Below is some informational tid bits about my pathology reports. Basically, my prognosis is this:
Clinical Stage Prognosis (when I first learned I had breast cancer): 40-50% chance of disease free survival (DFS); 50% chance of recurrence
Pathological Stage Prognosis (after chemo and surgery): Pretty much at the “DSF” point (excellent); 10% chance of recurrence (excellent)
|Pathology Report Indicator||Clinical Stage – determined by what the doctor learns from the physical exam and tests. (the one I got in the beginning from my biopsies)||Pathologic Stage – includes the findings of the pathologist after surgery. (the one I found out about after chemo and surgery)|
|T Category: Tumor SizeTis: Tis is used only for carcinoma in situ, or non-invasive breast cancer, such as ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS)T1: The cancer is 2cm in diameter (about ¾ inch) or smaller.
T2: The cancer is more than 2cm but not more than 5cm in diameter.
T3: The cancer is more than 5 cm in diameter.
T4: The cancer is any size and has spread to the chest wall or the skin.
|T2 – 3rd best out of 5 options||T1 – 2nd best out of 5 opions(the remaining IDC was only 1/20 inch in diameter)|
|N Category: Node InvolvementN0 Clinical: The cancer has not spread to lymph nodes, based on clinical exam.N0 Pathological: The cancer has not spread to lymph nodes, based on examining them under a microscope.
N1 Clinical: The cancer has spread to lymph nodes under the arm on the same side as the breast cancer. Lymph nodes are not attached to one another or to surrounding tissue.
N1 Pathological: The cancer is found in 1 to 3 lymph nodes under the arm.
N2 Clinical: The cancer has spread to lymph nodes under the arm on the same side of the breast cancer and the lymph nodes are attached to one another or to surrounding tissue.
N2 Pathological: The cancer has spread to 4 to 9 lymph nodes under the arm.
N3 Clinical: The cancer has spread to lymph nodes above or just below the collar bone on the same side as the cancer.
N3 Pathological: The cancer has spread to 10 or more lymph nodes under the arm or also involves lymph nodes in other areas around the breast.
|N1 Pathological – 3rd best/worst out of 8||N0 Pathological – 1st best out of 8|
|M Category: MetastasisM0: No distant cancer spread.M1: Cancer has spread to distant organs.||M0 – 1st best out of 2||M0 – 1st best out of 2|
|Tumor grade: How much the tumor looks like normal breast tissue. The higher the number, the more likely the risk for spread.1 – Low (best)2 – Moderate
3 – High (worst)
|3 – High Nuclear Grade – Poorly Differentiated (worst)||3 – High Nuclear Grade – Poorly Differentiated (worst) (doesn’t change; based on initial biopsy)|
|HER2/neu status: About 15-20% of breast cancers have too much of a growth-promoting protein called HER2 and too many copies (more than 2) of the gene that instructs the cells to produce this protein. Tumors with increased levels of HER2 are referred to as “HER2-positive”. HER2-positive breast cancer tumors tend to grow and spread more rapidly than other breast cancers.||HER2-positive (bad, except for the fact that Herceptin is so good) This is why I’m taking Herceptin.||HER2-positive (bad, except for the fact that Herceptin is so good) (doesn’t change; based on initial biopsy) This is why I’m taking Herceptin.|
|Hormone Receptors: Two hormones in women – estrogen and progesterone – stimulate the growth of normal breast cells and play a role in many breast cancers. Cancer cells respond to these hormones through the estrogen receptors (ER) and progesterone receptors (PR). ER and PR are each cell’s “welcome mat” for these hormones circulating in the blood. If a cancer does not have these receptors, it is referred to as hormone receptor-negative. If the cancer has these receptors, it is referred to as hormone receptor-positive.||ER+PR- This is why I’ll be taking Tamoxifen.||ER+PR- (doesn’t change, based on initial biopsy) This is why I’ll be taking Tamoxifen.|
|Findings||“Findings are highly concerning for multifocal invasive ductal carcinoma with involved lymph nodes. Highly suggestive of malignancy” – Gosh, that brings back scary memories.||Near complete response to chemo.|
|Staging: see below||Stage IIB: T2, N1, M0
Although after surgery, most of my lymph nodes were completely destroyed by the chemo and my surgeon said only lymph nodes with cancer in them would be so destroyed like that so I was initially stage 3 and just didn’t know it.
|Stage I: T1, N0, M0|
|Overall Stage||T Category||N Category||M Category|
|Stage IIIB||T4||Any N||M0|
|Stage IIIC||Any T||N3||M0|
|Stage IV||Any T||Any N||M1|