nuclear status???

indahood

Hi anyone out there care to explain what the nuclear status is? I can't find that term on my pathology report but keep hearing it mentioned here. From what I've read, it is part of the histo report. If that's so, then I got a 3 out of 3. I know it affects Grading. but how does it affect treatment and recurrence?

thanks

Laurie

BarredOwl

Hi indahood:

Here is a link to a description of the Nottingham Histologic Score (Elston grade) from Johns Hopkins, which considers three main features, scores each independently, and then combines the three scores for an overall grade:

http://pathology.jhu.edu/breast/grade.php

One of the features is a morphological assessment of the appearance of cell nuclei (the nucleus is the cellular compartment containing the chromosomes), and whether they more closely resemble the nuclei of normal cells (lower score) or that of cancerous cells (which have certain changes in appearance)(higher score) and how variable in appearance they are.

"Nuclear Pleomorphism:

- Score 1: Nuclei small with little increase in size in comparison with normal breast epithelial cells, regular outlines, uniform nuclear chromatin, little variation in size

- Score 2: Cells larger than normal with open vesicular nuclei, visible nucleoli, and moderate variability in both size and shape

- Score 3: Vesicular nuclei, often with prominent nucleoli, exhibiting marked variation in size and shape, occasionally with very large and bizarre forms"

Grade is just one factor in treatment decisions and that may modulate recurrence risk. For example, clinical guidelines for Breast Cancer from the National Comprehensive Cancer Network ("NCCN") provide recommendations regarding systemic drug therapies (e.g., chemotherapy; HER2-targeted therapy (for HER2-positive disease); and/or endocrine therapy (for hormone receptor-positive disease)). The NCCN recommendations are primarily based on: tumor histology (e.g., ductal, lobular), tumor size, lymph node status, hormone receptor status (i.e., Estrogen Receptor ("ER") and Progesterone Receptor ("PR")) and HER2 status. In addition, under NCCN guidelines, in certain cases of hormone-receptor positive, HER2 negative disease, the results of the "21-gene" (OncotypeDX test) (or other suitable test) are considered in connection with the question of chemotherapy.

BarredOwl

ps0705

BarredOwl gave you great information. i'm still working through what it all means.

It sounds like you just have the initial part of your path report back. The path report from my core biopsy came back 3 days apart. First I received the nuclear grade (3) like yours and whether it was invasive or not. Then 2-3 days later I got the hormone receptor status. My dr. did not call with that 2nd part, but after being on this website I knew to look for it so I picked up my report. Mine is ER-/PR-. They didn't do the HER on the initial biopsy.

Five days ago I had my bilateral mastectomy (my choice between lumpectomy plus radiation or mx). Everyone has their own reasons for their choice. I wanted to avoid radiation and due to the type mine was just felt like I'd have better peace of mind with it all taken off. Others with the same as me have done lumpectomy plus radiation. I still don't have the final on my path from the BMX and SNB but am hopeful.

Hang in there. The worst part for me was the initial diagnosis. It left me with so many questions and no action plan.

indahood

Thanks for the replies, PS and Barred Owl. I have already had my lumpectomy and I was reading my path report from the biopsy of my tumour. Might be they just used a different term on my path report. Oh never mind, I just looked again at my report. It actually does say nuclear pleomorphism, I scored a 3/3. Oops. Anyway, thanks again for your time. :-) With Christmas here, and having to wait a month before seeing the oncologist, I have too much time to wonder what my treatment plan might be and not knowing is driving me crazy. I have some major decisions that I HAVE to make before February.

Before my Cancer diagnosis, I was planning to take a lump sum cash out and retire early from teaching, since the new conditions in teaching were causing me way too much work and stress. But to take the lump sum rather that a pension, it had to be done before my 55 birthday Which is this February (that's the law).

Even though a pension offers security, my pension was not going to be very much. Since I was a younger 54 fit and healthy human, taking the lump sum of my pension plan money was better for my lifestyle. I have good investments and would make ends meet, working at a less stressful job. Anyway, a bit long winded but I had taken a lot of time to make this decision and spoken with many experts and friends.

Then came the diagnosis and now, I'm not so sure of my decision, because the benefits of not retireing are too good. At the moment I'm getting full pay while doing my treatment and will be bumped to 75% pay in February. If I do not take early retirement, I can continue to be supported throughout my cancer journey should it be more complex than what the doctors are predicting. I have an excellent prognosis, but also grade 2, scoring close to Grade 3

It's so hard to make a decision when I don't know the future of my health. I've been researching like crazy and finding out that you just can't know. On the other hand not knowing is driving me crazy.

indahood

Thanks PS and Barred Owl. I found it on the path report. Nuclear pleomorphism 3/3, Glandular diff 3/3, and mitotic rate 1/3 (thank god). PS, done the lumpectomy, the info I have is from the tumour path report. I'm struggling with wanting to know the outcome of this mess we call cancer. Trying to make decisions about my retirement or not. Before my diagnosis, I had already decided to take early retirement payout and walk away from the stress of being a teacher. Then I got the diagnosis. Having all the benefits of being employed while going through the treatment has been great (100% pay for 3 months then to 75% indefinitely depending on my ability to come back to work or not) and is hard to walk away from.

But for complicated payout rule regulation, I have to make my decision by my 55th birthday, Feb 21. My treatment will not be terminated yet by then. Making a life altering decision with cancer is so difficult. I hate the not knowing.