Knowing your Pathology

Nottingham Histologic Score

The Nottingham histologic score is a scoring system to assess the "grade" of breast cancers.

It is a total score based on 3 different sub-scores. The 3 sub-scores are determined based on three components of how the breast cancer cells look under a microscope. Each of the three components is assigned a sub-score of 1, 2, or 3 (1 being best and 3 being worst). A Nottingham score is achieved by adding the three sub-scores, with a minimum score possible of 3 (1+1+1) and a maximum of 9 (3+3+3).

Histologic Grade

  • Grade I (low grade or well differentiated) refers to Nottingham scores of 3, 4, and 5. These cancer cells look a bit different from normal cells and are usually slow-growing.
  • Grade II (intermediate/moderate grade or moderately differentiated) refers to Nottingham scores of 6 and 7. These cancer cells do not look like normal cells and are growing a little faster than normal.
  • Grade of III (high grade or poorly differentiated) is assigned to any patient with a Nottingham score of 8 or 9. These cancer cells look very different from normal cells and are fast growing.

The Nottingham score and histologic grades do not alter or determine final overall treatment recommendations and thus are of little use in the big picture and not used in making clinical decisions. (It may be noted that high-score cancers tend to relapse more often than low-score cancers.)


Breast Cancer Stages

Click Here for an overview of what "cancer staging" means 

A lymph node biopsy and the invasiveness and size of your tumor determines your initial stage

Stage 0    

Cancer cells remain inside the breast duct, without invasion into normal adjacent breast tissue.

Stage IA    

The tumor measures up to 2 cm AND the cancer has not spread outside the breast; no lymph nodes are involved

Stage IB    

There is no tumor in the breast; instead, small groups of cancer cells -- larger than 0.2 millimeter but not larger than 2 millimeters – are found in the lymph nodes OR there is a tumor in the breast that is no larger than 2 centimeters, and there are small groups of cancer cells – larger than 0.2 millimeter but not larger than 2 millimeters – in the lymph nodes.


Stage IIA    

No tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm) 
OR the tumor measures 2 centimeters or smaller and has spread to the axillary lymph nodes OR 
the tumor is larger than 2 but no larger than 5 centimeters and has not spread to the axillary lymph nodes.

Stage IIB    

The tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodes 
OR the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes.


Stage IIIA    

No tumor is found in the breast. Cancer is found in axillary lymph nodes that are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone OR the tumor is any size. Cancer has spread to the axillary lymph nodes, which are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone.

Stage IIIB    

The tumor may be any size and has spread to the chest wall and/or skin of the breast 
AND may have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone. Inflammatory breast cancer is considered at least stage IIIB.

Stage IIIC    

There may either be no sign of cancer in the breast or a tumor may be any size and may have spread to the chest wall and/or the skin of the breast 
AND the cancer has spread to lymph nodes either above or below the collarbone 
AND the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone.


Stage IV 

The cancer has spread — or metastasized — to other parts of the body.

Click Here for additional pathology report information from breastcancer.org