Mastectomy specimen containing a very large<unk>  ductal carcinoma of the breast. To the right, the nipple can be seen on the pink skin, while in the center of the picture a large blue and pink swelling or tumor can be seen. Blood stained fat tissue is seen at the cut margins. gross) appearance of the cut surface of a mastectomy specimen containing an<unk>  ductal carcinoma of the breast (pale area at the center). Tumor size Tumors under 1 cm in diameter are unlikely to spread systemically. Tumors are staged by size. Diameter Tumor size staging number 0–5 mm T1a 5–10 mm T1b 10–20 mm T1c 20-50mm T2 >50 mm T3 Tumor involves skin or chest wall T4 Lymph node involvement Absence of cancer cells in the lymph nodes is a good indication that the cancer has not spread systemically. Presence of cancer in the lymph nodes indicates the cancer may have spread. In studies, some women have had presence of cancer in the lymph nodes, were not treated with chemotherapy, and still did not have a systemic spread. Therefore, lymph node involvement is not a positive predictor of spread. Lymph node status Lymph node involvement grade No involved nodes N0 Involved node or nodes N1 Involved nodes that are fixed to one another N2 Clinical staging Tumor size staging and node involvement staging can be combined into a single clinical staging number. Tumor size staging Node involvement staging Clinical stage T1 N0 I T1 N1 IIA T2 N0 IIA T2 N1 IIB T3 N0 IIB T1-T2 N2 IIIA T3 N1 IIIA T3 N2 IIIA T4 N0-N2 IIIB Histopathologic criteria Carcinomatous cells are seen below the basement membrane of lactiferous ducts. Otherwise, there are no specific histologic characteristics, essentially making it a diagnosis of exclusion. Image:Muc1.Invasive ductal carcinoma of the Breast assayed with anti Mucin 1 antibody. Image:HER2(2).Breast cancer (Infiltrating ductal carcinoma of the breast) assayed with anti HER-2 (ErbB2) antibody. Image:Breast<unk>  scirrhous carcinoma histopathology (1).Histopathology of<unk>  ductal carcinoma of the breast representing a scirrhous growth. Core needle biopsy. Hematoxylin and eosin stain. Image:IDC1.Invasive ductal carcinoma of the breast. H&E stain. Image:Breast<unk>  scirrhous carcinoma histopathology (2) HER2 expression.Histopathology of<unk>  ductal carcinoma of the breast representing a scirrhous growth. Core needle biopsy. HER-2/neu oncoprotein expression by Ventana immunostaining system. Image:H&E 10x<unk>  ductal.Histopathology of<unk>  ductal carcinoma of the breast. H&E stain. File:Invasive ductal carcinoma, with occasional entrapped normal ducts.Invasive ductal carcinoma, with occasional entrapped normal ducts (arrow) Grading The appearance of cancer cells under a microscope is another predictor of systemic spread. The more different the cancer cells look compared to normal duct cells, the greater the risk of systemic spread. There are three characteristics that differentiate cancer cells from normal cells. # Tendency to form tubular structures # Nuclear size, shape, and staining intensity # Mitotic rate - Rate of cell division The histologic appearance of cancer cells can be scored on these three parameters on a scale from one to three. The sum of these grades is a number between 3 and 9. The score is called a Bloom Richardson Grade (BR) and is expressed sum of the grades/9. For example, cells that were graded 2 on all three parameters would result in a BR score of 6/9. A score of 5 and under is considered Low. 6 to 7 is considered Intermediate. 8 to 9 is considered High. Vascular invasion The presence of cancer cell in small blood vessels is called vascular invasion. The presence of vascular invasion increases the probability of systemic spread. DNA analysis DNA analysis indicates the amount of DNA in cancer cells and how fast the cancer is growing. Cells with the normal amount of DNA are called diploid. Cells with too much or too little DNA are called aneuploid. Aneuploid cells are more likely to spread than diploid cells. DNA testings indicates the rate of growth by determining the number of cells in the synthetic phase (S Phase). An S Phase > 10% means a higher chance of spreading. The results of DNA testing are considered less reliable predictors of spread than size, histology, and lymph node involvement.
Invasive carcinoma of no special type
Verrucous carcinoma
Basal-like carcinoma
Lymphoepithelioma-like carcinoma
Mucinous carcinoma
Sarcomatoid carcinoma
Ductal carcinoma in situ
Carcinoma ex pleomorphic adenoma