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Just diagnosed with breast cancer: Healthcare Provider's Office

What is a pathology report?

To learn which type of breast cancer you have, your surgeon may remove a piece of tumor tissue from your breast during surgery or by using a needle. The procedure is called a biopsy, and the tissue that is removed is called a biopsy sample. The tissue sample is studied in a lab by a type of doctor called a pathologist to determine exactly what kind of tumor it is. The pathologist then writes a report about the findings. This is called a pathology report.

A pathology report includes several things:

  • Personal information: You should make sure that your name and the correct date of operation are on the top of the report
  • A specimen section: This section of the report says where the tissue sample came from. The samples could come from the breast, the lymph nodes under the arm, or both. Lymph nodes are small masses of tissue found throughout the body that help fight infection
  • A clinical history section: This section describes how your surgeon found the tumor and what kind of surgery he or she did
  • A clinical diagnosis section: This section explains what the doctor thought you had before the sample was tested
  • A gross description: What the pathologist could actually see by looking at the biopsy sample with the naked eye
  • A microscopic description: This section talks about how the tumor looks under a microscope. The tumor is compared with normal tissue around it. This section also gives the size of the tumor
  • A special tests section: This section contains the results of tests for proteins, genes, and rate of cell growth
  • A final diagnosis: This section gives a short description of the sample tissue

Your pathology report will help your healthcare provider know what treatment may be best for you.

For breast cancer, your healthcare provider will want to know the cancer's hormone receptor status. Hormones such as estrogen and progesterone play an important role in the growth of many breast cancers. It is important to know whether a breast tumor is positive or negative for either of these hormone receptors.

  • An estrogen receptor–positive tumor is called ER positive
  • A progesterone receptor–positive tumor is called PR positive

Hormone therapy may help breast tumors that are positive for either of these hormone receptors.

Be sure to ask your healthcare team to give you a copy of your pathology report and to review it with you. And ask any questions you may have about the results.

To the right are examples of organizations and resources you may find helpful. Click on the links to visit those websites and learn more.


How can I better understand my diagnosis?

It is okay if you do not understand all that your healthcare team tells you right away. What is important is that you ask your doctor about the things you do not understand. If you don't feel that you can talk with your doctor, talk with a different member of your healthcare team, such as a nurse. Ask them to explain things by using other words or by showing you a picture or diagram of what they are talking about. You can also ask them to give you some written information to take home to read.

To the right are examples of organizations and resources you may find helpful. Click on the links to visit those websites and learn more.


What are my treatment options?

There are many treatments for breast cancer. Your treatment will depend on many factors, such as the stage of your tumor. Breast cancer treatment options may include:

Surgery

Most people with breast cancer will have surgery to remove the breast tumor. The surgery may be done before treatment or after treatment, depending on the type and stage of the tumor. The 2 most common kinds of surgery for breast cancer are:

  • Lumpectomy: In this surgical procedure, the surgeon removes the entire cancerous lump and some of the normal tissue around it but conserves the rest of the affected breast. After a lumpectomy, people often have radiation therapy to kill any cancer cells that may still be in the area
  • Mastectomy: In this surgical procedure, the surgeon removes the entire affected breast or a large part of it, sometimes along with other nearby tissue. After a mastectomy, some women choose to have a plastic surgeon reconstruct their breast. Talk with a plastic surgeon before having a mastectomy if you are thinking about having a mastectomy.

At the time of breast surgery, an additional type of surgery may also be performed called a lymphadenectomy. In this procedure, 1 or more lymph nodes in the armpit on the side of the affected breast are removed and looked at under a microscope to see if they have cancer. This information will help you know which treatment options are best for you

Choosing between a lumpectomy and a mastectomy depends on many things:

  • The size, location, and stage of your tumor
  • The size of your breast
  • Certain features of the cancer
  • How you feel about how surgery will change your breast
  • How you feel about radiation therapy
  • Your ability to travel to a radiation treatment center for daily radiation sessions

Your healthcare provider will help you decide which surgical option is best for you and when you should have it. Sometimes treatment in the form of chemotherapy is given before surgery to shrink the tumor.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells in the part of the body that is being treated. It may be used after breast surgery to destroy cancer cells that may still be in the area or if the cancer has spread to the lymph nodes. Radiation is also used to treat cancer that has spread to other parts of the body, such as the brain or bones

There are 2 kinds of radiation therapy:

  • External beam radiation therapy: The radiation comes from a large machine outside the body. Breast radiation is a lot like getting an x-ray except that the radiation is stronger
  • Brachytherapy: Brachytherapy is also known as internal radiation. In this type of radiation therapy, small radioactive objects called seeds are placed in or near the area from which the tumor was removed

Chemotherapy

  • Chemotherapy (or chemo for short) is a type of cancer treatment that uses medicines that kill cancer cells. Chemotherapy can also harm normal cells

Hormone therapy

  • Hormone therapy is a treatment with medicines that reduce the amount of estrogen in the body or that block the effect of estrogen (Estrogen causes some tumors to grow)

Targeted therapy

  • Targeted therapy uses medicines that target certain changes in a cell. These changes may lead to cancer. One type of targeted therapy uses monoclonal antibodies. Monoclonal antibodies are copies of proteins that are made in a laboratory. They are designed to recognize a specific cell, attach to it, and signal the body's immune system to destroy the cell. Monoclonal antibodies can also be designed to block the signals that tell a cancer cell to grow and divide quickly.

Talk with your healthcare team about your treatment options. Together you can make the choice that is best for you.

To the right are examples of organizations and resources you may find helpful. Click on the links to visit those websites and learn more.


Should I get a second opinion?

You need to be confident in the care that you are getting. A second opinion may give you the chance to gather and think about all the facts and options before choosing a treatment. You may worry that you might offend your doctor by getting a second opinion. But most doctors won't mind. And some insurance companies require you to get a second opinion, but you may want to be sure the visit is covered by your insurance plan.

To the right are examples of organizations and resources you may find helpful. Click on the links to visit those websites and learn more.


Who is on my breast cancer healthcare team?

Treating breast cancer is a team effort. Many types of healthcare providers make up a breast cancer treatment team:

  • Medical oncologist: A doctor who specializes in cancer
  • Radiation oncologist: A doctor who specializes in treating cancer with radiation
  • Surgeon: A doctor who specializes in performing operations on people with breast cancer
  • Oncology nurse: A nurse who specializes in cancer
  • Registered dietitian: An expert in nutrition
  • Plastic surgeon: A doctor who specializes in breast reconstruction
  • Oncology social worker: A social worker who specializes in cancer
  • Genetic counselor: A healthcare professional who is trained to help patients and their families understand genetic disorders and provide information and support to patients and their families
  • Nurse navigator: A nurse who specializes in navigating the cancer care system for patients by offering them medical guidance, acting as a support system for patients and their families, and walking patients and their families through the cancer treatment process

To the right are examples of organizations and resources you may find helpful. Click on the links to visit those websites and learn more.


What should I talk about with my healthcare team?

Your healthcare team is there to help answer any questions you have. To learn the most from them, it is important to be open and honest. And ask any questions you have-even if you think they are about something that is not important. It may help to write your questions down ahead of time and take notes during your visit.

To the right are examples of organizations and resources you may find helpful. Click on the links to visit those websites and learn more.

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