Breast Cancer Education: Understanding a Pathology Report

bc-education-mtp-pinkNot all breast cancers are the same. A biopsy is a test that removes cells or tissue from the suspicious area of the breast. It is needed in order to diagnose breast cancer. Once biopsied, cells are sent to a lab for a pathology report. The following information will usually be available on this report if the cells studied are cancerous:

  • Lymph Node Status: If lymph nodes were removed, a pathology report will show if the lymph nodes contain cancer cells.
  • Tumor Margins: When breast cancer is removed by surgery (during a surgical biopsy, lumpectomy or mastectomy), a rim of normal tissue surrounding the tumor is also removed. This rim is called a margin. It helps show whether or not all of the tumor was removed.
    • Positive (involved) margins: Contain cancer cells.
    • Close margins: Cancer cells approach but do not touch the edge of the biopsy.
    • Negative (not involved, clear or clean) margins: Do not contain cancer cells
  • Tumor Grade: For invasive breast cancers, the shape is noted and a grade is assigned. Tumor grade relates to the structure of the cells. It is different from tumor stage. This determines how different the cancer cells look from healthy cells. In general, the more the cancer cells look like normal breast cells, the lower the grade and the better the prognosis.
    • Grade 1: Cells look most similar to normal and are not growing rapidly.
    • Grade 2: Cells look somewhat different than normal.
    • Grade 3: Cells look very abnormal and may be spreading/growing rapidly.
  • Non Invasive vs. Invasive:
    • Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer (stage 0).
    • Invasive breast cancer (also called infiltrating cancer) means the cancer cells inside of a milk duct or lobule have broken out and spread to nearby tissues
  • Tumor Size: Tumor size is most often reported in centimeters or millimeters. The best way to measure tumor size is under a microscope. In general, the smaller the tumor size, the better the prognosis.
  • Diagnosis: This is the most important part of the pathology report. It gives the final diagnosis and may include information on the cancer such as tumor size, type, grade, hormone receptor status and HER2/neu status.
  • Hormone Receptor Status: Hormone receptors are proteins found inside some cancer cells. When hormones (estrogen and progesterone) attach to these receptors, they make cancer cells grow. Knowing the hormone receptor status will help guide your treatment.
    • Estrogen and Progesterone Receptive-positive (ER+ and PR+) tumors have many hormone receptors and there are treatments that prevent the cancer cells from getting the hormones they need to grow may stop tumor growth. .
    • Estrogen and Progesterone Receptive-negative (ER- and PR-) tumors have few or no hormone receptors and are not treated with hormone therapies.
  • HER2/neu Status: (human epidermal growth factor receptor 2) is a protein that occurs on the surface of some breast cancer cells.
    • HER2/neu-positive (HER2+) tumors have many HER2/neu genes inside the cancer cells (also called HER2/neu over-expression), which causes a large amount of HER2/neu protein on the surface of the cancer cells. About 15-20 percent of breast cancers are Her2+. These breast cancers tend to be more aggressive than other tumors. There are treatments that specifically target HER2/neu and block the ability of the cancer cells to receive the signals that cause them to grow.
    • HER2/neu-negative (HER2-) tumors have few HER2/neu genes inside the cancer cells and little or no HER2/neu protein on the surface of the cancer cells and are not treated with HER2-targeted therapies.
  • Triple Negative: If all three statuses are negative (ER, PR, and HER2/neu) then the patient’s cancer is Triple Negative Breast Cancer. The current standard of treatment for these cancers is some combination of surgery, radiation therapy and chemotherapy. These cancers tend to be very aggressive and recur (come back) early.

Learn more about breast biopsies: http://ww5.komen.org/BreastCancer/Biopsies.html

Learn more about types of breast cancer tumors:

http://ww5.komen.org/uploadedFiles/_Komen/Content/About_Breast_Cancer/Tools_and_Resources/Fact_Sheets_and_Breast_Self_Awareness_Cards/Types%20of%20Breast%20Cancer%20Tumors.pdf

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