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What Is Grade 1 Breast Cancer

Types Of Invasive Breast Cancer

How to Grade Breast Cancer – Clinical relevance

Two types account for about 90% of invasive breast cancer.

  • Invasive ductal carcinoma . This is the most common type, making up about 80%. With IDC, cancer cells start in a milk duct, break through the walls, and invade breast tissue. It can remain localized, which means it stays near the site where the tumor started. Or cancer cells may spread anywhere in the body.
  • Invasive lobular carcinoma . This type accounts for about 10% of invasive breast cancers. ILC starts in the lobules or milk glands and then spreads. With ILC, most women feel a thickening instead of a lump in their breast.

Some women may have a combination of both or a different type of invasive breast cancer.

What Is Stage 2 Breast Cancer

Also known as invasive breast cancer, the tumor in this stage measures between 2 cm to 5 cm, or the cancer has spread to the lymph nodes under the arm on the same side as the breast cancer. Stage 2 breast cancer indicates a slightly more advanced form of the disease. At this stage, the cancer cells have spread beyond the original location and into the surrounding breast tissue, and the tumor is larger than in stage 1 disease. However, stage 2 means the cancer has not spread to a distant part of the body.

At stage 2, a tumor may be detected during a breast self-exam as a hard lump within the breast. Breast self-exams and routine screening are always important and can often lead to early diagnosis, when the cancer is most treatable.

Stage 2 breast cancer is divided into two categories:

Stage 2A: One of the following is true:

  • There is no tumor within the breast, but cancer has spread to the axillary lymph nodes, or
  • The tumor in the breast is 2 cm or smaller and cancer has spread to the axillary lymph nodes, or
  • The tumor in the breast measures 2 cm to 5 cm but cancer has not spread to the axillary lymph nodes.

Stage 2B: One of the following is true:

  • The tumor measures 2 cm to 5 cm and cancer has spread to the axillary lymph nodes, or
  • The tumor is larger than 5 cm but cancer has not spread to the axillary lymph nodes.

At stage 2, TNM designations help describe the extent of the disease. Most commonly, stage 2 breast cancer is described as:

Stage 2 breast cancer survival rate

What Is A Cancer Grade

A cancers grade describes how abnormal the cancer cells and tissue look under a microscope when compared to healthy cells. Cancer cells that look and organize most like healthy cells and tissue are low grade tumors. Doctors describe these cancers as being well differentiated. Lower grade cancers are typically less aggressive and have a better prognosis.

The more abnormal the cells look and organize themselves, the higher the cancers grade. Cancer cells with a high grades tend to be more aggressive. They are called poorly differentiated or undifferentiated.

Some cancers have their own system for grading tumors. Many others use a standard 1-4 grading scale.

  • Grade 1: Tumor cells and tissue looks most like healthy cells and tissue. These are called well-differentiated tumors and are considered low grade.
  • Grade 2: The cells and tissue are somewhat abnormal and are called moderately differentiated. These are intermediate grade tumors.
  • Grade 3: Cancer cells and tissue look very abnormal. These cancers are considered poorly differentiated, since they no longer have an architectural structure or pattern. Grade 3 tumors are considered high grade.
  • Grade 4: These undifferentiated cancers have the most abnormal looking cells. These are the highest grade and typically grow and spread faster than lower grade tumors.

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What Is The Prognosis For Invasive Ductal Carcinoma

Based on individual markers and prognostic factors, including the staging of your tumor, your physician will work to give you a prognosis. At Johns Hopkins Medicine, our team of breast cancer specialists is dedicated to developing cutting-edge techniques for surgery, breast reconstruction, chemotherapy, biologic targeted therapy, radiation therapy and other hormonal therapies. Our research allows us to make great strides forward for patients with breast cancer.

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Grading Invasive Breast Cancer Cells

Your Pathology Results Explained

Three features of the invasive breast cancer cell are studied and each is given a score. The scores are then added to get a number between 3 and 9 that is used to get a grade of 1, 2, or 3, which is noted on your pathology report. Sometimes the terms well differentiated, moderately differentiated, and poorly differentiated are used to describe the grade instead of numbers:

  • Grade 1 or well differentiated . The cells are slower-growing, and look more like normal breast cells.
  • Grade 2 or moderately differentiated . The cells are growing at a speed of and look like cells somewhere between grades 1 and 3.
  • Grade 3 or poorly differentiated . The cancer cells look very different from normal cells and will probably grow and spread faster.

Our information about pathology reports can help you understand details about your breast cancer.

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What Does It Mean To Have Stage 1 Breast Cancer

In Stage 1 breast cancer, cancer is evident, but it is contained to only the area where the first abnormal cells began to develop. The breast cancer has been detected in the early stages and can be very effectively treated.

Stage 1 can be divided into Stage 1A and Stage 1B. The difference is determined by the size of the tumor and the lymph nodes with evidence of cancer.

What Does Grade Mean

Histolopathologic GradeThis measure is often reported using some version of the Bloom-Richardson or the Scarff-Bloom-Richardson scale. It is based on a combined score for nuclear grade, mitotic rate, and histologic grade or architectural differentiation. Each characteristic is given a score of 1 to 3, resulting in a total score ranging from 3 to 9.

Nuclear GradeNuclear grade is assessed on a scale of 1-3. A grade 1 indicates small nuclei with little variation in size and shape. A grade 3 indicates larger nuclei with marked variation in size and shape. Grade 2 nuclei show features between 1 and 3. The higher the grade is, the more aggressive the tumor is.

Mitotic RateThis rate indicates the number of malignant cells that are actively dividing. The mitotic rate is reported with numbers from 1 to 3. The higher the score, the more aggressive the tumor cells are.

Cellular DifferentiationThis measure is based on how close the specimen resembles normal breast tissue. This measure refers to tubular formation of the cells. A grade of 1 indicates a well-differentiated tissue with many tubules, grade 2 moderately differentiated, and grade 3 poorly differentiated tissue with few or no tubules.

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What Are The Different Grades Of Breast Cancer

There are three grades of invasive breast cancer:

  • Grade 1 looks most like normal breast cells and is usually slow growing
  • Grade 2 looks less like normal cells and is growing faster
  • Grade 3 looks different to normal breast cells and is usually fast growing

Sometimes the grade given to a cancer after a biopsy can change after surgery. This is because after surgery theres more tissue for the pathologist to look at, which can give them more detailed information about the cancer.

What Is Stage Ii Breast Cancer

How to Grade Breast Cancer – The basics

Stage II describes cancer that is in a limited region of the breast but has grown larger. It reflects how many lymph nodes may contain cancer cells. This stage is divided into two subcategories.

Stage IIA is based on one of the following:

  • Either there is no tumor in the breast or there is a breast tumor up to 20 millimeters , plus cancer has spread to the lymph nodes under the arm.
  • A tumor of 20 to 50 millimeters is present in the breast, but cancer has not spread to the lymph nodes.

Stage IIB is based on one of these criteria:

  • A tumor of 20 to 50 millimeters is present in the breast, along with cancer that has spread to between one and three nearby lymph nodes.
  • A tumor in the breast is larger than 50 millimeters, but cancer has not spread to any lymph nodes.

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What This Means For You

If youve been diagnosed with early-stage breast cancer, your doctor may recommend treatments after surgery to reduce your risk of recurrence.

If you were diagnosed with hormone receptor-positive, early-stage breast cancer, its likely that your doctor will recommend you take some type of hormonal therapy medicine either tamoxifen or an aromatase inhibitor depending on your menopausal status for five to 10 years after surgery.

Chemotherapy after surgery is usually completed in three to six months. If youre also receiving a targeted therapy, such as Herceptin , with chemotherapy, you may continue to receive the targeted therapy for up to a year after completing chemotherapy.

Radiation therapy after surgery can be completed in one to seven weeks.

So, hormonal therapy after surgery takes the longest to complete. Hormonal therapy medicines also can cause troubling side effects, such as hot flashes, night sweats, and joint pain. Less common but more severe side effects include heart problems and blood clots.

Research has shown that about 25% of women who are prescribed hormonal therapy to reduce the risk of recurrence after surgery either dont start taking the medicine or stop taking it early, in many cases because of side effects.

Learn more about Staying on Track With Treatment. You can read about why its so important to stick to your treatment plan, as well as ways to manage side effects after radiation, chemotherapy, and hormonal therapy.

Early Locally Advanced And Secondary Breast Cancer

Early breast cancer means the cancer hasn’t spread beyond the breast or the lymph nodes in the armpit on the same side of the body. So, the cancer hasn’t spread to any other part of the body.

Local recurrence means cancer that has come back in the breast, the armpit, or the chest wall after treatment.

Locally advanced breast cancer means the cancer has spread into the surrounding area, such as the lymph nodes, the skin or chest muscle. But it has not spread to other parts of the body.

Secondary breast cancer is also called metastatic breast cancer, advanced breast cancer, or stage 4 breast cancer. It means that the cancer has spread to other parts of the body, such as the liver or bones.

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What Does It Mean To Grade Breast Cancer

The grade of breast cancer is a way to describe how the cancer cells look under a microscope. It helps to understand how aggressive it may be. If the tumor cells look very abnormal under the microscope, theyre more likely to grow quickly and spread. If the cells look very similar to normal cells, theyre likely to be more slow growing.

To determine the grade, the following will be evaluated:

  • How much the cells look like normal gland cells

  • What the DNA-containing nucleus of the tumor cells look like

  • The amount of dividing cells a sign of how fast the cells are growing

Checking The Lymph Nodes

Breast Cancer Symptoms Review: 2017

The usual treatment is surgery to remove the cancer. Before your surgery you have an ultrasound scan to check the lymph nodes in the armpit close to the breast. This is to see if they contain cancer cells. If breast cancer spreads, it usually first spreads to the lymph nodes close to the breast.

Depending on the results of your scan you might have:

  • a sentinel lymph node biopsy during your breast cancer operation
  • surgery to remove your lymph nodes

You may have other treatments after surgery.

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Systemic Treatments For Stage 1 Breast Cancer

Systemic treatments, often termed add-on or adjuvant treatments, treat breast cancer throughout your body and not just at the site of the tumor.

These treatments help destroy cancer cells that have spread beyond your breast but are still too small to be spotted. They include the therapies outlined below.

Chemotherapy

Doctors may recommend chemotherapy, also called chemo, after surgery to help destroy any undetected cancer cells. Chemotherapy may also lower your risk of the cancer coming back at a later stage.

Chemotherapy may be recommended for a smaller tumor if:

  • Any cancer cells were found in the lymph nodes.
  • You score high on a gene test such as Oncotype DX, which shows whether chemotherapy could help treat your breast cancer and if its likely to come back after surgery.
  • The cancer cells are progesterone receptor- and estrogen receptor-negative.
  • The breast cancer cells are positive for human epidermal growth factor receptor 2 various therapies can target these receptors.

Hormone therapy

Hormone therapy can be used to help slow down the growth of cancer cells in people with estrogen receptor-positive or progesterone receptor-positive cancer cells. Hormone therapy works by blocking hormone receptors on the cancer cells or by lowering the amount of estrogen produced in your body.

Its important to ask your doctor about the potential side effects of hormone therapy before you begin this treatment, so can you know what to expect.

Targeted therapy

Additional Grading Criteria: A Composite Total Of Tubular Nuclear And Mitotic Index Assesments

As a grade of low, intermediate or high is obtained through a composite sum by assigning a score based on the nuclear assessment, a mitotic index assessment, and a tubular assessment.

The nuclear assessment is based on the nuclear size within the invasive cells. They are described from small to medium to large in size, as well as by their uniformity in size and shape.

The tubular assessment refers to an approximate, quantitative account of the amount of cell groupings which remain in their normal tubular shape. The smaller the percentage of tubular structures in comparison to other shapes, the higher the score. Other structures to appear may include solid trabecula, vacuolated single cells, alveolar nests, and solid sheets of cells.

The mitotic index refers to evident patterns of cell division.Mitosis is a process by which a cell separates into two genetically identical daughter cells. . So, the mitotic index is assessment of the abundance of these pairs of daughter cells, measured in the count per square millimeter. Mitoses are only counted in the invasive area of the lesion .

Histologic Grade

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Prognosis For Stage 1 Breast Cancer

Survival rates for breast cancer are determined based on whether the cancer is localized , regional , or distant .

Stage 1 breast cancer is localized and has a very favorable prognosis . Its five-year survival rate is at least 99 percent. Early diagnosis helps, as well as thorough tumor testing. This helps ensure that each person receives the right therapies for their cancer.

How Long Does It Take Breast Cancer To Grow

What Is the Difference Between Staging and Grading in Breast Cancer?

Every type of breast cancer varies based on individual factors and subtypes, says Dr. Roesch.

Different types of breast cancer tend to behave differently, and because every cancer is different and every person is too its hard to say exactly how quickly breast cancer can grow and spread. Still, experts understand that some types of breast cancer tend to be more aggressive and fast moving, while other types typically move slower.

Speed of breast cancer growth can be influenced by these factors:

Your cancer team will determine how likely or fast your breast cancer may spread based on your breast cancer subtype, stage and individual factors. Although breast cancer experts can hypothesis and estimate the speed of cancer growth, every breast cancer is different and distinctive to that person.

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What Does Invasive Mean

The normal breast is made of ducts that end in a group of sacs . Cancer starts in the cells lining the ducts and lobules, when a normal cell becomes a carcinoma cell. Invasive breast cancer is cancer that has broken through the wall of either a duct or a lobule. The most common form of breast cancer is invasive ductal carcinoma or a cancer that began in a duct and has spread outside the duct. Noninvasive breast cancer is referred to as in situ because it remains in the duct or the lobule. It is considered Stage 0.

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How Do You Prevent Invasive Ductal Carcinoma

There is no single way to prevent all cases of breast cancer but people can take steps to lower the risk.

  • Lose weight or maintain a healthy weight
  • Breastfeed for at least several months
  • Use non-hormonal options to treat menopausal symptoms
  • For women at increased risk of breast cancer :
  • Genetic counseling and testing for breast cancer risk
  • Close observation to look for early signs of breast cancer
  • More frequent doctor visits for breast exams and ongoing risk assessment
  • Start breast cancer screening with yearly mammograms at an earlier age
  • Other screening tests, such as breast MRI
  • Medicines to lower breast cancer risk
  • Tamoxifen and raloxifene
  • Aromatase inhibitors for women past menopause
  • Preventive surgery for women who have a very high risk for breast cancer, such as from a BRCA gene mutation
  • Prophylactic mastectomy to remove the breasts
  • Removal of the ovaries to reduce estrogen in the body
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    Hormonal Therapy For Idc

    If the cancer tested positive for hormone receptors, your doctor likely will recommend some form of hormonal therapy. Hormonal therapy, also called anti-estrogen therapy or endocrine therapy, works by lowering the amount of estrogen in the body or blocking the estrogen from signaling breast cancer cells to grow. Because hormonal therapy affects your whole body, its sometimes called a systemic treatment.

    In some cases of advanced-stage IDC, hormonal therapy can be given before surgery to help shrink the cancer . Still, its more common for hormonal therapy to start after other treatments, such as chemotherapy or radiation therapy, unless these treatments arent needed.

    Hormone receptors are special proteins found on the surface of certain cells throughout the body, including breast cells. These receptor proteins are the eyes and ears of the cells, receiving messages from the hormones in the bloodstream and then telling the cells what to do. In other words, the receptors act like an on-off switch for a particular activity in the cell. If the right substance comes along that fits into the receptor like a key fitting into a lock the switch is turned on and a particular activity in the cell begins.

    You and your doctor will work together to decide which form of hormonal therapy is best in your situation. Two types of hormonal therapy are most frequently used:

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