Learning About Your Unique Cancer
To help determine your best treatment option, you should gather as much relevant information as you can about your type of breast cancer. Your pathology report, which you can get from your physician, is the primary source of this information. The information included in the pathology report is obtained from tests performed on a biopsy or surgical sample taken from your tumor. To learn about the key factors that can influence your treatment decision, please follow the links below.
Non-Invasive or Invasive Breast Cancer
Non-invasive cancers are also called in situ breast cancers, meaning that the cancer cells are confined to one place and have not spread to tissue surrounding the milk ducts or the milk-producing glands (lobules).
- Ductal carcinoma in situ (DCIS) is confined to the milk ducts. It is the most common form of non-invasive breast cancer.
- Lobular carcinoma in situ (LCIS) is confined to the milk-producing glands. Unlike DCIS, LCIS is not known to be a premalignant condition, but rather a marker that identifies women at an increased risk for invasive breast cancer.
Invasive breast cancers, also known as infiltrating cancers, grow into the normal tissue surrounding a milk duct or lobule and may spread to other parts of your body.
- Invasive ductal carcinoma (IDC) forms in the milk duct and then breaks through to nearby tissue.
- Invasive lobular carcinoma (ILC) forms in the milk-producing glands and breaks through to the surrounding tissue.
Breast Cancer Grading and Staging
Cancer grade and stage are two important aspects of your breast cancer that are provided in your pathology report and used in making treatment decisions.
Breast cancer grading is a “score” based on how closely the cancer cells from your biopsy resemble those of normal breast cells, in terms of their appearance and growth patterns. The cancer cells are rated on a scale from 1 to 3:
- Grade 1 (well differentiated) – Grade 1 cancer cells look slightly different from normal cells and grow in slow, well-organized patterns.
- Grade 2 (moderately differentiated) – Grade 2 cancer cells do not look like normal cells and grow and divide somewhat faster than normal.
- Grade 3 (poorly differentiated) – Grade 3 cancer cells look very different from normal cells. They grow quickly in disorganized, irregular patterns.
Breast cancer staging is a classification method based on the size of your cancer and how far it has (or hasn’t) spread beyond its original location within the breast. In most cases, staging is done after the tumor is removed and the lymph nodes have been examined.
Lymph node status indicates whether any breast cancer cells have moved from the original tumor into the lymph nodes. Lymph nodes are small bean-shaped organs that make up part of the lymphatic system, which is part of the body's immune system. If breast cancer does spread, it usually spreads first to the lymph nodes under the arm on the side of the breast cancer.
- If lymph node status is positive, meaning the lymph nodes contain breast cancer cells, the cancer may be more likely to return or recur.
- If the lymph node status is negative, meaning that the lymph nodes appear free of breast cancer cells, the breast cancer is less likely to recur.
Stage is expressed as a number on a scale of 0 through IV – the higher the stage, the more extensive the cancer. Early-stage invasive breast cancer includes stage I, II, and some stage III patients.
Carcinoma in situ (DCIS or LCIS) — the tumor has not spread past the ducts or lobules
The tumor is small (less than 2 cm) and well-localized (has no spread to the lymph nodes)
The tumor meets any of the following conditions:
- Small (less than 2 cm) and has spread to axillary lymph nodes
- 2 to 5 cm and has not spread to axillary lymph nodes
- 2 to 5 cm and has spread to axillary lymph nodes
- No tumor evident in the breast but has spread to axillary lymph nodes
- Larger than 5 cm and has no spread to axillary lymph nodes
The tumor meets any of the following conditions:
- Smaller than 5 cm and has spread to connected axillary lymph nodes
- Larger than 5 cm and has spread to single or attached axillary lymph nodes
- Has spread to chest wall; diagnosed inflammatory
- Has spread to lymph nodes under and above the collarbone and inside the breast and nodes, but not other parts of the body
The cancer has spread to other organs in your body, such as your bones, lungs, liver or brain
Hormone Receptors and HER2 Status
Hormones are naturally occurring chemicals in the body that stimulate the growth of hormone-sensitive tissues, such as those in the breast. In some cases of breast cancer, the hormones estrogen and progesterone may stimulate tumor growth. Your doctor will likely have your tumor tested to find out if your cancer is hormone-dependent.
If your breast cancer is estrogen receptor-positive (ER+) or progesterone receptor-positive (PR+), you may be a candidate for hormonal treatment, which is used to reduce or regulate the activity of your hormones.
HER2 (human epidermal growth factor receptor 2) is a protein that controls cell growth and repair. Cancer cells that have high levels of HER2 tend to grow quickly and respond well to anti-HER2 therapy. A woman whose tumor cells have greater-than-normal levels of HER2 is considered HER2-positive. A woman whose tumor cells have normal levels of HER2 is considered HER2-negative.
Genomic Testing with the Oncotype DX test -- Take Charge of your Cancer Journey
If you have been diagnosed with early-stage invasive breast cancer or DCIS, you may be eligible for the Oncotype DX Breast DCIS Score test, a genomic breast cancer test that looks at the activity of certain genes in your tumor to provide individualized information that is not available from any other test or measure.
- If you have early-stage invasive breast cancer, the Oncotype DX test is the only genomic test shown to predict the likelihood that you will benefit from adjuvant chemotherapy, while also determining the chance that your breast cancer will return.
- If you have DCIS, the Oncotype DX test can help to determine the risk of your cancer returning locally – a key factor in deciding your treatment after surgery.
Along with the information in your pathology report and other factors, your Oncotype DX test results can help you and your doctor select the best treatment path for you.