Information overload: Pathology report

"Here's your pathology report, which is basically your breast cancer report card," Dr C said as we gazed at the three pages of single-spaced gobblety-gook. Mark and I had come to her office for the post-op visit.

Bottom line: I think I got a C+ or maybe a B-. Everything was sort of mid-range -- "not as good as it could be, but not as bad either," she said.

The tumor's "histologic grade composite (Nottingham)" was "II, tubule formation 3, nuclear grade 2, mitoses 1."

"Of course, you remember mitosis from high school biology," she said.

Mark nodded agreeably while I looked at her slack-jawed. Of course, I don't.

"Mitosis is the process of cell division." She went on to explain about spindle apparatus, chromosone centers, receptive nuclei and skewed arms, while I waited impatiently for the bell to ring so I could get to the cafeteria and strained to hear if that was "Band on the Run" coming in over the loudspeaker before the principal's announcement.

Anyway, my overall grade of II (on a scale of I to III) means that my chromosones are acting a little funky - bent arms, skewed. Grade I would mean they were normal; Grade III is seriously messed up. If I'm getting this right, the rate of cell division is mildly abnormal, and the way they're doing it is wacky.

The docs looked to see if any tumor cells were roaming around elsewhere in my breast and didn't see any, which was good. That was my favorite sentence of the report, and the only one in clear English: "The remainder of the breast is effectively unremarkable." Yay!!!! I'm thrilled to be unremarkable!

There definitely is some ductal carcinoma in situ - which she describes as "itty bitty and not super aggressive" and a tiny bit of additional invasive ductal carcinoma near the skin, so she will do a re-excision when I have the lymph node biopsy to get out every last bad cell.

Both estrogen and progesterone receptors were not just positive, but strongly positive, which means they will be treatable with tamoxifen. She mentioned taking it daily for 5 years.

HER2 status hasn't yet been determined, we should get a report on that soon.

She was totally supportive of my going to UCSF for a second opinion and gave me a referral.

Chemo still unknown based on the Oncotype DX score. But whether I have chemo or not, I definitely must have radiation. It will be every weekday for 6 to 8 weeks. Without radiation, there is a 30% chance that the cancer will return in that breast.

What are my risks for recurrence? They're highest in the first five years, she said, so I will be under "increased surveillance" with more frequent mammograms and at least an annual breast MRI (ugh, claustrophobia alert!).

She thinks I should stop eating soy at least until I'm on tamoxifen which would block its estrogen-like effects.

The lymph node biopsy will be Thursday, Sept. 2.