Understanding my Pathology report

Hello everyone, this is my first post here and I am hoping I can find someone knowledgeable to help me understand my path report. I don’t have any medical training although my Mum is a doctor (although she worked mostly in child health in the community) and I have picked up odd bits and pieces - as you do during 43 years of living.

I was given my breast cancer diagnosis, following a needle biopsy of a lump that I found. As I am sure other people have found, I was somewhat dazed by the whole thing so did ask some questions but not everything. I rang the hospital after a few days to ask them to send me my pathology report - so I could understand more. I’ve been trying to read it this morning but don’t understand it fully and when I tried looking things up on the internet - scared myself silly. I need to understand though.

This is what it says, with my understand in brackets:

Clinical: 2.4cm smooth partially solid/cystic mass ?nature ??phyllodes (there were two parts to the lump, a fluid filled (cystic) part and the solid part - the biopsy was of the solid part. I assume the question marks indicate that there are unknowns - which is why the biopsy was required. When I went for the results, the surgeon examined me and found the lump had grown to 4cm).

This is a grade 3 invasive carcinoma (T3, N3, M3) with a solid and focally spindle celled morphology with an associated lymphocytic infiltrate. Some of the features suggest a possible medullary-like carcinoma, although these appearances are not convincing. Associated with invasive carcinoma is high nuclear grade solid cribriform DCIS. (B5b)

(So, this means it is cancer and grade 3 is the most active or fastest growing. The TNM numbers confused and scared me when I looked them up as I assumed they wouldn’t know if it has spread to lymph nodes (N3) or matasised (M3) until after the surgery - if at all. The spindle cell also scared my when I looked it up as the only mentions I could find were clinal studies with poor survival rates. I didn’t ask the consultant what my chances of survival are as I thought breast cancer survival is generally good at 85% for adult women in this country. I didn’t understand the rest.)

This case is ER 3+1=4,  PR 0 quick score (so I think this means there is some oestrogen receptors but not progesterone. I have a contraceptive implant which is progesterone only but which I have been told I will have to get removed but I was on the pill for about 15 years in my 20s and 30s. I have been told when the rest of the treatment -surgery, chemo and radiotherapy- is over I will go onto Tamoxifen).

I would be very grateful if there is anyone who can help me understand.

Hello Shinningknight

Welcome to the BCC forums. 

Whilst waiting for support and shared experiences from fellow users maybe you would like to call our free helpline on 0808 800 6000 and talk to one of our staff who are there to offer support and information, lines are open weekdays 9-5 and Sat 10-2…

I’ve also attached a link to our publication on understanding your pathology report


Best wishes

June, moderator

Hi shiningknight

The TNM in this report is not the TNM stageing and us frequently changed to ANM to help avoid confusion for the very reason you have stated. It’s used to work out the grade. The score is for tubules, nucleus and mitosis… Not tumour, nodes and mets. Grade 1 cancers scores 3-5, grade 2 are 6-7 and grade 3 are 8-9… Yours is a 9 which is another way of saying a grade 3.

The final staging not be tll after surgery as you correctly say. The lump can often feel a different size clinically to what it looks mammographically or on ultrasound. And they aren’t accurate either. I had an ultrasound the day before surgery mine was 1cm after it was removed the next day it was actually 2 cm but extending to 3cm including DCIS. The radiology and clinical examinations are more of guide for the surgeon than to give definitive clinic information. That will all come from the path lab following surgery.

Good luck and try not to rely on dr google.

Take care

Love Lulu xxx