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cancer treatment - pathology

what the pathology report means

Your doctor will go through your pathology report in detail with you. This section will act as a reminder if you need it.
The report below is an example of the type of report you will have received. This is the 'microscopy' section, which contains most of the important information.
Microscopy.
    - Invasive Carcinoma
    - Histological Type: Infiltrating duct, no special type
    - Tumour size:     21 mm
    - Histological Grade:    2
    - Tubule Formation - score:3
    - Nuclear Atypia - score:2
    Mitotic Index - score:1
    Peritumoral lymphovascular Invasion:  Present
    Prognostic Markers: ER:   Positive (H-score=200)
    PR:   Positive (H-score=195)
     c-erbB-2  Negative (Staining =0)
    In-situ Carcinoma
    Ductal Carcinoma In-situ:   Present
    Histological grade:   Intermediate
    Architecture:    Comedo
    Necrosis:    Present
    Calcifications:    Present
    EIC:     Negative
    Lobular Carcinoma In-situ:   Absent
    Margins
    Status:      Clear
    Distance from closest margin:   Invasive - 12 mm deep
    In-situ – 5mm superficial, 10mm inferior
    Surrounding Tissue
    Proliferative fibrocystic change an d atypical ductal hyperplasia
    21MM GRADE 2 INFILTRATING DUCT CARCINOMA
    PERITUMORAL LYMPHOVASCULAR SPACE INVASION SEEN
    ER/PR BOTH POSITIVE
    C-ERBB-2 NEGATIVE
    INTERMEDIATE GRADE DCIS
    EIC NEGATIVE
    MARGINS CLEAR

We can look at each part of this report in turn.
Invasive Carcinoma
    - Histological Type: Infiltrating duct, no special type
    - Tumour size:     21 mm
    - Histological Grade:    2
    - Tubule Formation - score:3
    - Nuclear Atypia - score:2
    - Mitotic Index - score:1
    - Peritumoral lymphovascular Invasion:  Present
    - Prognostic Markers: ER:   Positive (H-score=200)
    - PR:   Positive (H-score=195)
    - c-erbB-2  Negative (Staining =0)
This part describes the invasive tumour which is present. The ‘histological type’ tells us what type of cancer it is (eg ductal or lobular). If the cancer is of a special type, it will be described here.
The size of the tumour is also given. The largest dimension given is the important one.
The ‘histological grade’ is a measure of how normal or abnormal the cells look under the microscope. Tumours are graded 1 to 3. Grade 1 tumour cells look most like normal breast cells, and the tumours tend to grow more slowly and spread late. Grade 3 tumour cells look much more abnormal. Grade 3 tumours may be faster growing and more likely to spread. The grade is worked out by looking at 3 characteristics of cell, and scoring each one.

'Peritumoural  lymphovascular invasion' describes whether tumour cells can be seen inside lymph or blood vessels close to the tumour. This is an indication that the tumour has invaded into the vessels and has the potential to spread.

The 'prognostic markers' are receptors which the pathologist looks for on the cell surface using special stains. ER stands for ‘oEstrogen Receptor’ and PR for ‘Progestogen Receptor’. If these are positive, it means that the cells are using the oestrogen and progestogen hormones to help it grow. Having these receptors generally means that the tumour is likely to behave better. If the ER is positive, it also means that the tumour can be treated with a hormone treatment (Tamoxifen or Arimidex).

'C-erbB-2' is also known as HER2. If this receptor is positive, the tumour is generally less well behaved. If this receptor is positive, your doctor may discuss treatment with Herceptin.

In-situ Carcinoma
     - Ductal Carcinoma In-situ:   Present
     - Histological grade:   Intermediate
     - Architecture:    Comedo
     - Necrosis:    Present
     - Calcifications:    Present
     - EIC:     Negative
     - Lobular Carcinoma In-situ:   Absent

This section describes any in-situ disease found. This may be mixed in with the main tumour, next to it, or in a completely different part of the breast. Sometimes the size is also given. Ductal carcinoma in situ (DCIS) is divided into low, intermediate or high grades. It can grow in a variety of patterns (‘architecture’) and may be associated with 'necrosis' (dead or dying cells in the middle of a clump) or calcifications. Calcifications may have been seen on your mammogram.

'EIC' stands for Extensive Intraduct Component. This means that a large amount of DCIS is associated with the invasive tumour. This may mean that the tumour is more likely to recur in the same place, and your doctor may recommend further surgery to improve margins or radiotherapy.

'Lobular carcinoma in-situ' (LCIS), despite its name, is not a type of cancer. It is however a marker that there is cellular activity in the breast, and that a cancer may develop later. It does not have any significance where there is a known cancer.

    Margins
    Status:      Clear
    Distance from closest margin:   Invasive - 12 mm deep
          In-situ – 5mm superficial, 10mm inferior

The 'margins' are the amount of normal tissue between the tumour and the edge of the removed tissue. A margin of 2mm is normally sufficient, and a smaller margin is often acceptable.

Surrounding Tissue
Proliferative fibrocystic change and atypical ductal hyperplasia
 
The 'surrounding tissue' is the rest of the removed tissue. Random blocks are looked at to be sure that no further cancer is missed.

21MM GRADE 2 INFILTRATING DUCT CARCINOMA
    PERITUMORAL LYMPHOVASCULAR SPACE INVASION SEEN
    ER/PR BOTH POSITIVE
    C-ERBB-2 NEGATIVE
    INTERMEDIATE GRADE DCIS
    EIC NEGATIVE
    MARGINS CLEAR

This is simply a summary of the information in the report.