QuestionQUESTION: I have just received my final pathology report after mastectomy. I have corresponded with you previously regarding the 2 tumours in my left breast and you asked me to update you after surgery ...so here it is although I don't understand it.
Multifocal invasive mammary carcinoma with ductal and lobular carcinoma features.
Tumour size(in aggregate)4.6 x 3.1 x 2.2 CM
MBR Grade II/III
MBR Score 7/9(tubule Formation 3, Nuclear Grade 3, Mitoses 1
No lymphvascular invasion or necrosis associated with tumour
Margins of resection negative for malignancy with tumour within: 3.0 mm of deep margin of resection, 5.0 mm of superior margin of resection
Represenative sections of nipple and skin neg for malignancy
Focal DCIS, Solid Type, Intermediate Nuclear grade without comedo necrosis or microcalcifactions identified.
Focal LCIS also noted
Fibrocystic type changes present including: stromalfibrosis, microcyst formation, fibroadenomatous-type change, focal columnar cell hyperplasia without atypia, apocrine change.
Left sentinel node disection negative for malignancy
er Poitive 8/8
Pr positive 7/8
left axilliary contents resection: 2 lynph nodes negative for malignanacy 0/2
There is also a lengthy comment section at the end which I can forward if that would be helpful.
they are recoomending chemo and then tamoxifen. I am 48 pre menopausal.Thank you so much for all of your information
ANSWER: It seems it was fortunate that the mastectomy was done since what you had there were several foci of invasive breast cancer. Also cancer in situ was observed. Your cancer grew within 3 mm of the deep margin, 5 mm of the upper margin. No tumor in any lymph nodes including both sentinel node & axillary nodes. Your cancer was positive for hormonal receptors. I agree that both chemotherapy and hormonal therapy should be used. Maybe also radiation therapy. The rest are technicalities.
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QUESTION: the surgeon said this is stage II breast cancer. I see there are also sub grades such as IIA, IIB. What is the difference? Also what is the difference between stage and grade. Do I have an aggressive cancer or is this quite manageable? I am still waiting on Her2 status.
Thank you so much
AnswerA stage 0 is a cancer in situ (in its site of origin), a stage 1 shows the beginning of invasive growth into surrounding tissues. A stage 2 is frankly invading its surroundings (the subgroups A & B tell the extent of that invasive growth), a stage 3 has invaded regional lymph node(s) - 1 node is enough (again there are subgroups depending on number of nodes etc.). A stage 4 has spread to more distant sites, other organs etc. So stage describes patterns of behavior of the tumor with prognostic importance and its state at the moment of staging. Grade is an evaluation of how the tumor tissues and cells look microscopically which also is of prognostic significance since it is associated with the degree of the malignancy of the tumor - how bad it is. Of course that is another way of doing a prognostic evaluation. Grades are from 1 to 3, sometimes from 1 to 4. Put together (grade & stage) it does give us a rather good prognostic evaluation and is a useful tool in choosing the best treatment for a particular case.
It should be manageable but no one can give you any guarantees unfortunately.
