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What Is Mitotic Rate In Breast Cancer

What Is The Significance Of The Reported Size Of The Tumor

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If the entire tumor or area of cancer is removed, the pathologist will say how big the area of cancer is by measuring how long it is across , either by looking at it under the microscope, or by gross examination of the tissue removed during surgery. The size of the tumor in the breast is part of what determines the stage of the cancer, which influences treatment and prognosis.

A needle biopsy only samples a part of the tumor, so measurements of the size of the cancer are often not given. Later, when the tumor is removed , a more accurate measurement is obtained.

The Pathology Report Is A Collection Of Information That Describes A Patients Breast Cancer

  • How aggressive is the breast cancer?
  • Have any cancer cells left the original tumor and traveled elsewhere, such as the underarm lymph nodes? Are they likely to travel?
  • What determines if my cancer will respond to treatment?

Pathologists are doctors responsible for looking at your tissue sample under the microscope. This allows them to assess the cells for abnormalities that could lead to the diagnosis of breast cancer. They prepare a report about their findings. The report has information about the size, shape and appearance of the cancer as it looks to the naked eye. Pathology reports play an integral role in the diagnosis of breast cancer and staging.

Breast Cancer Survival Rates According To The Stage Of The Cancer

Breast cancer stage of course refers to the spread and size of cancer at diagnosis. Stage zero means the breast cancer is still in situ or contained. Whereas, stage IV means that the cancer has metastasised to other body regions. The stage of cancer at diagnosis affects prognosis.

The statistics below are taken from the from the SEER database of the National Cancer Institute between the years 1975 to 2010.

The 5 year survival rate means that within 5 years around 93 people out of 100, diagnosed with Stage II breast cancer, will still be alive.

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Pathological And Molecular Characterization Of Triple Negative Breast Cancer

As a distinct molecular entity, TNBCs appear to be quite heterogeneous at a histopathological level. They frequently show features of ductal invasive carcinomas although metaplastic, medullary and apocrine features are also found . Moreover, TNBCs may present themselves as adenoid cystic lesions, histiocytoid carcinomas and even as invasive lobular carcinomas . A relatively large number of breast cancers that do not exhibit a basal phenotype appeared to have a triple-negative profile . Therefore, from a morphological and molecular point of view, TNBC may somehow be classified into four main categories that include the normal-like and the apocrine subtypes . It appears that some histopathological features of breast cancer such as pleomorphic lobular carcinoma and mixed ductal-lobular carcinoma exhibit a triple-negative molecular profile . Also, most invasive carcinomas that develop from microglandular adenosis areas are in fact triple-negative tumors . Recent studies have shown that metaplastic carcinomas are usually TNBCs . Metaplastic carcinomas are known to be rare, aggressive diseases of the breast that are usually diagnosed at grade 3 and, similar to TNBCs, have no specific therapeutic guidelines .

What If My Report Mentions Micrometastases In A Lymph Node

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This means that there are cancer cells in the lymph nodes that are bigger than isolated tumor cells but smaller than regular cancer deposits. If micrometastases are present, the N category is described as pN1mi. This can affect the stage of your cancer, so it might change what treatments you may need. Talk to your doctor about what this finding may mean to you.

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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.

Mitotic Activity Index Ids High

SAN ANTONIO-The mitotic activity index , a measure of tumor cell proliferation, has been shown to be an independent prognostic factor for recurrence-free survival in breast cancer. It is being used in the Netherlands to select which node-negative patients require adjuvant chemotherapy, Elsken van der Wall, MD, PhD, said at the 23rd Annual San Antonio Breast Cancer Symposium.

SAN ANTONIOThe mitotic activity index , a measure of tumor cell proliferation, has been shown to be an independent prognostic factor for recurrence-free survival in breast cancer. It is being used in the Netherlands to select which node-negative patients require adjuvant chemotherapy, Elsken van der Wall, MD, PhD, said at the 23rd Annual San Antonio Breast Cancer Symposium.

Dr. van der Wall spoke in place of the scheduled speaker, Paul J. van Diest, MD, PhD, of the Department of Pathology, Free University Hospital, Amsterdam.

Determining MAI

The mitotic activity index is determined by examining stained slides of tumor and counting the number of visible mitotic figures in the area containing the highest density of mitotic figures .

The total number of mitotic figures counted in an area of 1.6 mm2 is the MAI. An MAI less than 10 is considered low while an MAI of 10 or more is considered high.

Study Results

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Understanding Your Pathology Report: Breast Cancer

When your breast was biopsied, the samples taken were studied under the microscope by a specialized doctor with many years of training called a pathologist. The pathologist sends your doctor a report that gives a diagnosis for each sample taken. Information in this report will be used to help manage your care. The questions and answers that follow are meant to help you understand medical language you might find in the pathology report from a breast biopsy, such as a needle biopsy or an excision biopsy.

In a needle biopsy, a needle is used to remove a sample of an abnormal area. An excision biopsy removes the entire abnormal area, often with some of the surrounding normal tissue. An excision biopsy is much like a type of breast-conserving surgery called a lumpectomy.

Mitotic Rate And Your Melanoma Pathology Report

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One way to better understand your melanoma diagnosis and the resulting treatment strategy is to read your melanoma pathology report, which is sent to your healthcare provider and contains critical information such as the exact stage of your disease.

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Breast Cancer Type’ Is Determined By Cell Shape And Appearance

Breast cancers or carcinomas are mainly of epithelial cell origin.

Epithelial cells are the lining of most of our organs and vessels.

However, there are quite a few very rare types of breast cancers which are comprised of non-epithelial cells . Furthermore, a great many breast cancers are actually not pure, but rather a mixture of different types of cells.

In general, there are six types of standard breast carcinomas, and statistically, some of these tend to show a better prognosis than others.

The six most common types of breast cancer are as follows:-

  • General infiltrating ductal carcinoma
  • Infiltrating lobular carcinoma
  • Mucinous or colloid breast carcinoma
  • Medullary breast carcinoma
  • What Hormones Make My Cancer Grow

    Hormone Receptor StatusIf your cancer cells have a high proportion of estrogen or progesterone receptors, the report will say you are ER positive or PR positive. If your cells have a lower number of receptors, your report will say you are ER or PR negative. Another way to think of this is a car and driver example. The hormone buckles itself into the car seat to drive the tumor to make it grow. This is one of the most important pieces of information on the pathology report. Being ER/PR positive means you might benefit from hormonal therapy. Hormone therapy is actually therapy with an oral drug, usually Tamoxifen or aromatase inhibiters, which blocks hormone receptors in the cancer cell.

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    What If A Carcinoma Is Infiltrating Or Invasive

    These words are used to mean that the cancer is not a pre-cancer , but is a true cancer.

    The normal breast is made of tiny tubes that end in a group of sacs . Cancer starts in the cells lining the ducts or lobules, when a normal cell becomes a carcinoma cell. As long as the carcinoma cells are still confined to the breast ducts or lobules, without breaking out and growing into surrounding tissue, it is considered in-situ carcinoma .

    Once the carcinoma cells have grown and broken out of the ducts or lobules, it is called invasive or infiltrating carcinoma. In an invasive carcinoma, the tumor cells can spread to other parts of your body.

    What Is The Significance Of The Stage Of The Tumor

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    The stage of a cancer is a measurement of the extent of the tumor and its spread. The standard staging system for breast cancer uses a system known as TNM, where:

    • T stands for the main tumor
    • N stands for spread to nearby lymph nodes
    • M stands for metastasis

    If the stage is based on removal of the cancer with surgery and review by the pathologist, the letter p may appear before the T and N letters.

    The T category is based on the size of the tumor and whether or not it has spread to the skin over the breast or to the chest wall under the breast. Higher T numbers mean a larger tumor and/or wider spread to tissues near the breast. Since the entire tumor must be removed to learn the T category, this information is not given for needle biopsies.

    The N category indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are affected. Higher numbers after the N indicate more lymph node involvement by cancer. If no nearby lymph nodes were removed to be checked for cancer spread, the report may list the N category as NX, where the letter X is used to mean that the information is not available .

    The M category is usually based on the results of lab and imaging tests, and is not part of the pathology report from breast cancer surgery. In a pathology report, the M category is often left off or listed as MX .

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    How Does Tumor Grade Affect A Patients Treatment Options

    Doctors use tumor grade and other factors, such as cancer stage and a patients age and general health, to develop a treatment plan and to determine a patients prognosis . Generally, a lower grade indicates a better prognosis. A higher-grade cancer may grow and spread more quickly and may require immediate or more aggressive treatment.

    The importance of tumor grade in planning treatment and determining a patients prognosis is greater for certain types of cancer, such as soft tissue sarcoma, primary brain tumors, and breast and prostate cancer.

    Patients should talk with their doctor for more information about tumor grade and how it relates to their treatment and prognosis.

    Selected Reference
  • American Joint Committee on Cancer. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer 2010.

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    Reproducibility Of Mitotic Count

    In the entire series of 306 cases, the matched-pair determinations by the two independent observers on individual tumors showed very high interobserver reproducibility for both MAI and MI . Consequently, for basic and clinical analyses, the mean of the variable evaluations of the two observers was used. Moreover, a high correlation was observed between MAI and MI values .

    FIGURE 1

    Finally, in multivariate analysis using a Cox regression model containing tumor size, estrogen receptor level and menopausal status, both mitotic indices maintained their independent prognostic relevance on overall survival .

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    Mortality Rates Versus Number Of Breast Cancer Deaths

    Sometimes its useful to have an estimate of the number of people expected to die from breast cancer in a year. This numbers helps show the burden of breast cancer in a group of people.

    Numbers, however, can be hard to compare to each other. To compare mortality rates in different populations, we need to look at mortality rates rather than the number of breast cancer deaths.

    What Is My Breast Cancer Stage

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    A Stage is not always listed in pathology reports because it is derived from the results of the biopsy of the tumor tissue, any biopsies of the lymph nodes and other tests. These biopsies and some pathology tests may not be done at the same time. Thus, you may have more than one report that gives information on staging. Your medical team combines all the pathology information with any scans and determines the breast cancer stage.

    A complete pathology report will not be ready until you have the definitive surgery to take out all the breast cancer and one or more of the underarm lymph nodes to check for possible signs of cancer there. Over several days to a couple of weeks, this tissue is tested to create that final report. You may even receive a few reports as various tests are done.

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    What Is The Normal Mitotic Rate

    Mitotic activity should be recorded as an average of more than 10 hours per day . A sufficient number of fields should be counted in order to calculate a statistically meaningful average. In most cases, 30 hpf is sufficient, although 50 or more hpf may be required on occasion.

    The normal human breast has approximately 600-1000 epithelial cells in each square millimeter. At puberty, the number of epithelial cells increases to about 3000 per square millimeter. After menopause, the number of epithelial cells decreases again to about 1000 per square millimeter.

    In general, the higher the mitotic rate, the greater the risk of cancer development. However, this relationship does not apply to all types of cancers for example, increased rates of proliferation are seen in skin lesions such as melanomas but not sarcomas such as fibrosarcomas. Also, some cancer treatments can increase the rate of cell division and thus promote tumor growth. Finally, some types of cancer have been shown to undergo endoreplication , which could account for increased numbers of mitotic figures if no further division occurs.

    It is important to recognize that elevated levels of mitosis do not always indicate cancer. For example, high levels of mitosis can be found in benign tumors such as lipomas and sebaceous cysts.

    What If My Report Mentions Sentinel Lymph Node

    In a sentinel lymph node biopsy, the surgeon finds and removes the first lymph node to which a tumor drains. This lymph node, known as the sentinel node, is the one most likely to contain cancer cells if they have started to spread. This procedure may be done during surgery to remove a breast cancer. It is a way to check for the spread of cancer to underarm lymph nodes without removing as many of them.

    The sentinel lymph node is then checked to see if it contains cancer cells. If there is no cancer in the sentinel node, it’s very unlikely that the cancer has spread to other lymph nodes, so no further lymph node surgery is needed.

    If a sentinel lymph node does contain cancer, your report will say that cancer was present in the lymph node. It may also say how large the deposit of cancer cells is. In some cases, if cancer is found in a sentinel lymph node, you may then also need additional treatment such as surgery to remove more underarm lymph nodes or radiation therapy to the underarm region. You should discuss this with your doctor.

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    Mai Assessment On Wsi

    Glass slides were scanned using a Leica Scanner SCN400 at 40×. The standard image viewer for Leica Scanner Digital Image Hub was used for annotating and exploring WSI. WSI were displayed on high resolution 30 Barco Pathology Displays having a resolution of 6 MP. Examining WSI on 40×, in an area of 2 mm2, about 7 screen fields fitted into the same 2 mm2 area annotated before on the glass slides. Each observer was asked to annotate all the mitotic figures that he could detect within this area. Afterwards mitoses annotations were counted for each observer separately. Figure 1 is a snapshot from a WSI of an invasive breast cancer showing the selected areas for counting mitosis digitally and microscopically in addition to the digitally annotated mitotic figures within a 2 mm2 area.

    What If My Report Mentions Lymph Nodes

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    If breast cancer spreads, it often goes first to the nearby lymph nodes under the arm . If any of your underarm lymph nodes were enlarged , they may be biopsied at the same time as your breast tumor. One way to do this is by using a needle to get a sample of cells from the lymph node. The cells will be checked to see if they contain cancer and if so, whether the cancer is ductal or lobular carcinoma.

    In surgery meant to treat breast cancer, lymph nodes under the arm may be removed. These lymph nodes will be examined under the microscope to see if they contain cancer cells. The results might be reported as the number of lymph nodes removed and how many of them contained cancer .

    Lymph node spread affects staging and prognosis . Your doctor can talk to you about what these results mean to you.

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