Understanding Your Diagnostic Workup
For patients and caregivers
Multiple factors are considered when assessing the best treatment plan for early breast cancer, including the risk of cancer recurrence. The initial diagnostic work-up includes assessment of tumor biopsy material by a pathologist. This work-up includes:
- Determination of lymph node involvement
- Tumor size and stage
- Histological grade
- HER2/neu status
- Lymphatic Vessel Invasion
- Hormone receptor status
Health care professionals use these prognostic factors to determine an appropriate treatment plan (surgery, radiation, endocrine therapy, chemotherapy, etc.).
Lymph Node Involvement
- Node Positive = the tumor has spread to the lymph nodes at the time of diagnosis
- Node Negative = tumor has not spread to the lymph nodes at the time of diagnosis
Stage and Tumor Size
Stage 0 (called carcinoma in situ)
Lobular carcinoma in situ (LCIS) refers to abnormal cells lining a gland in the breast. This is a risk factor for the future development of cancer, but this is not felt to represent a cancer itself.
Ductal carcinoma in situ (DCIS) refers to abnormal cells lining a duct. Women with DCIS have an increased risk of getting invasive breast cancer in that breast. Treatment options are similar to patients with Stage I breast cancers.
Stage I: early stage breast cancer where the tumor is less that 2 cm across and has not spread beyond the breast
Stage II: early stage breast cancer where the tumor is either less than 2 cm across and has spread to the lymph nodes under the arm; or the tumor is between 2 and 5 cm (with or without spread to the lymph nodes under the arm); or the tumor is greater than 5 cm and hasn't spread outside the breast
Stage III: locally advanced breast cancer where the tumor is greater than 5 cm across and has spread to the lymph nodes under the arm; or the cancer is extensive in the underarm lymph nodes; or the cancer has spread to lymph nodes near the breastbone or to other tissues near the breast
Stage IV: metastatic breast cancer where the cancer has spread outside the breast to other organs in the body
Depending on the stage of the cancer, the physician may require additional tests to determine if the patient has metastatic disease. If a patient has stage III breast cancer, a chest x-ray, CT scan and bone scan may be used to look for potential metastases. The physician will decide what is necessary to adequately stage a patient’s cancer on an individual basis.
Histological Grade
- Grade is a calculation based on how abnormal the cancer cells look under a microscope and how fast they are growing.
- Three features determine a cancer's grade:
- The rate of cell division
- The percentage of cancer composed of tubular structures
- The change in cell size and uniformity.
If a tumor has been determined to be Grade 3, then there is a higher risk of recurrence than if the tumor was determined to be Grade 1.
HER2/neu (a growth-promoting protein) Status
- Gene that helps the growth of cells, how they, divide, and repair themselves. Positive or negative HER2/neu is important in the control of abnormal or defective cells that could become cancerous and has implications for treatment.
Lymphatic Vessel Invasion (LVI)
- When pathologists look directly at the cancer under a microscope they determine whether cancer cells are found in the lymphatic vessels within the cancer itself.
Hormone Receptor Status:
- This status reflects whether the cancer is estrogen receptor positive (ER+) or negative (ER-) or progesterone receptor positive (PR+) or not (PR-). This status may have some prognostic information and, at this time, is used to plan treatment.
Link to Glossary
For more information on breast cancer recurrence, patients should talk with their physician and healthcare team. In addition, informative websites are listed below.
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