Need Help With Meaning of Pathology Report

[bacrook]

My mother-in-law just had a mastectomy on her right breast. I need help understanding the prognosis based on the pathology report.  Here is a slightly redacted version of what the report says:

A.  Right axillary sentinel lymph node #1 - Metastatic carcinoma involving node; no definitive evidence of extranodal extension; node measures 1.2 cm in max.  Positive for high grade malignant neoplasm.
B.  Right axillary sentinel lymph node #2 - Metastatic carcinoma involving node; no definitive evidence of extranodal extension; node measures 1.0 cm in max.  Positive for high grade malignant neoplasm.
C.  Right axillary lymph node partial disection - Metastatic carcinoma involving 16 of 17 lulmph nodes; largest involved node measures 2.3 cm; with microscopic extranodal extension
D.  Right breast, simple mastectomy - Invasive lobular carcinoma, pleomorphic variant; tumor is in the 8:00 position; size of tumor is 2.5 x 1.8 x 1.8 cm (pT2); grade of tumor is II (tubule formation -3, nuclear pleomoprhpism -3, mitotic activity - 1; margins of excision are negative for involvement, nearest margin (superficial) is 1.8 cm; no invasion of chest wall, skin or dermal lymphatics is identified; no perineural invasion is identified; a minor component of high grade ductal carcinoma in situ is present adjacent to the tumor; random sections of breast demonstrate proliferative fibrocystic change with additional microscopic foci of invasive lobular carcinoma; two lymph nodes positive for metastatic carcinoma (2/2)
E.  Comment: Although the stated tumor size is 2.5 cm, random sections of additional quadrants demonstrate microscopic foci of tumor, with identical morphology, most likely representing intrmammary metastases. The pattern of infiltration is distinctly lobular, and despite the larger, more pleomorphic cell population, is best classified as lobular carcinoma, pleomorphic variant. Immunoperoxidase stains onfirm breast origin.  Per previous report performed on needle biopsy, ER and PR are both less than 1% positive and HER 2/neu is negative(1+); FISH results not known. Of 21 lymph nodes, 20 are positive (20/21).
Based on the available information, this represents at least AJCC Stage IIIC (pT2, N3, MX).
Microscopic Description - Additional stains are performed on the lymph node tissue in "axillary contents" including PAS diastase, an immunoperoxidase stains for GCDFP, S100, CK7 and keratin cocktail. The metastatic tumor cells mark strongly for keratin cocktail, CK7 and GCDFP, and are negative for S100. The tumor cells to not demonstrate convincing PAS positive cytoplasmic material.

My mother-in-law is 84 years old and in general good health.  I really need to know what we are truly facing here.  She is planning on having chemo, unknown what yet until she meets with Oncologist.  I know everyone is different but what are the statiscal outcomes of this type of finding?  What can we expect to face?  I just know it sounds bad and I am trying to find information on the raw truth and what the best course of attack may be.

Any and all help would be appreciated.

[Dennis MD]

Hi.
I understand what you are going through.
Your mother-in-law has breast cancer, at least stage IIIC, pending the result of further work-ups to determine if the cancer has spread to other site/s.
Prognostic factors for breast cancer include the age of the patient, stage of the disease (tumor size, lymph node status), histologic grading, hormone receptor status, Her2 status, presence or absence of lymphovascular invasion, proliferation indices.
After mastectomy, there is a need to undergo systemic treatment and radiotherapy to reduce the risk of recurrence and hence improve the overall survival.
Luckily, breast cancer treatment is evolving.  There are so many chemotherapy options available now.  However, you will need to discuss the risks and benefits of treatment with your mother-in-law's oncologist.
Good luck.