Meet our Medical Experts »“Pathology reports often come in bits and pieces. Just after surgery, the cancer cells are first looked at under the microscope. Results from additional studies that require special techniques may take longer. So you may have one, two, or three pathology reports from one surgery. Try to put them all together and keep them in one place, so that when you go for your treatment evaluations, the doctors will have all the information they need. ”
Marisa Weiss M.D., president and founder, breast radiation oncologist, Philadelphia, PA
Whenever tissue is removed from the body to check for cancer, a report is written, called the pathology report. Each report has the results of lab tests that were done on your tissue. The information in these reports will help you and your doctor decide which treatments are best for you. Your pathology report answers the following questions:
Most breast cancers in men are ductal carcinomas. Ductal means the cancer started in the milk pipes of the breast, called ducts. These cancers are usually invasive because they start inside the duct and then break through the wall of the duct, growing into the normal surrounding breast tissue. Non-invasive breast cancers, called DCIS (ductal carcinoma in situ), are uncommon in men. These cancers start and stay inside the milk ducts. Men rarely get lobular breast cancer (the kind of cancer that starts in the lobules where milk is made) because lobules are not fully formed in male breast tissue.
The stage of the cancer tells the doctor the extent of the cancer in the breast and how far the cancer might have spread. Several tests, procedures, and reports help determine the stage of the cancer. The pathology report gives information about the size of the cancer and whether it involves the skin in front of the breast or the muscles and chest wall behind it. The report also indicates whether the lymph nodes have any cancer cells in them and how many lymph nodes are involved. In addition, the report may say whether the cancer is contained within the lymph node or if there is any cancer extension from the lymph node, through the node's outer capsule and into the tissue outside the node (when this happens, it's called extracapsular extension).
Stages of breast cancer are:
Your doctor may order additional tests to see if the cancer has spread to other parts of the body (such as the liver, lung, brain, or bones). These tests include:
Whether your doctor orders these tests depends on a number of factors, including:
The pathologist will look at the tumor under a microscope to compare the appearance of the cancer cells to the normal cells nearby. How similar or different the cancer cells are relative to normal cells is called the grade of the tumor. Grade 1 cancers look similar to normal cells and grow the slowest. Grade 3 cancers look more disorganized and irregular than normal cells and grow the fastest. But even though Grade 3 cancers can act more aggressively, they are more easily killed off by chemotherapy and radiation.
The size of the tumor is important in helping to decide on treatment. It is also used to help determine the stage of the cancer. However, size doesn't tell the whole story. Lymph node status is also important. A small cancer can be very fast-growing. A larger cancer can be a "gentle giant."
Some breast cancers spread to the lymph nodes under the arm. When the lymph nodes are involved in the cancer, they are called positive. When lymph nodes are free or "clear" of cancer, they are called negative. Your doctors will examine samples from your lymph nodes under a microscope to determine whether any cancer cells have spread there.
In large medical studies, there seems to be a connection between the number of lymph nodes involved and how aggressive a cancer will be. Knowing how many of your lymph nodes are affected by cancer will help you and your doctor find the appropriate treatment to fight the cancer.
Doctors think in terms of three types of lymph node involvement when they look at an individual node:
In both men and women, the more extensive the lymph node involvement, the more aggressive the cancer usually is. But the extent of disease within a particular lymph node is less important than the total number of lymph nodes affected. The more lymph nodes involved, the more serious the cancer diagnosis can be.
A hormone receptor test is done on the cancer cells to see if they are sensitive to the hormones estrogen and progesterone. When estrogen shows up and sits on the estrogen receptors, cell growth is turned on. Most breast cancers in men have estrogen and progesterone receptors. If the receptors are present, the test will read "positive," and if the receptors are absent, the report will say "negative." Positive hormone receptors can mean a better prognosis and a potential role for anti-estrogen hormonal therapy.
The cancer tissue that's removed is tested for high levels of the HER2 gene or protein. HER2 is a gene that helps control how cells grow, divide, and repair themselves. The HER2 gene directs the production of special proteins, called HER2 receptors, in cancer cells. When levels of the HER2 gene or protein are high, the cancer is called HER2-positive (less than 25% of breast cancers are HER2-positive). Cancers that are HER2-positive tend to be more aggressive. But a targeted therapy called Herceptin (chemical name: trastuzumab) works well against these kinds of cancers.
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