What does it mean when my path report says carcinoma or adenocarcinoma?
A carcinoma is a cancer that originates in the lining layer (epithelial cells) of organs like the breast. Nearly all breast cancers are carcinomas. Most are the type of carcinoma that starts in glandular tissue called adenocarcinoma.
What does invasive mean?
The normal breast is made of ducts that end in a group sacs (lobules). Cancer starts in the cells lining the ducts and lobules, when a normal cell becomes a carcinoma cell. Invasive breast cancer is cancer that has broken through the wall (basement membrane) of either a duct or a lobule. The most common form of breast cancer is invasive ductal carcinoma or a cancer that began in a duct and has spread outside the duct. Noninvasive breast cancer is referred to as in situ because it remains in the duct or the lobule. It is considered Stage 0.
What does it mean if my carcinoma is well differentiated, moderately differentiated, or poorly differentiated?
The pathologist looks under the microscope to predict how likely the cancer is to grow and spread. Certain features are able to determine the prognosis of the cancer. Underneath the microscope pathologist look at the cell arrangement.
Well-differentiated carcinomas have relatively normal-looking cells that do not appear to be growing rapidly and are arranged in small tubules for ductal cancer and cords in lobular cancer. These cancers tend to grow and spread slowly and so have a better prognosis (outlook).
Poorly differentiated carcinomas lack normal features, tend to grow and spread faster, and have a worse prognosis. Moderately differentiated carcinomas have features and prognosis in-between these two.
What does Lymphovascular Invasion Mean?
This is the penetration of cancerous cells (often seen as small clusters under the microscope) into the interior of blood vessels and/or lymph channels. Lymphovascular invasion may indicate a more aggressive tumor.
What does grade mean?
This measure is often reported using some version of the Bloom Richardson or the carff-Bloom-Richardson scale. It is based on a combined score for nuclear grade, mitotic rate, and histologic grade or architectural differentiation. Each characteristic is given a score of 1 to 3, resulting in a total score ranging from 3 to 9.
Nuclear grade is assessed on a scale of 1-3. A grade I (low) indicates small nuclei with little variation in size and shape. A grade 3 (high) indicates larger nuclei with marked variation in size and shape. Grade 2 (intermediate) nuclei show features between 1 and 3. The higher the grade is, the more aggressive the tumor.
This rate indicates the number of malignant cells that are actively dividing. The mitotic rate is reported with numbers from 1 to 3. The higher the score the more aggressive the tumor cells.
This measure is based on how close the specimen resembles normal breast tissue. This measure refers to tubular formation of the cells. A grade of 1 indicates a well-differentiated tissue with many tubules, grade 2 moderately differentiated, and grade 3 poorly differentiated tissue with few or no tubules.
What hormones make my cancer grow?
Hormone Receptor Status
If your cancer cells have a high proportion of estrogen (ER) or progesterone (PR) receptors, the report will say you are ER positive or PR positive. If your cells have a lower number of receptors, your report will say you are ER or PR negative. Another way to think of this is a car (tumor) and driver (hormones) example. The hormone “buckles” itself into the car seat (receptor) to drive the tumor to make it grow. This is one of the most important pieces of information on the pathology report. Being ER/PR positive means you might benefit from hormonal therapy. Hormone therapy is actually therapy with an oral drug, usually Tamoxifen or aromatase inhibiters, which blocks hormone receptors in the cancer cell.