Help understanding my wife's biopsy report

robhsdca

Hi---glad I found this community. I am sure I am no more scared than anyone else is in this situation, but I am scared and could use some help trying to decipher our biopsy report. It's a Friday and we just met with our family doc who could not/would not tell us much but just referred us to an oncologist that we are waiting to hear from to get in and see. We have a 4 year old daughter and a brilliant life ahead of us that we have fought to build, and now have nothing but time and our imaginations to eat away at us. So I am here to hopefully get some help from you all with our biopsy report. Anything you can provide in plain English, and straight talk without sugar coating anything will be appreciated.

Here is what I am looking at:

Panel of Immunohistochemical stains for tumor is as follows:

P63: Negative, indicative of absence of myoepithelial cells

E.Cadherin: Positive, indicative of Ductal differentiation

CK-Pan: Positive for Tumor

Bloom Richardson Score 6/9:

Tubular Formation: 3/3

Nuclear Grade: 2/3

Mitotic Activity: 1/3

Ductal Carcinoma In-Situ: Not Identified

Vascular Lymphatic Space Invasion: Not Identified

Lymphoplasmacytic Response: Mild

Thanks in Advance!

Gully

Hello Rob,

First of all, just breath....Your wife's report looks alot like mine. It looks like a grade 2 IDC there will be more information to come from your doctor. Take a look at my stats, I had two of these one in each breast, and I am still here and healthy three years out. The beginning is the worst. You will feel better when you get to talk to your MO and get a plan. I had surgery, then they set out the tissue for Oncotype DX. It takes a couple of weeks but will help your doctor determine if Chemo is needed or not. If not, on to possibly rads, and then hormone therapy depending on the receptor stats , which they will also run on the tissue. I hope this helps a bit. Your are not alone and this site has a wealth of info. Best advice I can give is try and stay busy and dont Dr. Google. Much of that info is out of date. Good luck, and i will be thinking of you both. Hugs,,,,

robhsdca

Thanks Gully. Trying to get off of Google some, but it's hard. I want to understand the Bloom Richardson and how it may relate to what's going on, and so much more. I just want to be able to wrap my brain around it all so we can be ready to attack.

Gully

Rob, use this site under the tab for understanding your pathology report. Good info there. Hang in there!

Moderators

Hi Rob-

You can find more information about the pathology report and other important matters for the newly diagnosed here: https://community.breastcancer.org/forum/5/topics/.... Gully had some wonderful advice for you, hopefully this is all helpful!

The Mods

kytylove

Hi Rob,

Mine was a bit different, but similar in many ways as well. My son was just 4 when I was diagnosed as well, so I know how concerned scared you must be. My husband took a different approach when I was diagnosed, he tried to be strong, but he had a hard time uttering the words cancer. I mimic Gully's response, in that, first and foremost take a deep breath. I had IDC, Stage 1, Grade 3, no lymph node involvement. You need to take this one step at a time, and coming from someone (me) who likes things planned out, that was a hard thing for me to understand too.

I had chemo because of my oncotype score, but there are tricks to getting through chemo I learned along the way that helped, hormone therapy depending on receptors and maybe radiation. I am happy to answer any questions you or your wife may have, but you are NOT alone.

ChiSandy

Your wife’s biopsy report looks almost just like mine--the tubule score of 3, nuclear grade of 2 and mitotic rate score of 1 all add up to a Grade 2, cells “moderately differentiated” from the neighboring ones. It’s not DCIS, but probably IDC. Where my report was a bit more complete was that it mentioned the biomarker status: positive for estrogen & progesterone receptors, negative for HER2. The most encouraging finding on her report is the mitotic rare score of 1--which means the cells are dividing rather slowly. Many doctors consider that to be the most important of the three components of the “grade” score.

You can’t yet know the suggested surgical plan without knowing the tumor’s location and size (both absolute and relative to the size of her breast). You will probably know it’s hormone and HER2 status before surgery (they might get that result any day now) . But treatment beyond that point will determine whether whatever surgery she chooses got it all (“clean margins”) and if there’s any cancer in any of the lymph nodes. Those things can only be confirmed after surgery is performed.

I didn’t have chemo because of a low Oncotype score, hormone-positive/HER-2 negative status, clean margins and lymph nodes, and my age. I chose a lumpectomy because my tumor was quite small relative to my breast size and conveniently located. Because I chose lumpectomy rather than mastectomy, I did have radiation (a 3-week partial-breast protocol). But chemo and radiation (and they might not be recommended) are doable--and young women generally tolerate it better than those my age or older.

Right now, take heart that the tumor is Grade 2 with a mitotic rate of only 1. You can take a little time to get second opinions, weigh surgical options, shop around for the best surgeons/oncologists/hospital for her, and line up friends and neighbors to pitch in and help with running errands, helping with child & pet care, housework, etc. The tumor’s been there awhile, and it isn’t growing quickly enough to panic or decide rashly.

I’m going to post a picture of something I encountered chalked on a sidewalk between the rapid transit train and my house, shortly after I was diagnosed and scheduled my surgery. Take heart from it:

robhsdca

Thanks so much to you all.

I think the toughest part right now is the waiting. We have not seen the oncologist yet---diagnosis was just on Friday and today is only Monday, but the weekend in between was an interesting mix of hope and worry.

One of the things we find hardest to swallow right now is that as a matter of annual routine, she had a mammogram just back in October, and now this has shown up only a couple months later with differing tumor sizes told to us, ranging between 3 and 6cm. I personally am astonished if a tumor of 6cm exists that it could have grown from nothing in a mammogram just a few months back, especially with the mitotic score of 1. I am very grateful my wife found this in just routinely examining herself upon feeling some pain.

I think that once we have a plan in place, even though the surgery and treatment will be a difficult process, just knowing what we are facing and what we are doing will make a huge difference in how we are feeling about it all.

On a side note, to piggy back to your picture Sandy, on Saturday we decided we wanted just a fun, family day and we have annual passes to Knott's Berry Farm---when we got there they were in the middle of their "Fight for a Cure" annual celebration that we were not aware they even did. Maybe a sign in itself---we sure took it that way!

robhsdca

Gully---your diagnosis was spot on. She has an IDC Stage IIb, having spread to her lymph nodes, but only in her right breast. Nothing is showing on MRI's or any other test in the left. The doctor is suggesting a lumpectomy with node removal, followed by radiation and then chemo if they feel it is necessary at that point. She also told us where we are at leads to an 80% survival rate, which my wife was happy to hear and it scared the hell out of me---two opposite reactions.

Either way, we are encouraged some now that we have some direction and looking forward to getting moving on surgery and treatment very soon, following some genetic testing to rule out gene mutations.