Demystifying a Breast Cancer Diagnosis

A diagnosis of cancer can feel overwhelming. Understanding terms like stage, grade, and surgical margins requires you to learn a new language overnight. But it is time well spent. To make the most informed decisions about treatment it is important to understand your diagnosis. In order to help interpret your biopsy report, scans and cancer type, I am pleased to post this informative article by naturopathic oncologist Dr. Katherine Neubauer of Survive and Thrive Cancer Care, a national integrative oncology consulting practice.

Breast Cancer Overview

A new breast cancer diagnosis brings a lot of information. The good news is that the prognosis is good when breast cancer is caught early. For advanced breast cancers, there are still many good treatment options.

When making treatment decisions, it is important to know your breast cancer type. Some breast cancers respond to hormone therapy, while others don’t. Chemotherapy is beneficial for some tumors and not others.

It’s also helpful to develop an overall approach before beginning treatment. For example, some types of surgery need subsequent radiation, while others don’t. And, the timing of breast reconstruction is affected by whether you need radiation.

How do I know my breast cancer type?

There are a few key pieces of information to review in your biopsy, scans, and blood tests:

Kind of breast cancer Invasive ductal carcinoma is the most common type. Others include lobular carcinoma and inflammatory carcinoma. Ductal carcinoma in situ (DCIS) is a precancerous condition.

Tumor’s response to hormones For example, a tumor can be “ER positive” if it uses estrogen to grow, or “ER negative if it is not sensitive to estrogen. ER-positive tumors can respond to hormonal therapies like Tamoxifen, while ER-negative tumors do not.

Genetic studies These tell us how aggressive the tumor is likely to be. Her-2 positive tumors are more aggressive than Her-2 negative tumors. However, Her-2 positive tumors can respond to the drug Herceptin. Ki-67 indicates how quickly the tumor cells are growing. BRCA mutation indicates aggressiveness. BRCA mutations increase the risk for other kinds of cancer and the gene is inherited, so this may also guide health care for you and your family.

Tumor grade tells us how similar the tumor is to normal breast cells. It is a good thing if the tumor is “high grade” or “well differentiated”. This means that the tumor is more similar to normal cells, and is less likely to grow or spread. Tumors that are “poorly differentiated” or “anaplastic” may need more thorough care.

Tumor stage explains where the tumor is in the body, as well as how large it is. Stage is expressed as a number between 1 and 4. 1 is a small tumor that is only in the breast. 2 and 3 are tumors that are larger or have spread to nearby tissues. 4 is a tumor that has spread to other organs. Stage is often written as a Roman numeral, from I to IV.

Surgical margins If you’ve had a mastectomy or lumpectomy, the pathology report will specify the size of the surgical margins. To reduce the risk of leaving tumor cells behind, the surgeon tries to cut out a border of healthy tissue from around the tumor. This healthy tissue is the surgical margin. While the surgeon makes every effort to get a good margin, the pathologist may later find microscopic tumor cells that were invisible to the surgeon. This is an “involved margin”. If you have a poor or involved margin, it may be wise to get radiation and additional surgery.

Oncotype Dx Score some tumors clearly benefit from chemotherapy. For others, the decision is less clear. This test can be done on a sample of your tumor tissue from a lumpectomy or mastectomy. The results can tell you how beneficial chemotherapy would be.