Pathology Report

[JenRN221]

45 year old with no family history, did have 3 rounds of IVF, which I feel contributed to this cancer. Left breast Ca-IDC, Her2+, ER+,1cm tumor, grade II,Staging: pT1b, pNO(i-), pMX. My question is this, after 2 surgeries for +margins, I elected the 3rd surgery to be a double mastectomy. My first biopsy showed angiolymphatic invasion present, but the second surgery said "not identified". Is this possible to have invasion and then none? Would I still be at risk that when it was positive it could have spread? As an RN, invasion scares me terribly even with the negative nodes. 2nd question: what does the "b" mean in the tumor stage and the "i-" in the node stage? Am I stage one, early breast cancer? I am set up for chemo to begin next week, followed by one year of Herceptin, then 5 years of Tamoxifen. I am trying to stay positive, but a diagnosis of cancer is terrifying and I just want to be survivor. Thank you for your time.

[JenRN221]

Thank you so very much for helping me understand this. As a nurse, you know we are always going to read every detail of the report. I've been nursing for 8 years but this is all greek to me, I do ER nursing and we don't do a lot of oncology there. Anyway, I hate the thought of going through chemo, but I understand it is a must with my diagnosis. I will continue to pray to be a survivor in this battle and will share my experience with others by working in a breast center somewhere once I can return to work. Thank you for your time and God bless.

[PaulMD]

Hi there.

The "b" in T1b tumor is just a sub-classification of T1 tumors.  T1a are tumors less than 0.5cm, T1b is 0.6 to 1.0 cm, and T1c is 1-2cm in diameter.

The "i-" in the node status just means that the nodes are negative using immunohistochemical staining which is more accurate than standard pathologic preparations.

Yes you are in stage I disease, but due to the size of the tumor, you would still derive benefit from chemotherapy.  The Her2 status can be addressed by the Herceptin, while the tamoxifen will address the estrogen receptors.

Angiolymphatic invasion may not be present in the entire tumor specimen that's why the second report may not show this finding.  This finding also makes chemotherapy a good option since this would kill any cancer cells that might have escaped.

Regards and God bless.