Interpretation of Pathology Report

[Itsy]

My partner has just received the results of both biopsy's (left and right breast). She religiously has gotten mamo & ultrasounds annually (her sister was diagnosed with breast cancer two years ago).  Can you help us to understand what this means (more so with the right breast-nuclear grade 3? What options/treatments do we have? We see a surgeon next week,however, this unknowning period is very anxiety producing.
1.  Right breast-core needle biopsies:
*DCIS, nuclear grade (NG) 3, micropapillary type
*no definite invasive carcinoma seen
*microcalcifications present assoc. with DCIS
*foci of sclerosing adensosis.
Gross Desc: multiple cyclindrical, tan-white to yellow, soft, rubbery, slightly lobulated tissue frags range in length from .3 to 3.0cm.  Frags avg .2 cm in diameter.  There are several tissue fragments separated out from main specimen.
Microscopic Desc.: micropapillary DCIS, NG 3 is present in 4 or 4 blocks of tissue (involving multiple cores).  These is single particular focus of insitu carcinoma-appears to be traumatic (artifactual) rupture of the duct with extension of micropapillae into adjacent stroma. Psuedoinvasion is favored, however, it is difficult to completely exclude an early microinvasive focus of colloid carcinoma.  HELP!@!
2. Left Breast at 2o'clock-core biopsy
*Infiltrating ductal carcinoma grade I
*Nuclear score 1/3 (mild pleomorphism), tubule score 1/3 (well formed tubules) mitotic score 1/3 (low mitotic rate)
*associated ductal carcinoma in situ, nuclear grade 1-2, cribriform type
*ER/PR requested

Thank you. Happy Holidays!
Cindy G

[CCF-RN,MSN-JS]

Dear Cindy G, The right core biopsy has revealed an area of DCIS (ductal carcinoma in situ), meaning a precancerous area (cancer cells within the lining of the duct).  Nuclear grade gives an idea of the degree of growth rate and how odd-looking the nucleus of the cells are.  Pathologists usually grade on a scale of 1-3 or 1-4, with the higher number being the worst.  The left core biopsy has revealed an area of infiltrating ductal carcinoma, or invasive cancer, which is more of a concern, as cancer cells have invaded the lining of the duct.  Discussions with the surgeon will be what would be the next step, which may involve further surgery to make sure all of the cancerous area has been removed.

[cow chaser]

Hi!! I was dianosed with this same thing on thanksgiving eve... went to the doctor yesterday, sending me in a week to cancer doctor, sergeon wants chemo.. then mast.. how do I tell them I want this thiing your talking about.. if we have to go thru this? the surgeon said yesterday.. something like.. don't let anyone tell you a lumpectomy......  do not know what stage yet.. he said the cancer doc would let us know.. HHHEEELLPPP..
note:  I went to the Deland Assembly church on Sunday, and they laid hands on me and prayed,... the cut where the biopsie was.. is all but healed and the surgeon said. it looked excellent.... I know God has healed me but.. I still want this earthy part of me to have questions answered,  Carol

[heyjo]

Hi Cindy, my name is Jo, I am not a doctor, but perhaps I can help a little. DCIS means Ductal Carcinoma In Situ; which means ther is a cancerous lump in the milk duct, however it is still confined to the the duct and has not invaded any surrounding tissue. This is a good thing. However grade three means that it is a very agressive tumor. The lower the grade the better. 3 is pretty aggresive. Infiltrating Ductal Carcinoma means that there is a cancer in the duct, and it has invaded nearby tissue, and grade one is a good thing. There is alot there that I can't answer for you, but these things are the basics. Do you know what stage these tumors are yet? And how many are there? It sounds like there is a few. I am sorry that your partner has this. But be assured that all of these things are treatable. More than likely she will have surgery, radiation and chemo. These are all part of the standard care treatment.
How old is your partner? this will play a part of it as well.
I, too was dx with Invasive Ductal Carcinoma, Grade 3. So far I have had a lumpectomy, and sentinal node mapping to see if the cancer cell have invaded the lymph glands. I recommend this mapping to everyone!~!!! It can save your partner alot of surgery and pain. Find a doctor or cancer facility who can do this. I almost didn't. I almost listened to my first surgeon who said I have a choice of either Mastectomy or Auxillary lymph node removal of at least 10 nodes. I chose to go for a second opinion at the Moffit Center for Cancer research, And happened to find out about this procedure. After they mapped and did a biopsy on my sentinal node, they found it negative and I am relieved to have saved myself alot of surgery. The Moffit Center has an online web site with lots of info and numbers to call for answers.
I also recommend a web site for support and help for both of you, that is the msn.health. Come there to the breast cancer friend to friend board. There are alot of us who can be of big support to you and to yours. Or if you want you can email me if you want to chat, ***@****. Perhaps my partner could answer some of those medical terms for you. She is a Med student, which helps me to understand things also.
Take care of each other.
heyjohey

[surgeon]

the first thing to understand is that since the biopsies were core biopsies, there could be more to the story: it's necessary to re-excise both areas to be sure that all of the cancerous tissues are removed, and that there's nothing left that would change the picture. On the right, it appears that only DCIS was found, and as one comment above says, that means there's no invasion found, and if that remains the case, that there's essentially 100% chance of cure on that side. With DCIS, grade really isn't important: if it's non invasive, that's what matters. The report indicates there's an area where malignant cells are seen outside the duct, which could mean it's in fact invasive: but the pathlogist seems to believe that it's in fact an artifact of the process: that the biopsy needle might have pushed the cells into the tissues making it look like invasion when it really isn't. The other side shows invasive cancer, but suggests it's early and if so would still be very highly curable. More needs to be known: re-excision for one thing, and sampling of the lymph nodes under that arm, for another. As these things go, the news sounds good: there's cancer, but with every reason to expect cure based on the info so far.

[Liz S]

Hi Cindy - I'm sorry you and your partner are going through this.  Following is a link to a site that walks you through a sample pathology report - it might help:

http://www.susanlovemd.com/decision/c_2.htm