Understanding Your Breast Cancer Pathology Report

How do I get and understand my results?

You can ask for a copy and an appointment to go through it. A surgical report may contain more information than a needle-biopsy report because more tissue has been examined. Some tests take longer, so ask which results are still pending and when you should hear. A delay on its own does not tell you whether the result is good or bad.

What do invasive cancer, grade and stage mean?

• In situ: abnormal cells remain within the ducts or lobules. DCIS means ductal carcinoma in situ.
• Invasive: cancer cells have grown beyond where they started into surrounding breast tissue. This word alone does not mean the cancer has spread to a distant organ.
• Grade: how different the cells look from normal cells under the microscope. Invasive breast cancer is usually graded 1, 2 or 3; a higher grade tends to grow more quickly.
• Stage: the size and extent of the cancer, including whether it has spread. Stage is worked out using the wider set of examination, imaging and pathology findings. Grade 3 is not the same as stage 3.

What are ER and PR results?

ER stands for oestrogen receptor and PR for progesterone receptor. The laboratory checks whether the cancer cells have receptors for these hormones. Results help your team consider hormone therapy. Ask how the laboratory has reported your result and what it means for your treatment; a percentage is not your percentage chance of survival.

What does HER2 positive, negative or low mean?

HER2 is a protein involved in cell growth. Testing helps the team decide whether particular targeted medicines may help. An IHC test measures HER2 protein; an unclear result may need an additional test, often called ISH or FISH. “Equivocal” means that further interpretation or testing is needed.

HER2-low describes some cancers with a small amount of HER2 that do not meet the usual HER2-positive definition. It may be relevant to certain treatments in advanced cancer. It does not by itself mean that a particular medicine is suitable or NHS-funded for you. Ask the team to explain the complete result.

Triple-negative means that the cancer is negative for ER, PR and HER2. It is a description of these features, not three separate cancers.

What do margins and lymph-node results tell me?

A margin is the edge of tissue removed during surgery. The report describes whether cancer reaches or is close to that edge. The team uses this and other findings to decide whether more surgery or another treatment is needed.

Lymph-node results describe whether cancer was found in the nodes examined, often in the armpit. Cancer in nearby lymph nodes does not automatically mean stage 4 cancer. Ask what the number of nodes examined and involved means for your plan.

Is a tumour test the same as an inherited gene test?

No. Some tests examine features of the tumour to help choose treatment. An inherited genetic test looks for a gene change that may run in a family, such as a BRCA change. Ask what a proposed test is looking for, whether it could have implications for relatives, and who will explain the result.

What should I ask at my results appointment?

• What is the exact diagnosis, and is anything still being tested?
• Which findings affect the treatment choices for me?
• Are the stage and grade confirmed, or could further tests change them?
• Do the margins or lymph nodes mean I need another procedure?
• Can you give me a written explanation and a contact for questions afterwards?