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All TopicsForum: Stage IV and Metastatic Breast Cancer ONLY → Topic: Nottingham score of 9

Topic: Nottingham score of 9

Forum: Stage IV and Metastatic Breast Cancer ONLY —

A place for those managing the ups & downs of a Stage IV/metastatic breast cancer diagnosis. Please respect that this forum is for Stage IV members only. There is a separate forum For Family and Caregivers of People with a STAGE IV Diagnosis.

Posted on: Sep 11, 2010 07:46PM

lorrhaw wrote:

I've read my pathology report several times and didn't pay much attention to the Nottingham Score or the terms "high proliferative rate" but after having lunch today with some fellow breast cancer friends I decided to look it up on the internet and realized that this means I have the most agressive type of cancer.  Being Stave IV I guess this shouldn't have surprised me but I guess somewhere in the back of my mind I was hoping I was a slow growing Stage IV.  I haven't really taken a "head in the sand" outlook since my diagnosis but also I haven't looked for other reasons to freak myself out but now that I know this I am wondering about my other Stage IV friends and what your scores are and whether or not the higher score people do worse than others or do all Stage IV people have the highest score.

Thanks for any advice and information you can give me.


Diagnosis: 1/8/10, Stage IV, 1 met ER,PR +, HER2 negative Dx 1/8/2010, 3cm, Stage IV, 0/0 nodes, mets, ER+/PR+, HER2-
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Sep 11, 2010 07:59PM angelsabove wrote:

Mine too is a 9. I KNEW how aggressive mine was. I am in the group of the Triple Negative girls. I was originally Dx April 2009 stage IIB. I did surgery (double mastectomy). Then went off to six months of chemo. Then we did a PET SCAN December 2009...ALL CLEAR NED....Then off to rads. Did 32 treatments. Used bolice(sp) twice a week. AAAWWW was PRAYING IT WAS ALL BEHIND ME.....NOPE 10 weeks after finishing rads.  I completed rads Feb. 2010. I started having shoulder blade pain. Just KNEW something was wrong. Well....did some scans....got results which led to biopsy..........Resulst METASTATIC DISEASE TRIPLE NEGATIVE....mets to mediastinal node, left mammary node, and 1.4 cm in left lobe of liver......UUUUUGGHHHHHH!!!!!!!!!!

I am just praying that with us having the high score ....that if this means high proliferation rate...then THAT is what chemo works BEST on........I am here if u need to talk. I too at times go back to that original path report. IT DRIVES ME CRAZY!!!!!

Lots Of Love


Dx 4/27/2009, IDC, 4cm, Stage IV, Grade 3, 3/13 nodes, ER-/PR-, HER2-
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Sep 11, 2010 08:36PM clemson93 wrote:


My score was an 8 initially and a 7 after chemo.  I guess the rate at which the cancer was dividing was knocked down from the chemo to a 1/3 versus a 2/3.  I would guess that most people in our situation are 8 or 9 as that puts the cancer at a Grade 3.  I like Diane's way of thinking that the chemo works better on rapidly dividing cells :)

Susan J. 

Diagnosis: 9/17/08, IDC, 6cm+, grade 3, stage 3, nodes, dx with bone mets 9/09, stage 4, ER+/PR+, HER2-
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Sep 11, 2010 10:26PM JeninMichigan wrote:

I was a 9 too.   But chemo seemed to take care of mine.   I have been NED now for 2 1/4 years!!   I am going with easy come / easy go theory.  Granted easy go wasn't really easy per se but it was very effective.


Dx 2/22/2008, IDC, 2cm, Stage IV, Grade 3, 4/9 nodes, mets, ER+/PR-, HER2+
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Mar 10, 2011 11:23AM Bonnie7927 wrote:

Hi Lorraine,

It must be so tough for you ladies with Stage IV...I was just a Stage IIIB and, although I worry about the cancer metastasizing, I can't even imagine what it must be like for you ladies.  I admire your courage.  Keep strong and keep fighting.  I did notice you were ER+/PR+, so I'm guessing you were able to continue on with some type of treatment after course of chemo/radiation.  Be encouraged because I wanted to let you know that I do believe that the more agressive the tumor and cancer, the better the chemo works.  I was diagnosed Stage IIIB, 5/9 nodes, Triple Negative IDC.  I underwent chemo before having mastectomy and my tumor did shrink to 1/2 it's original size - proof that the chemo really did it's job.  After mastectomy, my tumor received a Nottingham score of 8, making it a Grade III tumor.  It might have been a 9 before treatment, but at any rate I'm doing well and I encourage you not to focus on the agressiveness, especially if you are taking treatments now.  May I ask where your cancer metastized and how you are doing now?  Please post an update.  Hang in there and good luck.


Dx 6/19/2009, IDC, 2cm, Stage IIIA, 5/19 nodes, mets, ER-/PR-, HER2-
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Mar 10, 2011 12:24PM susan_02143 wrote:


I had such a boring and slow cancer no one bothered with a Nottingham [though I can't stop thinking about Robin Hood. Who named this?]... a young woman with the "old person's" version. Sadly, even slow doesn't mean it won't progress.


... and its back. May 3, 2010 mets found. Five years NED on Faslodex * 4/2015 progression to bone * 6/11/2015 Femara/Ibrance * 12/27/2015 Xeloda * 2/24/2016 Xgeva Dx 6/8/2005, IDC, 3cm, Stage IIB, Grade 1, 0/3 nodes, ER+/PR+, HER2-
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Mar 10, 2011 12:31PM EnglishMajor wrote:

 I recall that I had a hight proliferation rate but my dr. said it wouldn't guide treament choice. I think some of this info is used more for someone who has an early stage cancer to maybe give an idea of recurrence odds. 

I also think you have to look at what's happened to you over the year of your treatment. If your cancer was super aggressive your experience would probably reflect that.  

Here's an explanation of how the scoring works. (Sounds like figure skating!)


Histological Grade

Histological grade is reported using the "Bloom Richardson Scale" or "Nottingham Score". It is a combination of nuclear grade, mitotic rate, and tubule formation, which are characteristics of the tumor cells seen under a microscope that predict its aggressiveness. Now, this scoring system is very detailed and usually does not affect treatment decisions, so it is not particularly helpful in the big picture. However, you will see it on the report and may be interested in what it means. In general, high grade tumors are more likely to recur when compared to low grade tumors.

* Nuclear Grade: a score is given from 1 to 3, based on the appearance of the nucleus of the cancer cells, with 1 being the closest to normal cells (better), 3 being the most variation (worse).
* Mitotic Rate: describes how quickly the cancer cells are multiplying or dividing using a 1 to 3 scale, 1 being the slowest, 3 the most rapid.
* Tubule formation: this score represents the percent of cancer cells that are in tubule formation. A score of 1 means greater than 75% of cells are in tubule formation (better), a score of 3 is used when less than 10% of cells are in tubule formation (worse), a score of 2 is in between 10 and 75%.

The three scores are then combined for a total score between 3 (1+1+1) and 9 (3+3+3). This score translates to a histological grade. You may see the three values and total score or just the final grade.

* Score of 3,4 or 5: Well differentiated or low grade (Grade 1)
* Score of 6 or 7: Moderately differentiated or intermediate grade (Grade 2)
* Score of 8 or 9: Poorly differentiated or high grade (Grade 3)

Dx 7/6/2009, IDC, 3cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Mar 10, 2011 12:33PM apple wrote:

i am not even going to look

peace and love, apple - ..... Mary Magdalen Dx 4/10/2008, IDC, 5cm, Stage IV, Grade 3, 4/9 nodes, mets, ER+, HER2+
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Mar 10, 2011 12:47PM susan_02143 wrote:

Just pulled out my pathology report... BINGO! I was/am a 3.


... and its back. May 3, 2010 mets found. Five years NED on Faslodex * 4/2015 progression to bone * 6/11/2015 Femara/Ibrance * 12/27/2015 Xeloda * 2/24/2016 Xgeva Dx 6/8/2005, IDC, 3cm, Stage IIB, Grade 1, 0/3 nodes, ER+/PR+, HER2-
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Mar 10, 2011 12:59PM dogsandjogs wrote:

Thanks for explaining this. I have a tubular score of 3 (the worst) a nuclear score of 2 (medium) and a mitotic count of 1 . Total score 6. 

However, the Onc didn't even comment about any of these scores so I guess they are not important in treatment decisions.

Dx 11/1982, IDC, <1cm, Stage I, Grade 2, 0/17 nodes Surgery 11/17/1982 Lymph node removal: Right; Mastectomy: Right; Reconstruction (right): Nipple reconstruction Dx 11/15/2010, IDC, <1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR+ Surgery 2/11/2011 Lumpectomy: Left; Lymph node removal: Left, Sentinel

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