Breast Cancer Experiences

Rate of Cell Growth

https://www.breastcancer.org/symptoms/diagnosis/rate_grade

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Your pathology report may include information about the rate of cell growth — what proportion of the cancer cells within the tumor are growing and dividing to form new cancer cells. A higher percentage suggests a faster-growing, more aggressive cancer, rather than a slower, “laid back” one. Tests that can measure the rate of growth include:

  • S-phase fraction: This number tells you what percentage of cells in the sample are in the process of copying their genetic information, or DNA. This S-phase, short for “synthesis phase,” happens just before a cell divides into two new cells. A result of less than 6% is considered low, 6-10% intermediate, and more than 10% is considered high.
  • Ki-67: Ki-67 is a protein in cells that increases as they prepare to divide into new cells. A staining process can measure the percentage of tumor cells that are positive for Ki-67. The more positive cells there are, the more quickly they are dividing and forming new cells. In breast cancer, a result of less than 10% is considered low, 10-20% borderline, and high if more than 20%.

Although the S-phase fraction and Ki-67 level may provide you and your doctor with useful information, experts don’t yet agree on how to use the results when making treatment decisions. Therefore, not all doctors order these tests routinely, so they may not appear in your pathology report. The other results in your report will be much more important in making informed choices. (If you decide to have an Oncotype DX test to check the likelihood of cancer coming back and whether you could benefit from chemotherapy…

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Size of the Breast Cancer

https://www.breastcancer.org/symptoms/diagnosis/size

Size indicates how large across the tumor is at its widest point. Doctors measure cancer in millimeters (1 mm = .04 inch) or centimeters (1 cm = .4 inch). Size is used to help determine the stage of the breast cancer.

Size doesn’t tell the whole story, though. All of the cancer’s characteristics are important. A small cancer can be aggressive while a larger cancer is not — or it could be the other way around.

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Expert Quote

“Size matters when it comes to breast cancer, but size is only one of the personality features on the list. You can have a small cancer that behaves like a bully, or a large cancer that is mild-mannered.”

— Marisa Weiss, M.D., chief medical officer, Breastcancer.org


Pathology Report ThumbnailYour Guide to the Breast Cancer Pathology Report is an on-the-go reference booklet you can fill out with your doctor or nurse to keep track of the results of your pathology report. Order a free booklet by mail or download the PDF of the booklet to print it at home.

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Surgical Margins

https://www.breastcancer.org/symptoms/diagnosis/margins

The surgeon’s goal during surgery is to take out all of the breast cancer along with a rim of normal tissue around it. This is to be sure that all of the cancer has been removed.

During or after surgery, a pathologist examines this rim of tissue — called the surgical margin or margin of resection — to be sure it’s clear of any cancer cells. If cancer cells are present, this will influence decisions about treatments such as additional surgery and radiation. Margins are checked after surgical biopsy, lumpectomy, and mastectomy.

Your pathology report may say that the surgical margins are:

  • Clear (also called Negative or Clean): No cancer cells are seen at the outer edge of the tissue that was removed (the tumor along with the rim of surrounding tissue). Sometimes the pathology report also will tell you how wide the clear margin is — the distance between the outer edge of the surrounding tissue removed and the edge of the cancer. When margins are clear, usually no additional surgery is needed.
  • Positive: Cancer cells come right out to the edge of the removed tissue. More surgery is usually needed to remove any remaining cancer cells.
  • Close: Cancer cells are close to the edge of the tissue, but not right at the edge. More surgery may be needed.

An important note: There is not a standard definition of how wide a “clear margin” has to be. In some hospitals, doctors want 2 millimeters (mm) or more of normal tissue between the edge of the cancer and the outer edge of the removed tissue. In other hospitals, though, doctors consider a 1-mm rim of healthy tissue — and sometimes even smaller than that — to be a clear margin. As you talk with your doctor about whether your margins were clear, positive, or close, you also can ask how “clear” is defined by your medical team.

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Vascular or Lymphatic System Invasion

https://www.breastcancer.org/symptoms/diagnosis/vasc_lymph_inv

The breast has a network of blood vessels (called the vascular system) and lymph channels (lymphatic system) that carry blood and fluid back and forth from your breast tissue to the rest of the body. They are the “highways” that bring in nourishment and remove used blood and the waste products of cell life.

Vascular or lymphatic system invasion happens when breast cancer cells break into the blood vessels or lymph channels. This increases the risk of the cancer traveling outside the breast or coming back in the future. Doctors can recommend treatments to help reduce this risk.

Your pathology report will say “present” if there is evidence of vascular or lymphatic system invasion. If there is no invasion, your report will say “absent.” Lymphatic invasion is different from lymph node involvement. The lymph channels and lymph nodes are part of the same system, but they are looked at and reported separately.

Vascular or Lymphatic Invasion


Pathology Report ThumbnailYour Guide to the Breast Cancer Pathology Report is an on-the-go reference booklet you can fill out with your doctor or nurse to keep track of the results of your pathology report. Order a free booklet by mail or download the PDF of the booklet to print it at home.

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Lymph Node Involvement

https://www.breastcancer.org/symptoms/diagnosis/lymph_nodes

Before or during surgery to remove an invasive breast cancer, your doctor removes one or some of the underarm lymph nodes so they can be examined under a microscope for cancer cells. The presence of cancer cells is known as lymph node involvement.

Lymph nodes are small, bean-shaped organs that act as filters along the lymph fluid channels. As lymph fluid leaves the breast and eventually goes back into the bloodstream, the lymph nodes try to catch and trap cancer cells before they reach other parts of the body. Having cancer cells in the lymph nodes under your arm suggests an increased risk of the cancer spreading.

When lymph nodes are free, or clear, of cancer, the test results are negative. If lymph nodes have some cancer cells in them, they are called positive. Your pathology report will tell you how many lymph nodes were removed, and of those, how many tested positive for the presence of cancer cells. For example, 0/3 means 3 nodes were removed and 0 were positive, while 2/5 means 5 were removed and 2 were positive.

Your results will also tell you how much cancer is in each node — ranging from a few tiny cells to many cells that can be seen easily. You might see this reported as:

  • Microscopic (or minimal): Only a few cancer cells are in the node. A microscope is needed to find them.
  • Gross (also called significant or macroscopic): There is a lot of cancer in the node. You can see or feel the cancer without a microscope.
  • Extracapsular extension: Cancer has spread outside the wall of the node.

The more lymph nodes that contain cancer cells, the more serious the cancer might be. So doctors use the number of involved lymph nodes to help make treatment decisions.


<img class="left" alt="Pathology Report Thumbnail" src="https://www.breastcancer.org/cms_files/24/Pathology_Report_Thumbnail.jpg"…

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Ploidy (Number of Chromosomes)

https://www.breastcancer.org/symptoms/diagnosis/ploidy

Ploidy is a measure of the number of chromosomes in a cell. Chromosomes are the threadlike structures that contain the genetic material known as DNA. As cells grow and divide to make new cells, chromosomes play a key role in making sure that DNA is copied and distributed correctly.

As part of your diagnosis, a pathologist may look at whether the cancer cells contain the normal amount of DNA. To do this, the pathologist looks at the number of chromosomes in the cancer cells and reports them as:

  • Diploid: This means that a proportion of cancer cells have the same number of chromosomes as normal, healthy cells (two sets of 23 each). They tend to be slower-growing, less aggressive cancers.
  • Aneuploid: This means that a proportion of cancer cells have too many or too few chromosomes. When cancer cells are rapidly dividing, mistakes in the distribution of chromosomes can happen, resulting in some cells having too many chromosomes and others too few. An aneuploid cancer may be more aggressive than a diploid cancer.

Although ploidy may provide you and your doctor with useful information, the test is considered optional and is not done routinely. Therefore, it’s possible that ploidy won’t be included in your pathology report. Experts don’t yet agree on how to use the results in the process of making treatment decisions.


Pathology Report ThumbnailYour Guide to the Breast Cancer Pathology Report is an on-the-go reference booklet you can fill out with your doctor or nurse to keep track of the results of your pathology report. Order a free booklet by mail or <a href="https://www.breastcancer.org/cms_fil…

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Tumor Genomic Assays

https://www.breastcancer.org/symptoms/diagnosis/genomic_assays

Tumor genomic assays (or tests) analyze a sample of a cancer tumor to see how active certain genes are. The activity level of these genes affects the behavior of the cancer, including how likely it is to grow and spread. Genomic tests are used to help make decisions about whether more treatments after surgery would be beneficial.

While their names sound similar, genomic testing and genetic testing are very different.

Genetic testing is done on a sample of your blood, saliva, or other tissue and can tell you if you have an abnormal change (also called a mutation) in a gene that is linked to a higher risk of breast cancer. See the Genetic Testing pages for more information.

There are several tests used to analyze the genes in a breast cancer to help predict whether the breast cancer will come back (recurrence). All of the tests can be done on a sample of preserved tissue that was removed from the breast during the original biopsy or surgery.

The differences between the tests are explained below. To learn about each in more detail, click the link for each test.

  • The Breast Cancer Index test analyzes the activity of seven genes to help predict the risk of node-negative, hormone-receptor-positive breast cancer coming back 5 to 10 years after diagnosis. The test can help women and their doctors decide if extending hormonal therapy 5 more years (for a total of 10 years of hormonal therapy) would be beneficial.

    The Breast Cancer Index reports two scores: how likely the cancer is to recur 5 to 10 years after diagnosis and how likely a woman is to benefit from taking hormonal therapy for a total of 10 years.

    The Breast Cancer Index test is not approved by the FDA but may be covered by some insurance compani…

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Your Diagnosis: Questions to Ask Your Doctor

https://www.breastcancer.org/symptoms/diagnosis/dr_questions

  • Is this breast cancer invasive, non-invasive, or both invasive and non-invasive?
  • Is the breast cancer more aggressive or less aggressive?
  • Are the surgical margins negative or positive?
  • Are there any cancer cells present in lymph channels or blood vessels?
  • What do the hormone receptor tests show? Am I a candidate for medicine that lowers or blocks the effects of estrogen?
  • Which of these HER2 tests was performed on the tissue? 
    • IHC (ImmunoHistoChemistry) test
    • FISH (Fluorescence In Situ Hybridization) test
    • SPoT-Light HER2 CISH (Subtraction Probe Technology Chromogenic In Situ Hybridization) test
    • Inform HER2 Dual ISH (Inform Dual In Situ Hybridization) test
  • Is the HER2 test positive, negative, or borderline? Am I a candidate for HER2-targeted therapy?
  • Is there cancer in any lymph nodes? If so, how many lymph nodes are involved?
  • Am I eligible for a genomic test?
  • If any of my test results were unclear, would you recommend testing the tissue again?
  • Is any further surgery recommended based on my results?
  • Which treatments are most likely to work for this specific cancer, based on my pathology report results?

Expert Quote

“The best patients are the worst patients. Nudge, nudge, nudge. Don’t sit back and accept anything that fails to satisfy you. Speak up, protect your interests.”

— Claire Fagin, Dean Emerita, University of Pennsylvania School of Nursing


Pathology Report ThumbnailYour Guide to the Breast Cancer Pathology Report is an on-the-go reference booklet you can fill out with yo…

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BRCA1 and BRCA2 Testing

https://www.breastcancer.org/symptoms/diagnosis/brca

Most people who develop breast cancer have no family history of the disease. However, if you do have a family history of breast cancer, ovarian cancer, or both, heredity could have played a role in the cancer’s development. Most inherited cases of breast cancer are associated with two abnormal genes: BRCA1 (BReast CAncer gene 1) or BRCA2 (BReast CAncer gene 2). Women who inherit a mutation, or abnormal change, in either of these genes — from their mothers or their fathers — have a much higher-than-average lifetime risk of developing breast cancer and ovarian cancer.

Genetic testing for BRCA1 and BRCA2 is NOT part of the standard pathology workup. Finding out whether you have an inherited gene abnormality requires a special test that uses a blood sample, not a tissue sample. If your doctor is concerned that you and your immediate relatives may have an inherited gene abnormality, he or she may recommend that you and other family members be tested.

According to the National Cancer Institute, women with an abnormal BRCA1 or BRCA2 gene have about a 60% risk of being diagnosed with breast cancer during their lifetimes (compared to 12-13% for women overall). These women’s risk of ovarian cancer is also increased. Abnormal BRCA1 or BRCA2 genes are found in 5-10% of all breast cancer cases in the United States. Other types of inherited gene abnormalities are less common.

Learn more about BRCA1 and BRCA2 (genetic) testing.

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