Reading your pathology report

Your summary

The first question, what the biopsy found, was left blank, so there is nothing to summarize yet. Choose Change my answers to go back to it.

You are waiting for a biopsy result. The first answer, whether the tissue is benign or cancer, usually arrives within a few business days. If it is cancer, the receptor tests take about another week, and the office will call you as results come in rather than waiting for all of them. Most breast biopsies come back benign.

While you wait, the benign, DCIS, and invasive pages describe each kind of result, so that whichever call comes, the words in it will already be familiar.

Your biopsy did not find cancer. Depending on the exact finding, the next step is either nothing further, a follow-up picture in six months, removing the area with a small operation, or a plan for closer monitoring because the finding raises your future risk. The benign and high-risk page explains which findings lead to which.

Your report says DCIS, ductal carcinoma in situ. This is stage 0. The abnormal cells are inside the milk ducts and have not grown out into the surrounding breast tissue, which means DCIS cannot spread to other parts of the body while it stays that way. It is treated to keep it from becoming an invasive cancer later.

Treatment is surgery, either a lumpectomy, which is usually followed by radiation, or a mastectomy. Chemotherapy is not used for DCIS.

Your DCIS is estrogen receptor positive. That means a daily anti-estrogen pill for several years may be offered after surgery to lower the chance of a new problem in either breast. It is a choice to discuss rather than a requirement.

Your DCIS is estrogen receptor negative, so anti-estrogen pills would not help and will not be part of the plan.

High-grade DCIS is more likely to be treated with radiation after a lumpectomy and is more likely to be found alongside a small invasive cancer at surgery, which is one reason the final report after the operation can differ from the biopsy.

Low-grade DCIS grows slowly. For some people with small, low-grade DCIS, radiation after a lumpectomy adds little, and that is a conversation worth having.

Read the DCIS page for what the appointment usually covers.

Your report says invasive breast cancer. The cells have grown out of the duct or lobule where they started into the breast tissue around them. Invasive does not mean it has spread anywhere else; it means it has the ability to, which is why the lymph nodes are checked and why medicine is often part of the plan alongside surgery.

The type is ductal, also written as no special type. This is the most common kind of breast cancer, and most of what is written about breast cancer treatment is written about it.

The type is lobular. Lobular cancers grow as single cells in lines rather than as a firm lump, which makes them harder to feel and harder to see on a mammogram. Their true size is often larger than the pictures suggest, so a breast MRI is often added before surgery. Most lobular cancers are hormone receptor positive. The lobular page has more.

The type is one of the less common patterns, or a mix. Several of the rarer types, such as tubular and mucinous, tend to behave more gently than average. Ask which type you have and whether it changes anything.

Your cancer is hormone receptor positive and HER2 negative. This is the most common combination. It grows in response to estrogen, so a daily anti-estrogen pill, taken for five to ten years after surgery, is the backbone of treatment. Surgery usually comes first. Whether chemotherapy would add anything is often decided with a test run on the tumor itself, such as Oncotype DX, rather than assumed. The hormone receptor positive page walks through it.

Your report also calls it HER2 low. That does not change the first steps. It matters mainly because a newer class of medicines can be used for HER2-low cancers if they ever come back, so it is worth having on the record.

Your cancer is hormone receptor positive and HER2 positive, sometimes called triple positive. It responds to two different kinds of treatment: medicines that block HER2, and anti-estrogen pills. HER2-targeted medicine is usually given together with chemotherapy, and for many people that combination comes before surgery so that the operation can be smaller and the team can see how well the cancer responds. The HER2 positive page walks through it.

Your cancer is HER2 positive and hormone receptor negative. The HER2 protein is what drives it, and medicines that block HER2 work well against it. They are given together with chemotherapy, usually before surgery when the cancer is larger than about 2 cm or has reached a lymph node. Anti-estrogen pills are not part of the plan because the cancer does not respond to estrogen. The HER2 positive page walks through it.

Your cancer is triple negative, meaning negative for estrogen receptor, progesterone receptor, and HER2. There is no hormone or HER2 switch to turn off, so chemotherapy does the work that those medicines do in other types, and it is usually given before surgery. For cancers that are larger than 2 cm or have reached a node, an immunotherapy medicine is usually added. Genetic testing for inherited gene changes is recommended for everyone with triple negative breast cancer. The triple negative page walks through it.

Your report calls it HER2 low. For triple negative cancer that does not change the first steps. It matters mainly because a newer class of medicines can be used for HER2-low cancers if the cancer ever returns.

Your estrogen receptor result is not back yet, or not on the report you have. It is the single most important test for deciding what medicine will be part of your plan, and it is worth asking when it will be ready.

Your HER2 result is not back yet. It decides whether HER2-targeted medicine is part of the plan, and for some people it changes whether surgery or medicine comes first. It is usually the last receptor result to arrive.

Grade 1 means the cells look close to normal and tend to grow slowly.

Grade 2 is in the middle: the cells look moderately different from normal.

Grade 3 means the cells look very different from normal and tend to grow faster. Grade on its own does not decide treatment, but a higher grade makes chemotherapy more likely to be discussed.

At 2 cm or smaller the cancer is on the small end, which usually means a lumpectomy is possible and, if the nodes are clear, this is stage 1.

Between 2 and 5 cm the cancer is medium sized. A lumpectomy is often still possible, depending on breast size, and for HER2 positive and triple negative cancers this size is usually a reason to give medicine before surgery.

Larger than 5 cm, or involving the skin, is usually a reason to give medicine before surgery to shrink it, whatever the receptor type. This is described in the stage 3 page.

Nothing suspicious was seen in the lymph nodes. The nodes are still checked at surgery with a sentinel node biopsy, which removes only the first one to three nodes the breast drains to.

A lymph node looked abnormal or was found to have cancer in it. That puts the cancer at stage 2 or higher and usually means medicine is part of the plan. For HER2 positive and triple negative cancers, and for some hormone receptor positive ones, it is a reason to give that medicine before surgery, which can reduce how many nodes need to be removed. Read the stage 3 page on treatment before surgery.

Genetic testing for inherited gene changes is offered to many people with a new diagnosis, not only those with a family history. Ask whether you qualify. The result can affect surgical choices, so it is best done early.

The final stage is set after surgery, from the actual size and the actual nodes, and it can differ from what imaging suggested. That is expected.