How do pathologists analyze the Invasive tumor?

neugirl

On these boards, I keep reading that the whole tumor is not always analyzed and that different parts of the tumor can be different. I don't understand this because the pathology report is split into multiple slides and i thought the entire tumor was examined. I am just wondering because I was told there is not any lymphovascular invasion in my tumor, but if the whole tumor is not analyzed how can we ever be certain that there is no LVI? 

How do they test the lymph nodes? Do they actually test the tissues or just look by sight?

I am also wondering how pathologists examine the rest of the breast tissue. I had a BMX and am wondering how they can accurately tell that there are not other spots of cancer. Do they just look by sight for something that looks like a tumor? Or do they have a way of testing the entire tissue? I am just worried that there could be tinier spots of cancer that weren't seen or something. If someone knows more of the process I would like to hear about it. Thank you.

voraciousreader

A world within a tumour – new study shows just how complex cancer can be

    By Ed Yong | March 7, 2012 5:00 pm

http://blogs.discovermagazine.com/notrocketscience/2012/03/07/a-world-within-a-tumour-new-study-shows-just-how-complex-cancer-can-be/

The current research of Charles Swanton speaks to your concern regarding tumor pathology and how to approach studying pathology.

Regarding your statement, "I am just worried that there could be tinier spots of cancer that weren't seen or something"...That is something that everyone who receives a cancer diagnosis is concerned about. 

Neugirl...Based on the information that you've provided regarding your diagnosis, I'm sure you've been told that you have EXCELLENT prognostics.  From reading some of your posts, it seems to me that you are grasping at the most bleak information you can discover about cancer and WORRYING how that might affect YOUR prognosis.  Perhaps you should discuss your concerns with your doctors so they can put YOUR diagnosis into perspective for you.  I know hearing the words, "You have cancer" can be very frightening.  Keep in mind though, there are more than 2.6 MILLION breast cancer survivors in the United States alone!  Your prognostics appear similar to mine and I've been told that I will probably die from something else. 

Rest assured that you were probably given the BEST available pathology testing and under PRESENT circumstances, you were given the MOST accurate information to base a treatment plan and prognosis. Without a doubt, sometimes with the current pathology testing that we have today, pathology information can be contradictory or vague.  In your situation, that doesn't seem to be the case. However, can medicine do better at finding the tiniest and most dangerous of cancer cells?  The answer to THAT question is what makes cancer researchers, like Dr. Swanton wake up in the morning and head to their labs.....

I hope you will follow up with your healthcare team.  I wish you well.

Beesie

neugirl, Microscopes! That's the answer to many of your questions. Pathologists use microscopes. Cancer cells are tiny and are not visible to the naked eye so there is no way that breast pathology, or lymph node pathology, can be done without the tissue being examined, in very fine detail, under a microscope.

Here is a website that shows how cancerous breast tissue is assessed.  It's much more detailed that you need, but my point in providing this link is so that you can see the pictures of what the pathologist is looking for, under the microscope, as he or she grades breast cancer cells and determines whether there is lymphatic or vascular invasion.  Please don't get caught up in any of the specifics.... this is just to make you aware that your pathologist was looking at your breast tissue samples in this level of detail... the descriptions and determinations on your pathololgy report could not possibly have been made by the naked eye. http://www.breastpathology.info/Grading.html

I agree with VR.  From everything you've posted about your diagnosis, you have an early stage BC and an excellent prognosis.  But you don't seem to believe that.  You are grasping at anything you can find that might suggest that there was an error in your pathology, or that something was missed, or that there may be bigger concerns that you weren't told about, etc..  You are not going to find anything on the internet that your doctors are not aware of that could signal a bigger problem for you. I agree with VR that you probably should talk to your doctors about your concerns.  Let them explain your diagnosis to you, let them reassure you. Let them answer all your questions. And if you don't have the faith in your doctors or the pathology, seek out a second pathology opinion. I really don't think that's necessary in your case because there doesn't seem to be anything that's questionable or concerning, but if that's what you need to do to get peace of mind, then that is something you should consider doing. 

neugirl

Thanks so much for the information. You both are very informative. I am not terribly frightened. I just am trying to understand things a little better because I think the more you know as a patient the better. I am also curious because there was a few different shadows and calcifications on my pre-surgery testing that they were looking at and I was wondering how they checked those out. Apparently, everything in the rest of my breast was benign and I was just curious how they go about with their work. I am pretty happy with my prognostics (even though there is still a 8% chance of recurrence- seems high to me) but there are so many different things that go into this diagnosis and new terms to understand. I do have a lot of questions for the oncologist, but the doctors are always so busy so you can't sit there asking pages and pages of questions so i am thankful for this site to possibly learn some of the answers here. 

voraciousreader

Neugirl...You mention that the more you know, "the better."  Sometimes that is a true statement.  Other times, it is not if you make wrong conclusions.  You mention that you are happy with your 8% chance of recurrence, based on the Oncotype DX score of 11.  BUT, you question the veracity of the test.  Then you mention that the 8% chance of distant recurrence seems "high" to you.  You clearly have not been told what perimeters physicians use to determine what is a "favorable" prognosis.  With ANY illness, physicians will add up information about you and come up with your chances of GETTING an illness or in this situation of GETTING a RECURRENCE.  Based on the "numbers," then physicians decide whether or not you need to be treated to prevent an illness, or prevent an illness from returning OR even CONTROLLING a disease.  An example, when you go to your primary care physician ands/ he examines you for heart disease and stroke in mind...which is a leading cause of death for women.  S/he looks at your weight, blood pressure, blood results, menopausal status and then arrives at a "number" which tells both of you your chances of having a stroke or heart attack in the next 5 or 10 years.  If s/he determines that your risk is UNDER 10% in 10 years, they will often NOT treat you because your RISK of getting the illness is greater than any benefit you might obtain from treatment.  That's not saying that you WON'T be treated.  Some women might choose a treatment to improve their survival benefit by as little as 1%.  That is a choice.  Most physicians will not want to treat a POTENTIAL disease if the chances are under 10% of getting an illness in the next 10 years in the first place.....

Now, regarding breast cancer.  There is a sub-category of rare breast cancer histologies that are classified as "favorable." I didn't choose the word "favorable."  That is how they are described in the literature. Mucinous breast cancer, which is what I have is considered a rare "favorable" breast cancer.  It is deemed "favorable" because the chances of recurrence is USUALLY 10% or BELOW in 10 years.  This information is based on studying the data of patients previously diagnosed with the disease.  When the Oncotype DX test was developed, "favorable" rare sub-category histologies were included and all were found to have low recurrence scores.  That is, the chance of recurrence was UNDER 11%.

So, having a recurrence score of 11, putting you at an 8% of distant recurrence is LOW.  It is NOT "a little high."  It is LOW.  Does this mean it will NOT recur?  No.  And perhaps THAT is what you DO find alarming.  And that is probably why you are grasping at the most bleak information that you can find in the literature and then questioning how that information pertains to you.  What Beesie and I are trying to tell you is that sometimes you might perceive that obtaining knowledge is powerful, but unfortunately, when you are not experienced at understanding that information, it can sometimes be harmful.  That is why you MUST sit down with your doctor and understand your disease in the most simple and MEANINGFUL way. 

I will conclude by saying, when the Oncotype DX test was finally put into use for the general population, it was determined that the average Oncotype DX score for people with mucinous breast cancer was 15.  That is EXACTLY the score that I received.  I subsequently spoke to the researcher of rare favorable sub-type breast cancer histologies and she said, from her research, that score of 15 was EXACTLY what she would have predicted.  Would I have prefered a lower number?  Of course.  But I put my number into PERSPECTIVE.  Mucinous breast cancer is a "favorable" breast cancer.  My chances of recurrence are 10%.  Based on ALL of my information, which includes my Oncotype DX score, I have a 10% or below chance of revisiting this disease.  Furthermore, another way to look at the data, my chance of dying from my disease is only SLIGHTLY below my chances of dying from a natural death.

The characteristics of your breast cancer are similar to mine.  Please speak to your team and have them explain to you your specific situation in the most simple terms.  And if they are too busy, then find another team that can.  I think explaining things in simple terms is often hard.  Too often physicians talk over our heads.  Likewise, delving deeply without a consumate understanding can also be bad. 

Good luck.