reading my path report - help please

pdaw · May 2009

Dr. says I have IDC, probably stage 2, but can't be sure until surgery and path report from nodes. I'm also triple negative, which apparently carries it's own set of issues. For example, from what I understand chemo is the only treatment for TN and apparently the likelihood of the C returning is greater for TN. Lumpectomy Surgery is June 1. Have already been told that I'll be having chemotherapy followed by radiation. I was diagnosed with DCIS in 06 - lumpectomy followed by 36 radiation treatments.

I got my path report today. I've heard a lot of terms but there are some items that I have not seen listed in any of the forums. Can anyone help with these?

Nottingham histological score 8

Tubule formation: 3 points

Nuclear pleomorphism: 3 points

Mitotic race: 2 points

total 8 points (poorly differentiated)

No definite angiolymphatic invasion by tumor is identified. (I'm assuming this means it appears the lymph nodes are not affected; however, dr. has indicated she will be very surprised if not - MRI showed nodes were clear)

Any assistance is greatly appreciated!!

debbie6122 · May 2009

Pedaw-I am sorry for what you are going thru and had to come here, but there are some wonderful woman here on this site and even tho i cant help you with the meaning of some of the scores that you mentioned, i can tell you that my daughter was dx 2 yrs ago, hers sounds just like yours and she is also tn, she didnt have any nodes involved but she is doing wonderful, althought every one is different , iam not a tn, and our chemos were different, and the chemo gives you better odds of it Not recurring, iam sure you will get someone that will explain all the other stuff you wanted to know, take care

angel hugs-debbie

jill323 · May 2009

Pdaw -

Hi. I will try to help you with this. I know my way around a pathology report pretty well these days.

The Nottingham score is a measure of your tumor grade (i.e. how aggressive it is). Some pathologists use what is called a Bloom Richardson scale, but both measure the same thing.

Basically, your Nottingham score was 8. The highest you can get is 9. Typically, an 8 out of 9 score will put you at grade three - which is the highest grade. Grade 1 is the lowest, or "least aggressive", Grade 3 is the "highest" or most aggresssive.

They get this score by looking at the three things listed below in your note - Tubule formation is how "different" the cancer cells look from "normal" cells. You got a 3 which means they looked very different (three is the highest score). The nuclear score looks at the cell nuclei and grade them based on how they look relative to normal cell nuclei. Again.. your cancer cell's nuclei were highly different. Mitosis is a measure of how fast they were dividing. On this one, your cells were "middle of the road" with a 2 score. So.. total score is 3+3+2 = 8 (out of a possible nine). So.. likely grade 3. Poorly differentiated is just another way of saying grade 3.

You are correct on your assumption about the lymph node thing. This means they did not see fluid that could be identified as coming from the lymphatic system. This is generally good news.

So... what does this mean... it means that the course of treatment identified for you is probably correct. But, typically aggressive tumors respond very well to chemo. So, that is the good news within the bad.

I hope that this is helpful for you. You can PM me any time if you need additional information. I wish you the best on this. Come back for support any time !

Jill

swimangel72 · May 2009

Pdaw I'm so sorry you have to go through this again. I'm a bit confused though - are you saying in 2006 you already had a lumpetomy for the DCIS followed by 36 radiation treatments - or that you are going to get radiation treatment now after your lumpectomy on June 1st? If the former - I don't think you can have radiation on the same breast again.........unless this is a different breast. I could be wrong though - something to ask your doctor - because if you can't have a lump with rads, you're looking at a mastectomy - so I hope I'm wrong!

Anonymous · May 2009

Pdaw... it's worth getting John Link's book - I think it's called the Breast Cancer Survival Guide. He explains all of this stuff in very clear language. You can get it in paperback - it'll help with all the stuff on your path report, which Jill explained very nicely (as usual)!

Many women with TN breast cancer do quite well on chemo. Aggressive cancers tend to be more vulnerable to the chemical disruptions of chemo because they're so weird and unstable. Don't panic yet... Stage II is still a local breast cancer.

Swimangel is right: you should check on the lumpectomy/radiation question. Are you seeing the same doctor that you saw for your DCIS? If not, you'll want to make sure s/he knows your history.

Will they do a sentinel node biopsy as well to test your lymph nodes?

pdaw · May 2009

thanks to all of you for helping me understand what's going on. The DCIS was in my left breast - the IDC is in the right. Actually, I've changed doctors 4x since 2006. My intital surgeon left to go to Texas and turned me over to a great man, who retired after seeing him 2x 0 - then they turned me over to someone else. For some reason, things just didn't "click" with him, so I asked around and changed to the present female dr.

Kaidog - I know they are checking the lymph nodes. The MRI did not show any signs, but dr. says she will be extremely surprised if there is nothing there. She did say that the treatment plan would not change either way.

If the lymph nodes are positive - does that automatically mean that the cancer has spread to other places in the body?

I will share one more thing about my diagnosis. I had a check-up with my radiation oncologist February 18, at which time he did a physical exam and found nothing. This grew between that time and April 24 when I had my yearly physical. And, of course, I feel like it's growing exponentially now since I know that it's there.

pdaw · May 2009

Thanks 2tzus - I think I would have rather the dr. say the MRI did not show any cancer - but sometimes that can be deceiving - however, she told me that she would be completely upfront with me. And as you know the waiting is very hard. Surgery on Monday (June 1) and back to dr. for results on June 10. HOw are you?

marmsie · May 2009

My first breast cancer was in early 2000. That IDC was a triple negative and graded a 9 out of 9 on the Nottingham scale. It was a 2.1 cm mass. Full axillary dissection collected 22 nodes, all found to be clear of cancer per 2000 pathology practices. Maybe I barely dodged a bullet? Like most things with cancer, I'll probably never really know. I did 4 rounds of A/C followed by 7 weeks of radiation.

The final "status" of the first was T2 N0 M0; Stage 2A.

Knock on wood - NED for that one! The new primary is a grade 1, with positive hormone markers.

Let's keep the collective fingers crossed that the MRI findings hold and the nodes are nice and clean. My original oncologist was very much a realist and always clear and upfront with me on the possible indications of my particular situation. Chemo really is highly recommended if not almost a given for invasive TN cancers, I seem to recall the survival rate goes up considerably with that additional treatment.

Positive thoughts - I'm really working on not wasting time worrying about "maybes" and "what ifs" these days. I'll save it for the "hard" facts. (Though sometimes those hard facts aren't exactly clear cut...but such is cancer.)

reading my path report - help please

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