diagnosis - why high nuclear grade?

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dragonfly55
dragonfly55 Member Posts: 235
edited June 2014 in DCIS (Ductal Carcinoma In Situ)

Hi, I just picked up my reports at doctors.

Diagnosis (3.5 x 3.5 x 0.8cm, 6/6 blocks)

DCIS, comedo, solid, cribiform, micropapillary types present

comedonecrosis present

microcalcifications  

detached fragment sclerosed possibly inductary papilloma (benign tumor)

ER/PR- 

So, why if I have all this would they diagnose it high nuclear grade?  I have read other postings where women have necrosis and are diagnosed low grade? Has anyone else had all these types of cells present in their diagnosis?

I see the BS Nov. 15 and don't know what to expect.  (first, he's a male doctor and that intimiates me beyond......don't know if I can deal with that one).  Besides the nervousness and inability to talk about private stuff with a man.... how the heck am I going to be able to discuss and ask questions about diagnosis and treatment?!#!  (writing out loud)

 What are the key things to look at when deciding on treatment? 

Reaching out to get a grip and try and ground myself. 

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  • Hindsfeet
    Hindsfeet Member Posts: 2,456
    edited October 2011

    Usually, comedonecrosis is high grade, not low grade.

    I too prefer a woman doctor as I am more comfortable talking about this with a woman. Can you ask for a woman doctor?

    I would say read as much here as you can on bco and other websites on dcis. Knowledge is power. Learn the pro's and con's to treatment, rads, and medicine. You are your best advocate. I' learned that you live with the consequences of whatever happens. You are just another cancer patient...so make sure the decision that's made is one you can live with.

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  • cycle-path
    cycle-path Member Posts: 1,502
    edited October 2011

    There's an article at this link called "Terminology, Natural History, and Taxonomy of Ductal Carcinoma in Situ." It explains the grading and other pathology issues. Unfortunately I can't link directly to the article -- you have to scroll about halfway down the page to find it. There are also some pictures of cells classified as "comedo/high-grade; noncomedo/low-grade cribriform; noncomedo/low-grade solid; noncomedo/low-grade micropapillary; noncomedo/low-grade papillary; and tumor cells invading out of DCIS into the surrounding stroma."

    Of course it's all written in med-speak but it will probably give you an idea of what all the grading is about.

    I agree with evebarry that you need to feel comfortable with your BS if at all possible. Is there no one else you can see? (Being intimidating isn't the exclusive domain of male doctors. I've been to some nasty female docs as well.) 

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  • Beesie
    Beesie Member Posts: 12,240
    edited October 2011

    The nuclear grade is based on how closely the cancer cells resemble normal cells.

    Grade 1 DCIS cells most closely resemble normal cells.  Grade 3 DCIS cells don't much resemble normal cells. Usually the presence of comedo-type DCIS and necrosis result in a Grade 3 classification however if there is only a small presence of those conditions, sometimes the DCIS might still be Grade 2. 

    You can read about this on the breastcancer.org website here:  http://www.breastcancer.org/symptoms/types/dcis/diagnosis.jsp   The discussion on grading starts about midway down the page. 

    And to your question, yes, I had all those different sub-types of DCIS in my diagnosis. It's not unusual to have more than one subtype and even more than one grade.  I had mostly Grade 3 but some Grade 2, plus in addition to every possible subtype of DCIS I also had ADH, a bunch of fibrocystic conditions and a microinvasion of IDC.  The description of my cancer looked like a complete listing from a breast cancer pathology manual - practically everything was in there! 

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  • dragonfly55
    dragonfly55 Member Posts: 235
    edited October 2011

    Thank you for the  information and support.

    Cycle-path and Beesie thanks for the detailed info. I have checked out the links and have found the information helpful.  There is so much to learn and your notes help it to sink into my brain.

    Evebarry and cycle-path: I did it.  I called and got an appointment with a female BS. It has delayed my appointment by only 9 days.  So my appointment is Nov. 24.  I just needed that push.

    This sure has been a long process.  My first mammogram was Aug. 15.  My biopsy was Oct. 4 and about 1 month 3 weeks to BS appointment.   Thank goodness it's DCIS.

    Wishing you good health.  Take care.

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