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pathology report questions
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pathology report questions

My mother has recently been diagnosed with invasive ductal carcinoma.  She had a modified radical mastectomy on March 1 as well as 7 lymph nodes removed.  Her pathology report has left us with questions.  

To begin with, her "addendum diagnosis" read 2 of 7 lymph nodes with metastatic infiltrating ductal carcinoma.  So, has her diagnosis been changed?  

She had a biopsy and what we thought was only 1 tumor, but the surgery revealed 2 smaller tumors, which has increased her primary tumor to a pT2.  the regional lumph nodes say pN1 - metastasis in 2 of 7 axillary lymph nodes, metastatic deposits greater than 2 mm.  Can you tell us if this is good or bad?  

On her biopsy and final pathology report it says distant metastasis is pMX - which means cannot be assessed.  Is it normal to not be able to assess as this stage?  This means we cannot determine the stage her cancer is in - correct?

On the Margins section - it says uninvolved by invasive carcinoma - translation?

Distance of tumor from closes margin - .6 cm (deep margin) - again translation?

lymphatic invasion - it reads absent - I think this is good, right?

Microcalcification - present in nonneoplastic tissue - translation?

I will look forward to your reply.  Thank you in advance for your assistance.
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Avatar_n_tn
Dear moocows:  Staging breast cancer is the process of finding out how far the cancer has progressed when it is diagnosed.  The system most often used to describe the growth and spread of breast cancer is the TNM staging system. This information is combined and a stage is assigned to specific TNM groupings.  The information from the pathology report gives the information mainly on the T - tumor and N - nearby lymph nodes.  The information regarding M - metatasis or spread to distant organs of the body is usually based on other studies looking at distant organs.

A T2 tumor is an area of cancer that is 2cm in diameter but not more than 5cm in diameter.  N1 means that the cancer has spread to lymph nodes under the arm on the same side as the breast cancer.  Lymph nodes have not yet attached to one another or to the surrounding tissue.   So putting this information together (T2N1MX) would put your mother's overall Stage at Stage IIB.  The MX means that it is unknown to the pathologist whether there is any metastases to distant organs. The information from the pathology stage is put together with the whole clinical picture meaning if there was found to be cancer in a distant organ then the Stage would change to Stage IV (anyT,anyN, M1).
The margins being clear means that there is an margin of normal breast tissue (at least .6mm) surrounding the areas of cancer removed.   Lymphatic invasion referrs to invasion of cancer cells into the the tiny lymphatic system within the breast tissue - not invading this is more favorable.  

The oncologist will use all of the above information from the pathology report as well as other factors such as the hormone receptor status of the tumor, and put this together with the overall clinical picture to determine what will be recommended to your mother in terms of any further treatment.  
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Avatar_n_tn
Thank you for reply to my questions.  We have an appointment to meet with the oncologist on Friday.  Hopefully then we will feel more at ease with what is happening.  Thanks again.
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