Confused About Pathology Report

4mm is very small! But it sounds like you have DCIS + IDC which means you do have breast cancer that is outside of the ducts (in the breast tissue). They will be focusing on treating IDC, the more troubling diagnosis. Your report just means there were both cancerous cells found within the ducts and outside of them, in the breast tissue. It's likely you will next get an MRI, your doctor should soon be able to tell you your options. DCIS is Stage 0.... I am not entirely sure of all the other stages but once it is in the breast tissue that is Stage 1... however just because it is in the breast tissue does not mean it has reached your lymph nodes. The Grade is how different the cells appear from normal cells. It's usually 1-3. And Grade 3 means it is likely growing or developing faster or is more advanced, from what I understand. Hopefully you have another appointment soon where you can gather more information. From the information you've posted it sounds like Stage 1, however you really don't know until after surgery and they look at the removed tissue under microscope. Goodluck.!

It is very common, I think much more common than not, to have DCIS alongside IDC. So don't worry about that.

A small tumor is good, but the genetics of the tumor also matters a lot for treatment and somewhat for prognosis. Estrogen and progesterone receptor positive are both favorable. A lot of places don't even do Ki anymore, but you'll probably get a bite of your tumor sent for genomic testing (likely either Oncotype or Mammaprint) after it's removed. That will help guide decisions about chemotherapy and also give you more specific to you statistics about recurrence.

Grades and stages are different. But it's normal not to have a stage on the pathology report because even initial clinical staging also depends on a doctor feeling your lymph nodes for palpable signs of possible lymph node involvement. For the final staging, that only comes post-surgery when they do the final pathology of the tumor. If you don't end up having neoadjuvant chemo (before surgery), you can look up your stage pretty easily though. Take heart, with such a small tumor and ER+/PR+, you can have multiple lymph nodes involved and still be stage I.

You'll know more about it once they finish the Her2 testing. Nowadays, Her2 is either neutral or favorable for prognosis because of the new drugs they've got. If you are Her2 positive, make sure to ignore any older statistics that use data from more than about 5-10 years ago.

It's a long haul and it's impossible to understand everything at the beginning. The picture will get more and more clear as you get more test results in, more doctors' explanations, and more knowledge. In many ways, you're at the most stressful part right now.

I had necrosis but my cancer was staged grade 1 on the biopsy and grade 2 after pathology. I'm not sure exactly how the necrosis numbers work.

The breast surgeon will advise you about options for surgery, likely after the MRI results are in. If the MRI doesn't show any other areas of concern, they're more likely to recommend lumpectomy. If the MRI shows multiple other areas of concern, they may want to do more biopsies first or recommend a mastectomy if they need to take out enough areas that a lumpectomy would have poor cosmetic results, or depending on the location of the areas.

Yes, like knowing the final size and grade/hormones of a tumor has to wait for pathology, same for knowing for certain on the status of lymph nodes. A person can have palpable lymph nodes that turn out not to be cancer, or there can be cancerous lymph nodes that are not palpable. If they haven't identified suspicious lymph nodes, you will probably have a sentinel lymph node biopsy, where they try to identify the first couple of lymph does that cancer from your breast would drain towards, remove just those (might be as few as 1 or as many as 7+, depending on your anatomy), and do an extensive pathology. They usually do that at the same time as the lumpectomy or mastectomy. If those come back clear, they assume there is no lymph node involvement (there are false negatives, but the rate is very low).

I agree that this site has been so helpful. I also had a silver lining, not too long before my diagnosis, I had changed to a job with excellent health insurance and FMLA protections. The job has had its ups and downs but wow was I glad about the change once I got my diagnosis!

Living a few blocks from the cancer center will make life much more convenient! I'm kind of jealous, and I wasn't so far myself!