Posted on November 1, 2010
When you have breast cancer, all the big decisions —will you get radiation, chemo, tamoxifen, etc—rest on one thing: your pathology.
Final pathology usually takes about a week after your surgery. Frozen sections in surgery can be misleading, so wait for the final pathology. What it will say:
What kind of cancer is it?
- In situ cancer- it has not left the breast. Lobular or Ductal.
- Invasive cancer- Invasive ductal starts in the breast duct but grows into the surrounding normal breast tissue. This is the most common form. Invasive lobular starts in the lobule and extends.
Grade
- Grade 1- Well differentiated, looks almost like normal cells. Tend to be slow growing
- Grade 2- Intermediate or Moderate grade. They grow somewhat faster than normal cells.
- Grade 3- Poorly differentiated. They do not look at all like normal cells. Tend to be faster growing.
How big is the cancer?
- This is the size of tumor. A large tumor does not always mean it is worse.
Margins?
- How far is the tumor from the edge? You want negative margins. Hospitals differ a little in what they consider negative.
Lymphatic or vascular invasion?
- Yes or no. Lymphatic and blood vessels are like highways through the breast. If you have lymphatic or vascular invasion, you have an increased risk of the cancer coming back or spreading.
How fast is it growing? (You don’t want it to be growing faster than normal cells)
- S phase
- K1-67
Hormone receptor status
- Estrogen positive or negative. If positive, then you respond to hormone therapy to help prevent cancer recurrence.
- Progesterone positive or negative.
- These can be scored as a percentage (0% of cells have the receptor up to 100% of cells) OR as 0, 1+(small number with receptor), 2+ (medium number), 3+ (most have the receptor).
HER 2
- Her-2 is a gene which helps control how cells grow and divide. If you have too many copies of this gene then the cancer grows faster and has an increased risk of spreading.
- This is NOT an inherited gene like BRCA.
- This can be tested for by Immunohistochemistry (“IHC”- where it is rated 1-3+), or by FISH test (positive or negative). Only the 3+IHC and FISH positive respond to therapy against Her-2.
Lymph node status?
- Positive
- Negative
- Microinvasion: partial invasion into a lymph node, usually seen in sentinel nodes. What this means depends on the amount of microinvasion.
- When looking at lymph nodes, there will be a total taken out. If you had a sentinel node, then you will only have one or two lymph nodes. If you had a full axillary dissection you may have 20 lymph nodes.
- Lymph node status helps you assess if the cancer has gotten out of the breast. If you have positive lymph nodes, then you will likely have other therapies like radiation and chemo.