BREAST CANCER PATHOLOGY - Microsoft
BREAST CANCERPATHOLOGYFAC T SH EETVersion 2, July 2010This fact sheet was produced by Breast Cancer Network Australia with input from The Royal College of Pathologists of Australasia‘I’m a nurse and know medical terminology, butwhen diagnosed, there was heaps in my breastcancer pathology report that I didn’t understand –and it all sounded pretty scary’ Helen, SAIf you have been recently diagnosed with breast cancer,this fact sheet can provide information to help youunderstand your breast cancer pathology reports, andhow these may influence your treatment and care.If it has been some months or years since youcompleted your treatment for breast cancer, this factsheet can help you revisit your pathology reportsto understand them better. We have also includedinformation on accessing your pathology reports ifyou did not get copies of them at the time of yourtreatment.Please note that the information contained in this factsheet is of a general nature. For information specific toyour individual situation, you may like to speak to yourtreating doctor.What is pathology testing forbreast cancer?A pathologist is a doctor who looks at tissue to see if itis normal or affected by disease. Breast cancer pathologytesting is where cells (such as blood and tissue) areremoved from your breast by a surgeon, and examinedby the pathologist under a microscope. The pathologistwrites the results of this examination in a pathologyreport. The report is then sent to your surgeon and/oroncologist so he or she can discuss the results with you,and determine the best course of treatment for you.A pathologist works in a laboratory which may ormay not be located at the hospital where you hadyour treatment. When your tissue is sent to thelaboratory, parts of it are set into paraffin wax blocksand thin sections are taken and placed onto a slide forexamination by the pathologist. The remaining tissuein the paraffin block is kept in the laboratory so thatfurther samples can be taken if more tests are required.What sort of pathology reportswill be produced?There are two main types of pathology reports –an initial biopsy report, which confirms whether youhave cancer or not, and a breast cancer pathologyreport after surgery, which provides specificinformation about your breast cancer.Your pathology reports will usually be sent directlyto your surgeon and/or oncologist. Your doctors canprovide you with a copy of your pathology reports, ifyou would like them.Initial biopsy reportThe basic aim of a breast biopsy is to determine whetheror not a change in your breast is cancer. There areseveral types of biopsies that can be performed.Common biopsy procedures include a Fine NeedleAspiration (FNA), where a thin needle is passedthrough the skin to sample fluid or cells. Anothercommon procedure, a core biopsy, is wherean incision or puncture is made through the skinand several narrow samples of tissue are removed.Sometimes, a surgical biopsy may be performed.
B R EA ST C A N C ER PAT H OL OGYIf you would like more information about why theseprocedures were performed in your particular situation,you may like to ask your treating doctor. The resultsof your biopsy will usually be sent to the doctor whorequested your test one to three days after the biopsyprocedure has been performed.Pathology report after surgeryA breast cancer pathology report is produced afterthe surgery to remove your breast cancer. This reportprovides a lot of information about your breast cancer.It will show how big the cancer is, how fast the cellsare growing, whether there is cancer present in yourlymph nodes in the armpit, and whether there are anyhormone receptors on the cancer.What is in my pathology reportafter breast cancer?The format of your pathology report will vary fromlaboratory to laboratory. Each report may also varydepending on what type of tissue specimen wasprovided, for example whether you underwent a biopsy,or whether you had a mastectomy.The table on the opposite page outlines the type ofinformation that you may find in a ‘typical’ breast cancerpathology report following surgery.Your pathologist will send your pathology report to yoursurgeon and/or oncologist. If they are working as part ofa multidisciplinary team, it is likely your pathology reportwill be discussed by the team to determine the besttreatment options for you. Your surgeon or oncologistwill explain the results to you and discuss with you yourtreatment options.What sort of breast cancer do I have?Many people talk about having ‘breast cancer’, but infact there are many different types of breast cancer. Themain types of breast cancer include:Ductal Carcinoma In Situ (DCIS)A non-invasive breast cancer that is confined to theducts of the breast.The breast cancer pathology report after surgery isthe main tool used by your oncologist to plan yourtreatment. It is important to note that the pathologyreport does not predict whether your cancer willprogress, but it can provide an indication of how fastgrowing or aggressive your cancer might be, and howlikely or not it is to spread. This in turn will impact on thetype of treatment that is recommended for you.Preliminary pathology results from your surgery areusually sent to your surgeon and/or oncologist withintwo to four business days. However, further testingis often required, and so it may be up to two weeksbefore the final complete results are available.While waiting for test results can make many womenanxious, it is important to remember that having thefull complement of test results will help to plan thebest course of treatment for you.www.bcna.org.au 1800 500 258 (freecall)Lobular Carcinoma In Situ (LCIS)A non-invasive breast cancer that is confined to thelobules of the breast.Invasive breast cancer (early breast cancer)This can develop in the ducts or lobules of the breast.The cancer cells spread outside the ducts or lobulesinto the breast tissue and may form a lump. This isalso referred to as early breast cancer.Other less common forms of breast cancer includePaget’s disease of the nipple and inflammatory breastcancer. Locally advanced breast cancer is an invasivebreast cancer that has spread to other areas of thebreast such as the chest wall. Breast cancer that hasspread to other, more distant, parts of the body is oftenreferred to as secondary breast cancer.
CL I N ICBRAEAL TRIST ACLSA NC ER PAT H OL OGYWhat do all the ‘positives’ and‘negatives’ mean?There are lots of ‘positives’ and ‘negatives’ in breastcancer pathology reporting. This does NOT necessarilymean that something is good (positive) or bad (negative).Below is a chart of commonly used terms that refer topositives/negatives:The pathologyis ‘positive’This means that you have adiagnosis of breast cancer.OestrogenreceptorpositiveThis means that the growth of yourbreast cancer is affected by thehormone oestrogen.ProgesteronereceptorpositiveThis means that the growth of yourbreast cancer is affected by thehormone progesterone.HER2-positiveThis means that the breast cancercells have higher than normal levelsof a protein called HER2. TheHER2 protein affects how quicklycells divide in response to certaingrowth factors.Positivelymph nodeinvolvementThis means there are cancer cellsfound in the lymph nodes in yourarmpit (axilla) or near the breast.‘Triplenegative’breast cancerThis means that there are nooestrogen, progesterone, or HER2receptors which are influencingthe growth of your cancer. Aproportion of triple negative breastcancers can also be classified as‘basal-like’ cancers. These cancersmay require a different combinationof chemotherapy treatment.NegativemarginsThis means that the edge of thenormal tissue around the tumourremoved by your surgeon is freeof cancer cells. If the margins are‘positive’, this means that the edgeof the normal tissue around thetumour has cancer cells in it.www.bcna.org.au 1800 500 258 (freecall)What if I don’t understand mypathology report?‘My doctors were great and they probably told mea lot, but I wasn’t really listening. I didn’t even knowhow big the breast cancer was.’ Serafina, QLD.We know that many women only take in a small partof the discussion with their doctors about their testresults and treatment plans. It may help to take someonewith you to important consultations where tests andtreatment plans are discussed. It may also help to jotdown any questions as they occur to you for discussionat these consultations.‘I couldn’t tell you what grade my cancer was –my doctors certainly didn’t give me anything to takehome.’ Julie, TAS.Many women also tell us that they don’t rememberseeing their pathology report – either because theydidn’t ask for it, or the option was not made available tothem.You may like to ask your doctor for copies of yourpathology report and other tests. This can help you toask questions about your diagnosis that you may nothave thought to ask initially, as well as providing a recordfor future reference, should you need it later on.If in doubt about your pathology report, or if you havequestions about your particular situation, you may like todiscuss this with your surgeon or oncologist. If you arenot happy with the information that is being providedto you, or if you feel that your questions are not beinganswered, you may like to seek a second opinion. Thiswill not affect your treatment, and may help you to feelmore confident in your health care team, and the adviceyou’re being provided.You can store your test results in Breast CancerNetwork Australia’s My Journey Kit. You can also recordthe important parts of your pathology report in yourMy Journey Personal Record. Details for ordering this freepack are available at the end of this fact sheet.
B R EAST C A NC ER PAT H OL OGYWill the cancer come back?‘I really wanted to know its state of aggressiveness,and hence its likelihood of ‘doing a runner’.’Helen, SA.Women tell us that one of the first questions on theirminds is ‘How likely is it that this cancer will comeback?’ This is often referred to as a prognosis, which isa forecast about the likely course or outcome of thebreast cancer.However, everyone is different and there is noway of telling for sure if breast cancer will orwill not come back.How are treatment decisions made?‘With treatment, there is no ‘one-size-fits-all’formula. Treatments are tailored to women’sparticular circumstances.’ Heather, VIC.Many different factors are taken into consideration byyour doctors when they are determining the treatmentoptions for you. These include:– the type of cancer, the grade and the presence ofhormone receptors– whether you have a lower or higher risk cancer– your general health and age at the time of treatmentplanning.It’s important to remember, however, that every tumouris different. What may be suitable treatment for onewoman may not be suitable for another.If you are concerned or not clear about why a particulartreatment is being recommended for you, ask yourtreating doctor to explain. Once again, it can help towrite down questions as they occur to you, and takethese with you to the consultation. If you are concernedabout the advice provided, you might want to get asecond opinion.It is ok to take a week or two to be comfortable andconfident about your treatment options and decisions.This will not affect the outcome of your treatment.www.bcna.org.au 1800 500 258 (freecall)The likelihood of the cancer coming back or spreadingmay depend on a number of factors:– The amount of time the cancer has been there. Alot more cancers are being picked up early by breastscreening, which means that there is generally a betterprognosis overall, and that the cancers found tend tobe smaller.– The cancer biology, which is the makeup of thecancer. For example, the grade, presence ofoestrogen, progesterone, and HER2 receptors.Doctors use this information to get a sense of howlikely it is that the cancer will come back, and plan yourtreatment accordingly.More information on pathology reporting and on breastcancer treatments can be found in the National Breastand Ovarian Cancer Centre’s free Guide for Women withEarly Breast Cancer. Ordering details are available at theend of this fact sheet.
B R E A ST C A N C ER PAT H OL OGYA ‘typical’ pathology report after breast cancerSection of ReportDescriptionMacroscopicDescriptionThis is what the pathologist sees by looking at the tissue sample with the naked eye.It also describes what sort of tissue was provided by the surgeon (for example, tissuefrom a core biopsy, a mastectomy, or lymph nodes).MicroscopicExaminationThis is what the pathologist records after looking at sections of your tissue under amicroscope. It is a summary of all the important information needed by your treatingdoctors.The location – where the cancer is in the breast.The ‘Stage’ of the breast cancer – this is determined by the results of yourpathology tests. Breast cancer ranges from Stage 1 (low-grade early breast cancer)through to Stage IV (secondary breast cancer, where the cancer has spread to moredistant parts of the body). The Stage will depend on the size of the tumour, whetherthe cancer is invasive or non-invasive, whether lymph nodes are involved, and whetherthe cancer has spread beyond the breast.The grade – this indicates the patterns of the cancer cell growth and how fast thecancer cells are growing. The grade is numbered from 1 to 3:– Grade 1 (Low Grade or Well Differentiated) cancer cells still look a lot like normalcells. They are usually slow growing.– Grade 2 (Intermediate/Moderate Grade or Moderately Differentiated) cancer cells donot look like normal cells. They are growing somewhat faster than normal cells.– Grade 3 (High Grade or Poorly Differentiated) cancer cells do not look at all likenormal cells. This means the cells are growing more quickly.Whether the margin is clear – the surgeon will remove your breast cancer, andsome healthy looking tissue around it, to ensure that the cancer is completely removedfrom the breast. The healthy looking tissue is called the surgical margin. If the edge of thesurgical margin is not ‘clear’ of breast cancer cells, you may need to have more surgery.Lymph nodes - the report shows whether there are cancer cells in the lymph nodesin your armpit (axilla) or near your breast.Hormone receptors – the report shows whether hormone receptors are presenton your breast cancer. This will affect whether hormonal therapies are recommendedfor you. There are two types of hormone receptors – oestrogen (ER) and progesterone(PR) receptors.HER2 status – the report shows whether there are HER2 receptors on your breastcancer. HER2 is a protein on a cell that allows growth factors to bind to the cell, causingthe cell to divide. HER2 is also called HER2-neu or c-erbB2. If you have these receptors,you may have particular treatments recommended for you, such as HerceptinSummary anddiagnosisThis is a summary of the above information, as well as a diagnosis. For example,‘Invasive carcinoma of no special type, grade 2, 17mm diameter, clear surgical margins,with no evidence of axillary lymph node involvement.’www.bcna.org.au 1800 500 258 (freecall)
B R EA ST C A N C ER PAT H OL OGYHow can I access my pathologyreports months or years aftertreatment?‘I asked for all my results from the clinical recordspart of my hospital. I’ve photocopied them andgiven them to my kids – I want them to havecopies should anything happen to them down thetrack.’ Serafina, QLD.You can ask your surgeon, oncologist or hospital staffabout getting copies of your pathology reports, evenmonths or years after your breast cancer treatment.These may be kept in your file in the clinical recordsdepartment of the hospital, or they may be availablefrom the pathology laboratory that ran the tests. Itmay take a bit of work to find these, particularly if theywere a long time ago, or if the pathology laboratory hasmerged with another laboratory.More informationBreast Cancer Network AustraliaA glossary of pathology terms and information onbreast cancer tissue banks is available on our geryor by phoning us on 1800 500 258 (freecall).National Breast and Ovarian Cancer CentreGuide for Women with Early Breast Cancer (2008).To order your copy, visit www.nbocc.org.au orphone 1800 624 973.Lab Tests OnlineThis US website has been designed to help peoplebetter understand the many clinical lab tests that arepart of the diagnosis and treatment of a broad range ofdiseases, including breast cancer. Some tests may not beavailable in Australia, and some tests may differ slightly.For more information about pathology tests visitwww.labtestsonline.org.What happens to my breastcancer tissue?About usPreservation and storageBCNA is the peak national organisation for Australianspersonally affected by breast cancer. We provide arange of free resources for women with breast cancer,including the My Journey Kit for women with early breastcancer and the Hope & Hurdles Pack for women withsecondary breast cancer. BCNA’s free quarterlyThe Beacon magazine includes stories from women withbreast cancer, as well as information on a wide range ofbreast cancer issues.After your surgery, portions of your breast cancertissue are preserved in a paraffin wax block. The blockis identified with your details and is used to preparesections on glass slides for the pathologist. Multiple testscan be done using this same paraffin block, even manyyears following your diagnosis. This paraffin block iskept by the lab where your tissue sample was originallytested. In some cases the laboratory stores these paraffinblocks off site in a storage facility because of space issuesin the laboratory itself.Should your doctor want to access your paraffin blockin the future for further testing, he or she can do thisusing the identifying information contained in yourpathology report.Compiled by Breast CancerNetwork Australia. BCNA 2007 –Version 2, July 2010Readers are welcome to reprintas long as BCNA is fullyacknowledged as the source.www.bcna.org.au 1800 500 258 (freecall)Breast Cancer Network Australia (BCNA)More information about BCNA and our resources isavailable at www.bcna.org.au or by phoning us on1800 500 258 (freecall).The Royal College of Pathologists of Australasia(RCPA)The RCPA is responsible for the training and professionaldevelopment of pathologists. Its mission is to improvethe use of pathology testing to achieve better healthcare. For more information, visit www.rcpa.edu.au orphone (02) 8356 5858.BCNA acknowledges the contribution of the Royal College of Pathologistsof Australasia in the development of this fact sheet.
hormone receptors on the cancer. The breast cancer pathology report after surgery is the main tool used by your oncologist to plan your treatment. It is important to note that the pathology . This will not affect the outcome of your treatment. BREAST CANCER PATHOLOGY
4 Breast cancer Breast cancer: A summary of key information Introduction to breast cancer Breast cancer arises from cells in the breast that have grown abnormally and multiplied to form a lump or tumour. The earliest stage of breast cancer is non-invasive disease (Stage 0), which is contained within the ducts or lobules of the breast and has not spread into the healthy breast tissue .
Breast cancer development In the United States, breast cancer is the most common cancer diagnosed in women (excluding skin cancer). Men may also develop breast cancer, but less than 1% of all people with breast cancer are men. Breast cancer begins when healthy cells in the breast change and grow uncontrollably, forming a mass called a tumor.
breast cancer, metastases, advanced breast cancer, secondary tumours, secondaries or stage 4 breast cancer. For most people with secondary breast cancer in the brain, breast cancer has already spread to another part of the body such as the bones, liver or lungs. However, for some people, the brain may be the only area of secondary breast cancer.
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cancer amongst breast cancer survivors is a metachro-nous contralateral breast cancer[7].Factors associated with an increased risk of a second breast cancer include an initial diagnosis of DCIS, stage IIB, hormone receptor negative cancers, and young age[8]. Breast pathology Proliferative breast disease is associated with an increased
5 yrs of anti-hormone therapy reduces the risk of: – breast cancer coming back somewhere else in the body (metastases / secondaries) – breast cancer returning in the same breast – a new breast cancer in the opposite breast – death from breast cancer The benefits of anti-hormone therapy last well
Breast Cancer Breast cancer is one of the most common forms of cancer among women (40,290 in 2015). It is second only to lung cancer as a cause of cancer deaths in American women, One-third of women with breast cancer die from breast cancer, One out of every eight women will be
the adoption and adaptation of agile software development practices. This model was found especially useful when the project context departs significantly from the “agile sweet spot”, i.e., the ideal conditions in which agile software development practices originated from, and where they are most likely to succeed, “out of the box”. This is the case for large systems, distributed .
