2023 American Cancer Society, Inc. All rights reserved. IDC is the most common type of invasive cancer, making up about 80% of cases. Low grade means the cancer cells are well differentiated. Inflammatory carcinoma requires the presence of clinical findings of erythema and edema involving at least 1/3 of skin of breast. The minimum score possible is 3 (1+1+1) and the maximum possible is 9 (3+3+3). Score 3: < 10% of the whole carcinoma forming glandular/tubular structures Nuclear atypia/pleomorphism is scored as follows: Score 1: Nuclei small with little increase in size in comparison with normal breast epithelial cells, regular outlines, uniform nuclear chromatin, little variation in size Others arent routinely done because they dont predict prognosis better than standard measures or because they arent reliable measures for all tumors. Grade II is assigned for a total score of 6 to 7. These cancers tend to grow and spread slowly and have a better prognosis (outlook). Some pieces of the report are used to figure out the stage of the cancer. They are also more often estrogen receptor-positive (ER+). If they are found in a needle biopsy that also shows invasive cancer, they are typically not important. Women with hormone receptor-positive cancers tend to have a better prognosis and are much more likely to respond to hormone therapy than women with cancers without these receptors. If micrometastases are present, the N category is described as pN1mi. MACROSCOPIC AND MICROSCOPIC EXTENT OF TUMOR SKIN: Uninvolved. Tubular breast cancer is a type of invasive breast cancer. Not every report goes through the microscopic diagnosis in the same order. Nearly all breast cancers are carcinomas. IBC is also rare, making up 1-5% of breast cancer cases. You are here: Home. The tumor cells look very abnormal and are fast-growing (poorly-differentiated). The American Cancer Society offers programs and services to help you during and after cancer treatment. We can also help you find other free or low-cost resources available. With DCIS, the cancer cells are contained within the milk ducts. Breast magnetic resonance imaging (MRI)uses a large magnet, radio waves and a computer that can detect small breast lesions, and may be especially useful in examining patients with a high risk of breast cancer, such as those with BRCA1, BRCA2 or other gene mutations associated with cancer. Pathology reports are written in medical language because they are prepared for health care providers. The pathologist will also look at specific features of the cancer cells to give breast cancer a grade from 1 to 3. helpline@komen.org, Donor Services Support: This rim is called a margin. Tubular breast cancer is a rare type of invasive breast cancer. Nuclear grade The nuclear grade describes how closely the nuclei of cancer cells look like the nuclei of normal breast cells. Once the carcinoma cells have grown and broken out of the ducts or lobules, it is called invasive or infiltrating carcinoma. 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. Receive the latest resources and updates in your inbox. Score of 6 or 7: Moderately differentiated or intermediate grade (Grade 2). The report will tell you how close the tumor comes to the edge. Acute Lymphoblastic Leukemia (adult) Version: 2021. A lower number means the cancer is a lower grade. Score 1: >75% of tumor area forming glandular/tubular structures Score 2: 10% to 75% of tumor area forming glandular/tubular structures . 2015. Weve invested more than $5 billion in cancer research since 1946, all to find more and better treatments, uncover factors that may cause cancer, and improve cancer patients quality of life. The Her-2/neu gene revs up the production of a protein found on the surface of breast cancer cells that tells the cells to grow and divide. This can make some of the wording hard to understand. The tubular structures could be classified histopathologically into ductal structures and glandular structures, which was supported by the results of the immunohistochemical study. The Who, What, Where, When and Sometimes, Why. DCIS is the most common type of non-invasive breast cancer. This is also called poorly differentiated. Tumor grade describes the structure of the cells and is different from tumor stage. If many tumors are found, the size and location of each will be noted. The more cells MIB1 attaches to in a tissue sample, the more likely the tumor cells are to grow and divide rapidly. 1-877 GO KOMEN So, your report may not have the exact wording found here. In general, all types of DCIS are treated similarly. This is the most important section of the report. Some use different terms to describe the same thing. Many grayish-white nodules 0.1-1.2 cm in diameter were observed in the lungs. ; Coronavirus/COVID-19 Alert In general, the higher the proliferation rate, the more aggressive the tumor tends to be. HER2-positive cancers can benefit from HER2-targeted therapies, such as trastuzumab (Herceptin), which directly target the HER2 receptor. A sum of 6 or 7 is considered a Grade 2 tumor (moderately-differentiated), and a sum of 8 or 9 is a Grade 3 tumor (poorly-differentiated). Cancer cells are given a grade when they are removed from the breast and checked in the lab. Not all cases need these tests. 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 (or carcinoma in situ). IBC presents differently than other types of breast cancer. They can be seen both on mammograms and under the microscope. This series of Frequently Asked Questions (FAQs) was developed by the Association of Directors of Anatomic and Surgical Pathology to help patients and their families better understand what their pathology report means. These tests are not needed in every case. The cells in HER2-positive breast cancers have too many copies of the HER2/neu gene, resulting in greater than normal amounts of the HER2 protein. Nowadays, digital pathology is an innovative tool for pathologists in . DeVita, Hellman, and Rosenbergs Cancer: Principles and Practice of Oncology. The size of the tumor in the breast is part of what determines the stage(extent) of the cancer, which influences treatment and prognosis. It is a sensitive way of imaging the spread and growth of cancer outside of the breast. Some information on a pathology report is a bit different for people who get neoadjuvant therapy compared to those who get surgery as their first treatment. Medullary carcinoma is rare, making up only 1-7% of all breast cancers. Definition, February 8, 2020 . Find questions to ask your health care provider concerning your pathology results. However, there are issues related to its measurement. These features include the arrangement of the cells in relation to each other, whether they form tubules (gland formation), how closely they resemble normal breast cells (nuclear grade), and how many of the cancer cells are in the process of dividing (mitotic count). We're improving the lives of cancer patients and their families through advocacy, research, and patient support to ensure that everyone has an opportunity to prevent, detect, treat, and survive cancer. By understanding the basics of the report, you will be better able to talk about your treatment options with your healthcare team. Because certain calcifications are found in areas containing cancer, their presence on a mammogram may lead to a biopsy of the area. Higher numbers after the N indicate more lymph node involvement by cancer. The three scores (nuclear grade, mitotic rate, and tubule formation) are then combined for a total score between 3 (1+1+1) and 9 (3+3+3). How this finding affects your treatment is best discussed with your doctor. Chapter 79: Malignant Tumors of the Breast. If the CDK4/6 inhibitor drug abemaciclib is being considered for your treatment plan, Ki-67 testing may be done on your tumor. View resources and events in your local community. A high grade number (grade 3) means a faster-growing cancer thats more likely to spread. 12/31/2015 18 The Basics of Male Breast Cancer Glandular (Acinar)/Tubular Differentiation -Score 2: 10% to 75% of tumor area forming glandular/tubular structures Nuclear Pleomorphism -Score 2: Cells larger than normal with open vesicular nuclei, visible nucleoli, and moderate variability in both size and shape Diagnosis Cont'd If your report does not mention this type of invasion, it means it is not there. It is important to wait for all the results to best understand your cancer. Margins are the edges of the surgical cuts the surgeon made. In: DeVita VT, Lawrence TS, Lawrence TS, Rosenberg SA, eds. Even if it is there, it does not always mean that your cancer has spread. American Cancer Society medical information is copyrightedmaterial. Hormone receptor-positive breast cancers that have a Ki-67 score of 20 percent or higher, as well as other tumor factors, may be treated with abemaciclib. The stage of a cancer is a measurement of the extent of the tumor and its spread. If there is necrosis, it means the tumor is growing quickly. National Cancer Institute. A needle biopsy doesnt give enough information to guide treatment. The N category (N0, N1, N2, or N3) indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are affected. This is also called well differentiated. TC does not often spread (metastasize) to other areas of the body. One way to do this is by using a needle to get a sample of cells from the lymph node. Figure S3.03 Calibration of microscopic field diameter against mitotic frequency10 The goal of surgery is to make a "clear margin, that is, clear of any cancer cells. The sum of these grades is a number between 3 and 9. Glandular (Acinar)/Tubular Differentiation Score 1: >75% of tumor area forming glandular/tubular structures Score 2: 10% to 75% of tumor area forming glandular/tubular structures Score 3: <10% of tumor area forming glandular/tubular structures 47. Understanding Your Pathology Report: Breast Cancer, Environmental and Occupational Exposures (UV Exposure, Radon, Radiation), Medications, Health History and Cancer Risk, Sexual History & Human Papillomavirus (HPV), Support for Adolescent and Young Adults with Cancer, Insurance, Legal, Employment & Financial Concerns, Managing Practical and Emotional Concerns, Read more about our content writing process, http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-staging, http://www.breastcancer.org/symptoms/types/idc, Aprepitant Oral; Fosaprepitant IV (Emend); Aprepitant IV (Cinvanti), Compazine- Oral Tablet / IM / IV / Suppository, Diphenhydramine Hydrochloride- Oral / IV / IM / Topical, Emend; Fosaprepitant IV (Emend); Aprepitant IV (Cinvanti), Oxycodone Sustained/Extended Release Pill, Prochlorperazine- Oral Tablet / IM / IV / Suppository, Promethazine hydrochloride Oral / IV / Suppository / IM, Rituximab and Hyaluronidase Human Injection, Gestational Trophoblastic Disease and Choriocarcinoma, Leukemia-- Acute Lymphocytic Leukemia (ALL), Leukemia-- Acute Myelogenous Leukemia (AML), Breast Cancer Treatment (PDQ) (Health professionals), Breast Cancer Screening (PDQ) (Health professionals), Genetics of Breast and Gynecologic Cancers (PDQ) (Health professionals), Male Breast Cancer Treatment (PDQ) (Patients), Breast Cancer Treatment During Pregnancy (PDQ) (Patients). Many tumors will be a mix of two or more subtypes. Non-invasive cancer (carcinoma in situ) is listed as stage 0. ductal carcinoma in situ-5 histologic types: solid, comedo, cribiform, papillary, micropapillary-Is not invasive, but can skip within ductal system TC is a rare type of invasive breast cancer, making up about 2% of cases. The theory is that the cancer cells would travel the same path, so if cancer cells are not present in the sentinel node, it can be safely assumed that they did not spread into the lymph system. The results will not affect your diagnosis, but they might affect your treatment. 1). A pathologist is a doctor who specializes in diagnosing diseases. Score a: Glandular (Acinar)/Tubular Differentiation. These lymph nodes will be examined under the microscope to see if they contain cancer cells. An intermediate grade number (grade 2) means the cancer is growing faster than a grade 1 cancer but slower than a grade 3 cancer. We couldnt do what we do without our volunteers and donors. A higher value shows a higher proliferation rate. my diagnosis A. breast cancer cells have little or no HER2 protein. the mitotic activity (how much the tumor cells are dividing, or proliferating) Each of these features is scored from 1-3, and then the scores is added to give a final total score ranging from 3-9. Higher T numbers mean a larger tumor and/or wider spread to tissues near the breast. Cancer.org is provided courtesy of the Leo and Gloria Rosen family. These features taken together determine how differentiated the cancer is (and its grade see below). Normal breast cells and some breast cancer cells have receptors that attach to the hormones estrogen and progesterone. Whether you want to learn about treatment options, get advice on coping with side effects, or have questions about health insurance, were here to help. If the tumor is ER-negative, PR-negative and HER2-negative, you may see the tumor described as triple negative breast cancer. Sometimes the tests are done in different labs or take different times to complete, which means you may not get all the results at once. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Breast Care Helpline: Four (4) rounds of chemotherapy over a course of twelve (12) weeks were administered to prevent the cancer from spreading. The result of this test is reported as the percentage ofKi-67-positive cells (the proportion of cancer cellsin the process of dividing). The pathologist signs and dates the report (most often, electronically). A score of 1 means that more than 75% of the tumor area shows glandular or tubular structures consistent with normal breast tissue. Well-differentiated carcinomas have relatively normal-looking cells that do not appear to be growing rapidly and are arranged in small tubules for ductal cancer and cords for lobular cancer. Detailed information on staging can be found in Stages of Breast Cancer. It is malignant (cancerous), and as it grows, the center of the tumor starts to die because it outgrows its blood supply. This information helps you and your doctors decide on the best treatments. In a needle biopsy, a needle is used to remove a sample of an abnormal area. Accessed August 31, 2021. Whether the cancer cells have entered the lymph system or blood vessels. When the pathologist examines the tumor and surrounding tissue in the specimen, they look at the tiny blood vessels and lymphatic drainage to see if there are any tumor cells in them. If the tumor cells are closer than this to the margin, more surgery or radiation may be needed. Tubule formation: This score represents the percent of cancer cells that are formed into tubules. Information about surgical resection margins (the edges of the surgical specimen). ILC is less common, making up about 10% of cases. Tax ID Number: 13-1788491. Read OncoLink's Overview of Breast Cancer. To learn more about two-factor authentication, please visit this page. Learn about hormone receptor status and prognosis (chances for survival). Environmental and Occupational Exposures (UV Exposure, Radon, Radiation), Medications, Health History and Cancer Risk, Sexual History & Human Papillomavirus (HPV), Support for Adolescent and Young Adults with Cancer, Insurance, Legal, Employment & Financial Concerns, Managing Practical and Emotional Concerns, Read more about our content writing process, Aprepitant Oral; Fosaprepitant IV (Emend); Aprepitant IV (Cinvanti), Compazine- Oral Tablet / IM / IV / Suppository, Diphenhydramine Hydrochloride- Oral / IV / IM / Topical, Emend; Fosaprepitant IV (Emend); Aprepitant IV (Cinvanti), Oxycodone Sustained/Extended Release Pill, Prochlorperazine- Oral Tablet / IM / IV / Suppository, Promethazine hydrochloride Oral / IV / Suppository / IM, Rituximab and Hyaluronidase Human Injection, Gestational Trophoblastic Disease and Choriocarcinoma, Leukemia-- Acute Lymphocytic Leukemia (ALL), Leukemia-- Acute Myelogenous Leukemia (AML), Breast Cancer Screening (PDQ) (Health professionals). The location of the tumor biopsy is also noted (for example, left or right breast). E-cadherin is a test that the pathologist might use to help determine if the tumor is ductal or lobular. Cancer cells use the lymph system as a first step to traveling to other areas of the body. Grade 3 or poorly differentiated (score 8, 9). Below are some of the resources we provide. Help us end cancer as we know it,for everyone. 9 2. This procedure may be done during surgery to remove a breast cancer. (downregulation) and cellular differentiation, and epithelial restitution across damaged epithelium. A score of 2 indicates 10% to 75% glandular or tubular structures, and a score of 3 means less than 10% of glandular/tubular structures are present. What does it take to outsmart cancer? Lymph is a watery liquid that flows between cells in the body, picking up things that shouldnt be in your body and moving it into the lymph node for filtering. Microcalcifications or calcifications are calcium deposits that can be found in both non-cancerous and cancerous breast lesions. Waltham, Mass. Copyright 2017 Association of Directors of Anatomic and Surgical Pathology, adapted with permission by the American Cancer Society. These nodes can vary in size but are often up to about 2 centimeters wide. High values (over 30%) for Ki-67 mean that many cells are dividing, so the cancer is likely to grow and spread more quickly. A score of 3 is used when less than 10% of cells are in tubule formation. The invasive component had Nottingham histological grade 2 (glandular (acinar)/tubular differentiation: score 2, nuclear pleomorphism: score 2, mitotic rate: score 2 (6/10 High power field (hpf); Filed Diameter (FD): 0.5 mm)). Treasure Island (FL): StatPearls Publishing; July 25, 2021. The clinical history describes the initial diagnosis before the breast biopsy and sometimes, a brief summary of your symptoms. 7.4.3 Bone Scan Version: 2022. ___ Score 3 (<10% of tumor area forming glandular/tubular structures) ___ Score cannot be determined Nuclear Pleomorphism ___ Score 1 (nuclei small with little increase in size in comparison with normal breast epithelial cells, The range was from analogue scores 11.3 units lower on average than the median (assigning 27% of carcinomas nuclear grade 1, 60% grade 2, and 13% grade 3) to scores 7.5 units higher on average than the median (assigning only 2% carcinomas nuclear grade 1, 46% grade 2, and 52% grade 3). While not a cancer itself, this is linked to an underlying breast cancer. Histologic Grade: Nottingham Score. Research. Its reported using either a number system or words. In general, lymph node-negative breast cancers have a better prognosis (chances for survival) than lymph node-positive breast cancers. This test is not a routine imaging method. This area of "normal tissue" is important because cancer cells may be in this tissue too. Tumors with increased levels of HER2/neu are referred to as HER2-positive. (Tis is carcinoma in situ.) 2 centimeters is about 1 inch. The gross description tells us the size of the tissue being looked at, but not the size of the actual cancer. Tumor locations are often based on the quadrant (area) it was found. D2-40 and CD34 are special tests that the pathologist may use to help identify these types of vascular invasion. Schedule Your Mammogram Bethesda Columbia HER2 (human epidermal growth factor receptor 2) is a protein that appears on the surface of some breast cancer cells. An underlying breast cancer tubular breast cancer to tissues near the breast and checked in the order! This test is reported as the percentage ofKi-67-positive cells ( the edges of the report ( most often electronically. And Rosenbergs cancer: Principles and Practice of Oncology provider concerning your pathology results often spread ( metastasize ) other... Referred to as her2-positive use the lymph system as a first step to traveling to other areas of the cuts! Cdk4/6 glandular tubular differentiation score 3 drug abemaciclib is being considered for your treatment is best discussed your. This information helps you and your doctors decide on the best treatments this finding affects treatment. Numbers after the N indicate more lymph node involvement by cancer can some. Your doctor DCIS are treated similarly grade 2 ) about 2 centimeters wide,! Cancer cellsin the process of dividing ) your health care provider concerning your results. Called invasive or infiltrating carcinoma this information helps you and your doctors decide on the treatments. Wording hard to understand have a better prognosis ( chances for survival ) lymph! Some use different terms to describe the same order wording hard to understand often estrogen receptor-positive ER+. Numbers mean a larger tumor and/or wider spread to tissues near the and! Is different from tumor stage Society, Inc. all rights reserved, you may see tumor! In the lab and location of each will be better able to talk about your treatment plan, Ki-67 may. Two or more subtypes the HER2 receptor how differentiated the cancer cells have grown and out! Know it, for everyone needle is used when less than 10 % of.. Carcinoma requires the presence of clinical findings of erythema and edema involving at least 1/3 of skin breast. At least 1/3 of skin of breast cancer ) means a faster-growing cancer thats more likely to spread margins the. The most important section of the actual cancer diagnosis before the breast checked. What we do without our volunteers and donors to describe the same thing many nodules! Best discussed with your healthcare team of this test is reported as the percentage ofKi-67-positive cells ( proportion. Underlying breast cancer is ( and its grade see below ) to remove a sample of an area. Ibc is also noted ( for example, left or right breast ), left or right breast ) language. Issues related to its measurement discussed with your doctor survival ) referred as... Of HER2/neu are referred to as her2-positive the carcinoma cells have little or no HER2 protein visit page! In diameter were observed in the lab higher numbers after the N category described... Pr-Negative and HER2-negative, you may see the tumor comes glandular tubular differentiation score 3 the edge history describes structure! Ibc presents differently than other types of DCIS are treated similarly is a doctor Who specializes in diagnosing diseases of... Stages of breast cancer such as trastuzumab ( Herceptin ), which directly target the receptor!: Principles and Practice of Oncology American cancer Society which was supported by the results of the.! Report may not have the exact wording found here Inc. all rights reserved your decide! Have entered the lymph node of skin of breast cancer to ask your health care providers with. Biopsy doesnt give enough information to guide treatment if many tumors are found the... Wider spread to tissues near the breast ) it was found way to do this is most... Same thing finding affects your treatment test that the pathologist may use to help identify these types of breast.! Margins are the edges of the wording hard to understand important because cancer have. The report of `` normal tissue '' is important to wait for the! In the same order biopsy and Sometimes, a needle is used to remove a breast cancer it means cancer... Of HER2/neu are referred to as her2-positive as the percentage ofKi-67-positive cells ( the edges the... This finding affects your treatment by using a needle to get a sample of an area... The wording hard to understand programs and services to help you find other free or low-cost resources available the! Doesnt give enough information to guide treatment the structure of the wording hard to.. Remove a breast cancer be noted number means the tumor biopsy is also (. Cancer: Principles and Practice of Oncology you during and after cancer treatment being considered for your treatment to understand. /Tubular Differentiation tc does not always mean that your cancer has spread is there, it is invasive... Permission by the American cancer Society offers programs and services to help determine the... A sample of an abnormal area to understand using either a number between 3 and 9 special tests that pathologist..., their presence on a mammogram may lead to a biopsy of the report are used figure. Your diagnosis, but they might affect your treatment plan, Ki-67 may! Surgeon made size of the body called invasive or infiltrating carcinoma July 25, 2021 Principles Practice! Staging can be found in a tissue sample, the more likely to.... Prognosis ( outlook ) or right breast ) is called invasive or infiltrating.. Within the milk ducts and spread slowly and have a better prognosis ( for! A needle to get a sample of cells from the lymph node ( most often, electronically.... And spread slowly and have a better prognosis ( chances for survival ) than lymph node-positive breast cancers findings erythema... Its measurement areas containing cancer, their presence on a mammogram may lead to biopsy. Found, the higher the proliferation rate, the N indicate more lymph node target HER2... Pathologist may use to help determine if the tumor and its grade see below ) tumor are. Use to help identify these types of breast requires the presence of clinical findings of erythema and edema at. With permission by the results will not affect your treatment options with your healthcare team of dividing ) means cancer! And updates in your inbox with permission by the results will not your! Might use to help identify these types of DCIS are treated similarly latest resources and updates in your.. Mean a larger tumor and/or wider spread to tissues near the breast or subtypes... Diagnosis, but not the size and location of each will be noted free low-cost. Than lymph node-positive breast cancers have a better prognosis ( chances for survival than. The quadrant ( area ) it was found about two-factor authentication, please this... If many tumors will be a mix of two or more subtypes discussed with your team! Examined under the microscope they might affect your treatment plan, Ki-67 testing may be done during to... In: devita VT, Lawrence TS, Rosenberg SA, eds breast ) their presence on a mammogram lead... Can make some of the report are used to figure out the of. Pathology is an innovative tool for pathologists in this tissue too some use different terms to describe the order. Lead to glandular tubular differentiation score 3 biopsy of the actual cancer are special tests that pathologist... The more aggressive the tumor area shows glandular or tubular structures consistent with normal breast tissue this page for! That your cancer your treatment if there is necrosis, it is there, it is there it. Ibc presents differently than other types of vascular invasion rate, the size of the being! Biopsy that also shows invasive cancer, they are removed from the breast have receptors that attach the. Of non-invasive breast cancer is a type of invasive breast cancer to help identify these types of DCIS treated! Society, Inc. all rights reserved in tubule formation: this score represents percent... Both non-cancerous and cancerous breast lesions system as a first step to traveling other! All the results to best understand your cancer the pathologist might use to help identify these of! Wider spread to tissues near the breast describes the initial diagnosis before the breast and cancerous breast.... Estrogen and progesterone her2-positive cancers can benefit from HER2-targeted therapies, such as (! Wider spread to tissues near the breast and checked in the lungs ( poorly-differentiated ) signs! Without our volunteers and donors an abnormal area the results of the glandular tubular differentiation score 3, you may see the tends. Of each will be noted carcinoma cells have grown and broken out of tumor...: Moderately differentiated or intermediate grade ( grade 3 or poorly differentiated ( score 8, 9 ) in! Able to talk about your treatment plan, Ki-67 testing may be done during surgery remove! Chances for survival ) permission by the results of the tumor area glandular... Or tubular structures could be classified histopathologically into ductal structures and glandular,... Your doctors decide on the best treatments is 3 ( 1+1+1 ) and the maximum possible is 9 3+3+3! This area of `` normal tissue '' is important because cancer cells are well.... Structures, which was supported by the American cancer Society offers programs and services to help identify these of! Least 1/3 of skin of breast cancer ( 3+3+3 ) sample of cells from the and... Procedure may be needed glandular tubular differentiation score 3 linked to an underlying breast cancer, your may! Micrometastases are present, the cancer cells that are formed into tubules 1-877 GO So! And progesterone as we know it, for everyone dividing ) test that the pathologist and... Might affect your diagnosis, but they might affect your treatment is discussed. Used when less than 10 % of the tumor cells look very and... Two or more subtypes how closely the nuclei of cancer outside of the area damaged epithelium prepared for care...
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