Your Guide to the Breast Cancer Pathology Report Developed for you by Breastcancer.org is a nonprofit organization dedicated to providing education and information on breast health and breast cancer. The pathology report is used by your doctor to determine which treatments are right for you. Your Guide to the Breast Cancer Pathology Report A report is written each time tissue is removed from the body to check for cancer. These are called pathology reports. Each report has the results of the studies done on the removed tissue. The information in these reports will help you and your doctors decide on the best treatment for you. Reading your pathology report can be scary and confusing. Different labs may use different words to describe the same thing. On page 34, you’ll find an easy-to-understand word list. We hope we can help you make sense of this information so you can get the best care possible. TABLE OF CONTENTS Wait for the Whole Picture • Waiting for test results ............................2 • How much cancer is in each lymph node? ..........................................17 • Get all the information you need .............3 • Do the cancer cells have • Parts of your pathology report .................4 hormone receptors? ..............................18 Reading Your Pathology Report • Does the cancer have genes that • The pathology report answers affect how the cancer might questions about a breast abnormality ......6 be treated? .............................................20 • Genetic testing that is not a part of • Is the breast abnormality a cancer? ........6 your pathology report .............................25 • Is the breast cancer invasive? ..................7 • What stage is the breast cancer? .........28 • How different are the cancer cells — Stage 0 ..............................................28 from normal cells?...................................9 — Stage I ...............................................29 • How fast are the cancer cells growing? ................................................10 — Stage II ..............................................30 • How big is the cancer? .........................12 — Stage III ............................................31 • Has the whole cancer — Stage IV ............................................33 been removed? ......................................13 Word List .................................................34 • Are there cancer cells in your lymph channels or blood vessels? ...................15 Key Questions .........................................44 • Are there cancer cells in your Pathology Report Checklist ...................45 lymph nodes? ........................................16 • How many lymph nodes Notes .......................................................46 are involved?..........................................17 WAIT FOR THE WHOLE PICTURE Waiting for test results Get all the information you need When you have all of the test results, When you have all the test information you and your doctor can make the you need, you and your doctor can right decisions for you. The analysis of make a final decision about your the removed tissue can lead to several treatment. Don’t focus too much on any different reports. Some tests take longer one piece of information by itself. Try to than others. Not all tests are done by look at the whole picture as you think the same lab. Most information comes about your options. within 1 to 2 weeks after surgery, and Different labs and hospitals may you will usually have all the results use different words to describe the within a few weeks. Your doctor can let same thing. If there are words in your you know when the results come in. If pathology report that are not explained you don’t hear from your doctor, call in this booklet, don’t be afraid to ask the office. your doctor what they mean. For more information, go to: www.breastcancer.org EXPERT TIP: Marisa Weiss, M.D., breast cancer doctor “The information in your pathology report three lab reports from one surgery. Together, often comes in bits and pieces. Just after the lab reports make up your pathology surgery, the cancer cells are first looked at report. Try to keep all your reports in one under the microscope. Results from additional place, so that when you go for your treatment studies that require special techniques may evaluations, the doctors will have all the take longer. So you may have one, two, or information they need.” 2 3 WAIT FOR THE WHOLE PICTURE (continued) Parts of your pathology report Personal information. Make sure it’s Gross description. This section describes your correct name and date of operation the pieces of tissue removed. It talks at the top of the report. about the size, weight, and color of each piece. Specimen. This section describes where the tissue samples came from. Tissue Microscopic description. This section samples could be taken from the breast, describes the way the cancer cells look from the lymph nodes under your arm under the microscope, their relationship (axilla), or both. to the normal surrounding tissue, and the size of the cancer. Clinical history. This is a short description of you and how the breast Special tests or markers. This section abnormality was found. It also describes reports the results of tests for proteins, the kind of surgery that was done. genes, and cell growth rate. Clinical diagnosis. This is the diagnosis Summary or final diagnosis. This section the doctors were expecting before your is the short description of all the important tissue sample was tested. findings in all of the tissue examined. For more information, go to: www.breastcancer.org 4 5 READING YOUR PATHOLOGY REPORT The pathology report answers questions may grow into the normal tissue around about a breast abnormality them. Cancer cells may also spread beyond the breast. Breast tissue can develop abnormalities that are sometimes cancerous. Usually The abnormal lump or spot may be found breast cancer begins either in the cells using mammography or other testing of the lobules, which are milk-producing methods. A procedure called a biopsy glands, or the ducts, the passages that removes a piece of tissue from the lump or drain milk from the lobules to the nipple. spot to find out if cancer cells are present. Breast cancers have many characteristics The pathology report will tell you what that help determine the best treatment. kinds of cells are present. Is the breast abnormality a cancer? Is the breast cancer invasive? A lump or spot in the breast can be made If breast cancer is found, it’s important of normal cells or cancer cells. There can to know whether the cancer has spread also be cells that fall somewhere between outside the milk ducts or lobules of the normal and cancerous (“atypical” cells). breast where it started. Cancer cells are cells that grow in an Non-invasive cancers stay within the milk uncontrolled way. They may stay in the ducts or milk lobules in the breast. They place where they started to grow, or they do not grow into or invade normal tissues This is what the inside within or beyond the breast. Non-invasive of a breast looks like. cancers are sometimes called in situ or pre-cancers. The real size of a normal If the cancer has grown into normal duct or lobule rib cage tissues, it is called invasive. Most breast fat is smaller chest wall than this cancers are invasive. Sometimes cancer . cells spread to other parts of the body through the blood or lymph system. When muscle lobule cancer cells spread to other parts of the duct body, it is called metastatic breast cancer. In some cases, a breast cancer may be both invasive and non-invasive. nipple non- This is what normal cells invasive invasive inside a milk duct look cells cells like under a microscope. 6 7 READING YOUR PATHOLOGY REPORT (continued) You may see these descriptions of the How different are the cancer cells type of cancer cells in your report: from normal cells? DCIS (Ductal Carcinoma In Situ). This is a cancer that is non-invasive. It stays Grade is how different the cancer cells inside the milk ducts. are from normal cells. Experts compare the appearance of the cancer cells to NOTE: There are subtypes of DCIS. You’ll normal breast cells. Based on these find their names in the word list that begins comparisons, they give a grade to the on page 34 of this booklet. cancer. Grade is different from stage LCIS (Lobular Carcinoma In Situ). This (see page 28 for information about is a tumor that is an overgrowth of cells stage). that stay inside the milk-making part There are three cancer grades: of the breast (called lobules). LCIS is not a true cancer. It’s a warning sign Grade 1 (low grade or well of an increased risk for developing an differentiated). Grade 1 cancer cells look invasive cancer in the future in either a little bit different from normal cells. breast. They are usually slow-growing. IDC (Invasive Ductal Carcinoma). This is Grade 2 (intermediate/moderate grade a cancer that begins in the milk duct but or moderately differentiated). Grade 2 has grown into the surrounding normal cancer cells do not look like normal cells. tissue inside the breast. This is the most They are growing a little faster than common kind of breast cancer. normal. ILC (Invasive Lobular Carcinoma). This Grade 3 (high grade or poorly is a cancer that starts inside the milk- differentiated). Grade 3 cancer cells look making glands (called lobules), but very different from normal cells. They are grows into the surrounding normal fast-growing. tissue inside the breast. NOTE: There are other, less common types of invasive breast cancer. You’ll find their names in the word list beginning on page 34 of this booklet. For more information, go to: www.breastcancer.org MY REPORT SAYS: The type of cancer I have is ______________ The cancer is: (check one) _______________________________________ . j Grade 1 j Grade 2 j Grade 3 8 9 READING YOUR PATHOLOGY REPORT (continued) How fast are the cancer cells In breast cancer, a result of less than growing? 10% is considered low, 10-20% is intermediate/borderline, and more Your pathology report may include than 20% is considered high.