Help!

Is it abbreviated? Most pathology is about size,  grade,  type ER+/-, PR +/-  and if positive a number out of 8 (eg. 7/8), HER2 +/-,  nodes (number and size of sentinels and if clear, extracapstular spread etc,  any areas of DCIS, if LVI present/ not present etc.  I was given my surgeons report (by accident I think!)  which also mentioned things like hot and blue (radioactive and dyed) for the nodes,  type of sutures,  weight of tissue removed,  pain block used etc. 

I am not sure what you mean when you say, "non medical answer." Are you trying to find out what the terms and language in the resport mean? If so, here is some information that might help.

There are different types of breast cancer. Some breast cancers are sensitive to and responsive to certain hormones, so that pathologist would determine if this is the case, and if so, the level of responsiveness of the cancer cells to these hormones. As Londonmumof2 said, they use a scale that goes from 0 (not responsive at all) to 8 (highest level of response.)

"ER" stands of Oestrogen Receptor (American spelling Estrogen) and "PR" stands for Progesteron Receptor. The numbers attached to ER and PR would tell you the level of sensitivity to each of these hormones. HER2 is a type of protein that may or may not be involved and is tested for.

The grade of cancer determines how different the cells are to normal cells, and how fast growing they may be. The scale for this goes from 1 to 3.

The treatment path will be forumlated based on all of the above factors as well as on the stage of the cancer, meaning, how contained or spread the cancer is. This link will give you a bit more information about the above and a few other things:

https://www.nhs.uk/common-health-questions/operations-tests-and-procedures/what-do-cancer-stages-and-grades-mean/ 

If by "non medical answer" you actually meant something else, please tell us.

Thanks, I had researched that bit :) it what the (TPM) format means in laywoman's terms ..... The Dr did not say, (he was shadey about saying anything btw) & I was too shocked to ask, and he got funny about absolutely any question I asked after that, like what is the likely timeframe to the op?

Hi Tia, the TPM format relates to how the cancer cells look under the microscope and is used to grade the cancer (completely different from the TNM format that is used to stage the cancer).

As the TPM format is a pathological one it's not easy to explain what the letters/numbers mean in a non-medical way as they refer to how different the cancer cells look compared to normal cells but here's some info I found when I was looking at my own pathology report. The categories are each scored from 1 to 3, with 1 meaning that the cancer cells appear relatively normal and 3 meaning that they are very different to normal cells: 

T = Tubule formation, which is the percentage of tubular structures within the cells. 

P = Nuclear Pleomorphisim, which relates to the changes to the size/shape of the cells. 

M = Mitosis count, which relates to how much the cells have divided.

The higher the scores the higher the grade of the cancer. I scored T3 P3 M2 so my cancer is Grade 3 as I have a total score of 8. 

So in simple terms the TPM formula is just something that the pathologist uses to work out what grade the cancer is. Does that help? You will receive a lot of information after a diagnosis and things can get confusing but the thing to bear in mind is that your treatment plan will be tailored specifically to you and your cancer type, and will be dependent on lots of different things such as how receptive the cancer is to hormones, the size, whether it has spread, your age/general health etc, not just the grade. If you have been allocated a designated nurse they should hopefully be able to explain things in a less medical way so don't be afraid to ask them if you are not clear about anything. Hope your treatment goes well, and there is a lot of support on this forum if you need it. 

Hi LalaLou, 

Thank you  x  for explaining this, yes - very helpful x is this serious?

Obs Grade 3 cancer is not great, but is the (T3 P3 M2) good? treatable? likely survival rate? (I've not been informed of any of this btw) it doesn't read well imo. Results also said HER-2 (4B5) negative - I'm not sure if this is a good thing or not.

I haven't got a treatment plan yet & I have no idea when they will contact me either - although I may phone up on Monday - (although when I phoned before the person answering the phone was far from 'helpful' ie ranted for 10 mins about how busy she was - which has somewhat put me off completely having to phone up!)

So  atm, I don't have a treatment plan,  or a ?nurse?  & have no idea of timescales moving forward, either - all really helpful right? Dreading talking to the HR dragons at work on Monday :( 

Thank you once again for explaining this x I hope your treatment goes well x and wishing you & yours every success going forward x

Caz x

Hi Caz (just realised I mistook Tia as your name. Doh!) Similar to your experience I have found that it's not always easy to get answers to all questions, plus there will be a multi disciplinary team (MDT) involved in your treatment and as things move on you will likely speak to a variety of different people - surgeon, consultant, clinical oncologist, medical oncologist etc - who can sometimes only speak in relation to their particular 'area of expertise'. The MDT process can also result in delays sometimes as the results tend to be discussed at weekly meetings and you won't be given information until after the meetings have been held. Ideally someone should go through the details of the pathology report with you but it didn't happen with me, I was just sent the pathology report because I asked for it.  Timescales can be difficult to predict though, particularly during the initial stages after diagnosis, as sometimes other tests will be needed. Some hospitals seem better than others in terms of timings, communication etc so the best advice I can give is to just take things a day at a time and chase up appointments if you are having delays.

I'm also HER negative and I was told that this is a good thing in terms of potential treatment options. Grade 3 isn't the best result but it is treatable and there are lots of us on here who are Grade 3 and doing well. I was told that my cancer is curable so I haven't gone down the route of asking about a likely survival rate. My treatment plan involved surgery to remove the cancer and I'm now going through the various treatments that are aimed at preventing a recurrence - hormone therapy, radiotherapy etc. Have you just had an initial biopsy and no surgery yet? If so you may find that the pathology report following surgery differs from the initial pathology report so don't get too fixed on what the initial report says, plus treatment plans can also change as time goes on.

In terms of talking to HR I found that early on it was difficult to provide any 'concrete' information other than to say that you have had a diagnosis and will need treatment, but hopefully they will be supportive. Don't be afraid to take time off if you feel that you need it as there is a lot to take in mentally, in addition to physically when the treatment starts, and I have found the whole process, which has been going on for nearly a year now, exhausting. You need to look after yourself as best you can but keep us posted about how you are doing as there are others here in the same position as you who can offer friendly advice and support as you go through your treatment x

Hi LalaLou, 

Wow, (hugs) what a roller coaster for you, and nearly a year .... and still going through it all .... oh my goodness, it sounds exhausting, let alone 'living it'. Hugs, strength & a full recovery to you x

I've only had the imagery & aspiration, & path lab results. Waiting on the 'one stop' clinic now, for the rest of everything, see if / what / when the hideous reception dragon gets back to me.

The thing with taking time off ... well, it is challenging, but very necessary, I am a key worker in an engineering field, and currently, the company (its NOT a government company / agency / organisation) Basically I get 3 days paid a year, then its SSP, use your holiday or it's unpaid. Although the paid sick is going up to 5 days from April 2022, I'll be needing a bit more time off that that I suspect. HR were completely and utterly appalling to a colleague who had cancer (when I joined the company - 3 years ago), he is now with harps & halos x.

I truly doubt if HR will be at all supportive, ie anything more than what they legally 'Have' to do, and even then I strongly suspect I'll have to know ALL the in's & out's, so they don't try and blindside me, or coerce me into stuff that really should not be so. Which is another reason why I am dreading communicating with HR, I might do an email, with the barest of bones in it, as I really can not face conversing with them. Oh well I'll just have to woman up & 'do it'.

Anyway can't grumble too much, at least in this country we have SSP :) Although that will get consumed very quickly (even just bare necessities') with the direction of the cost of living atm, even just fuel getting to hospital appts! 

Wishing you every success in your recovery journey x

Hi Greycats, 

Thank you for your reply, and clear explanation :)

My ER QS is 8, & PR QS 7, so these are the highest responses :( crickey, sounds a tad ominous.

Just curious, what does the LETTER-number-letter preceding the ER & PR ratings refer to?

Tia. & thank you once again.

Unknown said:

what does the LETTER-number-letter preceding the ER & PR ratings refer to?

I need to see it; not sure I know what you mean.

About the high numbers: when I see such high numbers I always get the idea that since the cancer relies so much on these hormones, then depriving it of these hormones will have big impact on its ability to keep going. I have never explored this theory because my own cancer is not hormone sensitive; it's just what comes to mind and may be worth checking with your team.

About HR. There is a section here on the Macmillan site where you can post a question to an expert, and they will respond and guide you. There are also a couple of booklets that Macmillan produces, one for patients and one for employers, to do with this. Additionally, Maggie's offer advice and support in a face-to-face setting. I have had a lot of help from their benefits expert, who made sure I got everything I was entitled to as well as some travel grants. I would very much recommend making contact with either or both Macmillan and Maggie's, and if Maggie's in your area is the same as it is at mine, their expert will help you formulate the email to HR and stay with you throughout the process to make sure HR are kept on the straight and narrow.

Hi Caz, I've had a look at my pathology report and like Greycats I'm not sure about the letter,number, letter preceding the ER & PR ratings - what do these say in your report? I'm ER-8 and that means that my cancer is strongly receptive to oestrogen - in simple terms the hormone is 'feeding' the cancer and helping it to grow/spread. I am now on hormone tablets to reduce the amount of oestrogen I produce to help stop the cancer coming back. There are different options available dependant on whether you are pre or post menopause.

As already posted, Macmillan will be able to provide advice about work and financial related issues so give them a call if you have any problems. Might be best to contact HR via email as that way you will have an audit trail if there are any issues later. Hope you can get an appointment soon to talk through your pathology results and treatment plan as I found that things seemed better once you know what is happening x