Thursday, February 02, 2012 Beachmist asks

Q: Nottingham grade 3 score 9 and cancer cells in the lymph nodes.

Hello!

I'm 37 years old and I've just been diagnosed with breast cancer. I found a lump in my right breast that was removed. I had sectional mastectomy and sentinel lymph node biopsy done 3 weeks ago and I've just been back to the hospital to see the surgeon and to get my pathology report.

The surgeon just said that the tumor was removed successfully and that I will not have more surgery but probably have chemo, radiation and hormonal therapy. He didn't want to answer my questions about the pathology report and just kept saying that it was not important for me to understand the details and that I should just concentrate on preparing for the treatments.

But I do want to know! I want to know how bad it is and I want to know my chances of surviving. Could you please help me understand my pathology report! I read your "Guide to Understanding Your Pathology Report" but I can't find all the answers there. I live in Europe and maybe the reports are written a little bit different here even if they are in English.

My report says Nottingham grade 3 score 9 and that there are cancer cells in the lymph nodes. As I understand this is not good at all? And the "comedo necrosis", how is that affecting the overall result? And the "in situ" component, how is that affection the result?

What are my chances of surviving this, are there any statistics based on my results?

Thank you for your help!

MICROSCOPIC DESCRIPTION
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Type of tumor: invasive ductal cancer

In situ component: present in the area/in the relation to the invasive cancer
Tumor size/distribution: 20*18 mm
Tumor grade (Nottingham): Grade III (tubulus: 3, nuclear: 3, mitosis: 3)
DCIS-grade: Grade III (with comedo necrosis)
Radicality assessment, nearest RR: radical excision, 18 mm from the lateral RR
Deep (pectoral) RR: 3 mm
Vascular invasion: not present

SENTINEL LYMPH NODE BIOPSY
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5 lymph nodes removed/analyzed during surgery: no malignancy
Laboratory analysis - supplementary opinion: further immunostaining of lymph node A, B and C done. In the peripheral sinus of lymph node B there is an area with less than 100 isolated tumor cells. In the peripheral sinus of lymph node C there is an area with less than 12 isolated tumor cells.

IMMUNHISTOCHEMICAL PANEL
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Oestrogen receptor: 90% positive tumorcells (strong)
Progesteron receptor: 65% positive tumorcells (mild-moderate)
Proliferation, MIB-1: 50% positive tumorcells
Her2-status: negative

PAD DIAGNOSIS
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Right sector excision with NGH III invasive ductal cancer, radical excision.

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Answers (1)

PJ Hamel, Health Guide

2/ 2/12 7:28pm

Hi - I'm not surprised your surgeon doesn't want to discuss your pathology report - that's the oncologist's job, and surgeon's usually stay away from anything beyond their surgery. So don't read anything negative into the surgeon's reluctance to talk, OK?

The bad news is, you're fairly young to be diagnosed with cancer; and your cancer is aggressive. The good news is, you have no lymph node involvement, beyond a tiny amount of microscopic involvement, which won't affect your prognosis; and your tumor is small. Also, comedo necrosis is simply a term for dead cells - cells that have been killed by the cancer. Very common, and nothing in particular to worry about.

With your surgery, radiation is pretty much a given; as is hormonal therapy. Chemo would be the treatment that might be in question. If you're able to have the Oncotype-DX test, it would show how much chemo would help you, if you chose to have it; ask your oncologist if it's an option for you.

Bottom line, you have hormone-receptive IDC (invasive ductal carcinoma), which is the most common type of breast cancer; and DCIS (ductal carcinoma in situ), a type of "pre-cancer," and also a very common diagnosis. This is good; doctors have lots of experience treating these types of cancer. Given your diganosis, statistically speaking, your 5-year survival rate (with appropriate treatment) would be probably in the 90% range - e.g., there's a 90% chance you'll be alive in 5 years. And once you make it 5 years, the odds get even better that you'll survive breast cancer, and die of some other cause.

So, although it would be nice if your cancer weren't so aggressive, overall this is a "good" diagnosis, and should be very treatable. I realize it's all pretty shocking and scary right now; but gradually, you'll absorb the fact that you have cancer, you'll kick yourself into gear, and start the treatment journey. You can get through this - millions of us have. And you'll take strength from every woman that's been down this path before you.

Please come back here anytime you have questions, or need some support - we're here for you. PJH

Q: Nottingham grade 3 score 9 and cancer cells in the lymph nodes.

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