measuring the lump

[smokey 234]

On my pathology report is states that the cancer is 2.3 cm measured grossly.  My question is what does that mean?  How is it measured?  Also, it says it had a high proliferation index.  I assume it means alot of cells are dividing.  Is that the same as a nuclear grade?  My doctor said they don't give it a nuclear grade because it is invasive lobular cancer. Assuming it is all out, no lymph nodes, no blood or vascular involvement how does this affect my prognosis.

[smokey 234]

Thank you for answering so quickly.  so even though my alkaline phosphatate level is elevated b 8 to 10 points, it is likely that the bone and CAT scan won't show spread?  That is what I'm counting on.  I know I am repetitive and obsessive on this one topic, but i'm hoping it is all for nothing.  Do you have an opinion about this?

[surgeon]

Yes, I am a surgeon, board certified, member of the American College of Surgeons, in practice more than 25 years, listed in a national publication as one of America's top doctors (not that I'm the kind to toot my own horn....). As to lobular cancer: whereas the treatment is exactly the same for all forms of primary breast cancer, data suggest that lobular behaves better than ductal, in that it seems less likely to spread.

[smokey 234]

Surgeon,
I hope you really are a surgeon, because your answers make me feel so much better.  So even with slightly elevated alkaline phosphates, and a high proliferation rate, you are giving me hope.  A question you said because it's lobular my survival chances are good (see above)  why is that?

[surgeon]

It is literally measured with a ruler, holding it against the tumor portion of the tissues removed. It's easy to tell by looking what is tumor and what isn't. That is what the term "grossly" means: measuring by looking directly as opposed to under the microscope. A tumor that size indicates the need for chemotherapy. Having negative nodes is a very good sign. So is no vascular involvement. "Proliferation index" is subjective enough that it's not really possible to draw a specific correlation to prognosis. In any case, prognosis is an educated guess based on data for large numbers of people. The outcome in an individual case is not really predictable. Overall, because this is lobular, node-free the cure rate is very good.

[CCF-RN,MSN-JS]

Dear smokey 234, The edges of a cancer tumor are usually uneven so a precise measurement is dificult, the pathologist will measure the largest dimension of the cancerous portion of the specimen.  Proliferative index (measurement of the S-phase of the cell cycle) refers to how fast cancer cells are growing. A high proliferative index is indicative of faster growing cells, and is associated with worse prognosis.  This information is put together with the overall picture in order to determine a recommended plan of treatment.