Aggressive Tumor

Ma had triple negative breast cancer (TNBC), an aggressive subtype. Fortunately, my cancer is not triple negative, something that had worried me, but I will get BRCA testing anyway because breast cancer patients with the BRCA1 mutation are more likely to have TNBC, and BRCA is heritable.

I was initially told I was PR+, but after I pointed out what looked like a mistake in the biopsy report, the lab retested my biopsy sample and corrected the report to say PR-. But the PR status doesn't affect my treatment.

ER+, PR-, HER2+ (estrogen receptor -- positive, progesterone receptor -- negative, human epidermal growth factor receptor 2 gene -- positive)
Grade 2 ((moderately differentiated)
Ki-67 30%
Size: 4.5 x 3.7 x 3.5 cm (MRI),  3.5 x 1.5 x 3.5 cm (ultrasound)
No palpable lymph nodes. MRI report said No suspicious axillary lymphadenopathy.

Just because the lymph nodes aren't bigger than normal doesn't mean they don't have cancer cells. Chemo should take care of that. 

HER2+ and a Ki-67 oof 30% makes my cancer aggressive. I'm surprised it's only Grade 2 instead of Grade 3. Maybe that's another mistake.

The biopsy report shows how they came up with Grade 2: The invasive component is organized in nests with minimal gland formation (<10%, Tubular formation - score 3). Tumor cells have oval to round nuclei with dispersed chromatin, inconspicuous nucleoli and eosinophilic to amphiphilic cytoplasm (Nuclear - score 2). Several mitotic figures are seen (Mitoses - score 2, 12 in 10 hpf). The overall provisional Nottingham grade is 2 (7 of 9). Lymphovascular invasion is absent. The in-situ component is solid with areas of necrosis and micro calcifications. The in-situ component is grade 2.

Staging is usually done after surgery. But based on the size of my tumor, I'm Stage II. If there truly is no lymph node involvement, then I'm Stage IIA instead of Stage IIB. Stage II is still considered early stage.