatic fluid (lymph) as it flows to the nearest lymph node.  As lymph enters a lymph node, whatever is suspended in the lymph gets caught in the node.

OTOH, if the cancer cells at the site of the original tumor chew/crawl throught the wall of a blood vessel rather than a lymphatic vessel (and I don't know what influences the choice), they will find themselves in the blood.  Again, they might remain stuck on the inner wall of the vessel, or they might break free and flow with the blood ... to where?

That's where the problem lies.  Once the BC cells are in the blood, they cannot be filtered out by a lymph node.  Because of the way lymph nodes are built, the only way things can get trapped in them is to enter them through what are called "afferent lymphatic vessels" (afferent = leading toward).  Those are the ends of the lymphatic vessels that started out in the breast tissue, carrying debris away from the breast.  There are blood vessels that pass into and out of lymph nodes, but any loose BC cells, bacteria, etc., that are in the blood won't get caught as the blood goes through the node.

If a BC cell is in the blood, it can get trapped in tissues that "filter" blood. (I'm using the term loosely.)  One such place I think is the liver.  Actually, if you think about all the places where mets develop (besides nodes), it was probably the blood that carried the BC cells there.  There are particular things about certain tissues that cause circulating cancer cells to lodge in those tissues.  That's called "tissue tropism", and I don't know much about it.

So, it's bad news I guess.  If the BC cells are for sure in the blood, there is nothing in particular to stop them from spreading to important places.  When a pathologist says there is "lymphovascular invasion," I'm not sure he/she can tell whether it's lymphatic or blood vessels that are being invaded.  In either case, chemo is a pretty good bet.

otter