I honestly don't know how I got to this site...I was surfing the net and landed here! I was recently diagnosed with lobular carcinoma breast cancer on November 21, 2008. Needless to say, this was a total shock to me...I am 38 years old and married with 4 (little) kids ages 4, 6, 8, and 9. I have been married for 10 years and I breast fed all four kids for a minimum of 11 months each! I still don't understand how....but I have moved forward and am ready to fight this battle. Since I have two lumps in tI have been told that a full mastectwo different quadrants of my right breast, I have been informed that a full mastectomy is my only option. I am definitely interested in breast reconstruction. I am waiting on the biopsy results from the other breast to see if I will be having a double mastectomy or not...
Reading your story has inspired me and encouraged me! Can you please tell me who your plastic surgeon was?
I have requested a copy of my pathologist report, however, it does not have the same information that you described in your post (i.e. historiology, description, demographics, etc...) Should the reports vary that much???
Jackee - I'm so glad you found this site! You can make this journey, and you won't be alone. There are many, many women ready to reach out their hands to you. Breast cancer is indeed shocking; it's silent, and about 80% of us who get it have no known risk factors, other than being women.
Anyway - gradually you'll feel less shocked, and you'll move forward. You WILL be there for your kids, all the way. As for your pathology report, as I said, theyre confusing, and sometimes use different headings, but once you get your report, see if you can find areas where it matches my explanation. Because the information should definitely be in there. Stay connected here, OK? And be well - PJH
Whoops, sorry - didn't answer your question. My plastic surgeon was Carolyn Kerrigan, at Dartmouth-Hitchcock Medical Center in Lebanon, NH. However, unless you're up this way, you'll want to find a plastic surgeon near you; there are plenty of talented breast reconstruction surgeons out there. And be sure to read our information on breast reconstruction, OK? we have a whole series of FAQS on the different kinds. Best of luck with this - PJH
Thanks PJ! Well...I am in Texas so that is a bit far for me. At any rate, I met with a Plastic Surgeon today and have a meeting with another one next week. I found out today that the reports from the biopsy indicate that I have breast cancer in my other breast also. So it looks like a double mastectomy for me.... At any rate, thanks again for sharing your story and for responding to me. I really appreciate it. Have a blessed day! Jackee
Just had a mastectomy and came from surgeon's office - one week post surgery follow-up appointment. Thought he would go over my pathology report thoroughly, but he only brought it up when I did. He briefly discussed terms I didn't understand and asked his nurse to give me a copy of report. When I got home, I realized she only gave me pages 2,3,4,5,20 of 27. Much of it matches what you describe, however the HER-2 page has a chart that says "unamplified / her-2 spot count / cep 17 spot count / her2 cep 17 spot count ratio. Then the very bottom of the chart has the totals by ratio: negative unamplified / equivocal / positive. None of this page seems to match anything on your postings. None of it seems to match any of the words regarding what to look for on my HER-2 information. I am confused. I don't like my surgeon well enough to call his office unless you think I should. I have an appointment with an oncologist next week and it sounds like the oncologist might be the one that will go over it thoroughly with me? Right? I thought it would be my surgeon. Any advice you can give would be appreciated. Thanks. Rhonda in Reno.
Rhonda, your oncologist is definitely the one to go over the pathology report with you. The surgeon won't be directing your treatment - that's the oncologist's responsibility and you and (s)he will probably have a years-long relationship. So get comfortable with your oncologist, be prepared to ask questions, and I'm sure you'll find out whether you're HER2 positive or negative next week. (Sorry, I can't decipher anything from that information the surgeon gave you either!) Good luck - PJH
Does multifocal mean it's spread through out the breast? My doctor performed a lumpectomy and said there's still some in there. He did a 1mm margin but said even if he went back to remove more he wouldn't be sure if it would be removed. So, he recommends radiation of the whole breast. My right breast has microcalcifications but he and the radiologist didn't think is was cancer but they're going to watch it. Do you have any suggestions? Debbie 46 years old.
Hi - Multifocal doesn't mean it's necessarily spread thoroughout the whole breast; just that it's in more than one spot. I'd suggest you do radiation of the whole breast, as the radiologist suggests; OR have a mastectomy. It's always best to do what the doctor says, unless you don't trust him/her, in which case you should get a second opinion or find another doctor. Good luck - PJH
I have been told two things..one is that my tumor is over 2 cent. and the other is..that it is not. On my pathology report it says
SIZE OF INVASIVE COMPONENT GREATEST DIMENSION 0.8 cm
It also says EXTENT OF INVASION
PRIMARY TUMOR
pT1b Tumor more than o.5cm but not more than 1.0cm in greatest dimension.
Doesn't that mean that the actual tumor ( the cancer, in otherwords ) is less than 1.o cm?
Had a lumpectomy 2.6 cm tumor removed shows infiltrating ductal carcinona, grade 3/3, tubule 3/3, mitotic 2/3, nuclear 3/3 = 8/9. Lumphovascular invasion not demonstrated. Numerous ducts present with high grade ductal carcinoma in stiu both solid and comedo patterns. Occasional cribriform DCIS noted as well.The tumor does not appear to be EIC status positive. (what doe this mean???)
Don't know stage of cancer or what next step is. Lumpectomy to clear margins? Lymph nodes? Or Mastectomy? Treatment - Chemo or radiation? Surgeon is a very rude individual and I have asked for second opinion. Your thoughts?
This web site has been very helpful so far. Thanks
Hi Mary - Your next step should be getting another surgeon, for sure! The last thing you need is a RUDE doctor to deal with, at this point. You'll be dealing with your surgeon for several years, probably, as you go back for checkups. Please find a new one that treats you well - I think this is important.
Once you find a new surgeon, ask him/her if the margins look so "unclear" that you should go ahead and have a mastectomy. It sounds like your cancer is fairly aggressive, with an 8/9 score. You also need to have your underarm lymph nodes tested, to see if it's spread. That will give your oncologist enough information to give your cancer a stage - I, II, III, or IV. And the information he/she needs to recommend treatment: chemo, radiation, hormone therapy, whatever's indicated. Oh - and EIC is "extensive intraductal component" - and yours is NOT positive - which, contrary to how it sounds, is a good thing!
So - first, find a new surgeon. Second, decide on mastectomy vs. another lumpectomy. Third, get those lymph nodes tested (which they'll do at the same time as your next surgery). And once all of that is done, discuss with your oncologist whether or not you need radiation/chemo/hormone therapy.
In the meantime, please read our Guide to Understanding Your Pathology Report, which will help you put into plain English all of that mystifying medicalese! Thanks for connecting here, and please come back - we can help you through this. Good luck - PJH
Thanks for your reply. I did read "how to read a pathology report" which was extremely helpful! Only part I could not find was the portion about the EIC.
Had a subsequent MRI done which says there was a non masslike clump near the postop scar.."the overall enhancement pattern is concerning for residual DCIS. Some of the nodules are rather masslike and possibility of invasive competent cannot be completely ruled out. There are no suspicious lymphadenopathy in bilateral axillary or along the internal mammary chain." Just had a ultrasound and US guided biopsy completed and am awaiting the results. This was on the mass like area. There is a comment on the report "No abnormal nodes are seen in the right axilla". Am trying to get a referral to second surgeon as when I requested information from the clinic on how to do this they told me they had never heard of such a thing. When I told Dr. he said if I did that then he was not going to do surgery and if I needed anything to call the clinic and hung up on me.
Hi Peg - Actually, I didn't get my actual pathology report till 7 years post-treatment! I finally asked for the document. They may or may not give it to you - you may have to ask, then wait for it (though not for 7 years...). The oncologist will summarize the findings for you, using the information to inform treatment decisions. But you sound like a person who'd like the actual report in your hand - so if s/he doesn't offer it, ask for it, OK? Good luck - PJH
my pathology report indicates er/pr negative as reported by my Dr. Please discuss treatments
With hormone-negative breast cancer, you'll have chemo for sure; possibly radiation as well. Since long-term hormone therapy to prevent recurrence isn't an option, your doctor will want to throw everything at it right at the start - and that means chemo. Please ask your oncologist for further informaiton about schedule, what type of chemo, etc. Good luck - and stay in touch here; we can help. PJH
My "Addendum Report" from the original ultrasound guided core biopsy, left breast inferior shows: ER/PR/HER-2NEU Summary
Estrogen Receptor 97% - Positive
Progesterone Receptor 67% - Positive
HerceoTEST (HER2) 1+ - Negative
all of which I now understand from reading your information but then the next line says:
Ki-67 60% - High
What does that mean (the Ki-67 60%-High).
Keep up the great work to help us. I am in chemo first, the full surgery will not be until I finish the chemo in March, 2010. It is in my lymph nodes under left arm and in my neck area (collar bone).
Cindy
Hi Cindy - Ki-67 is a test that helps determine how aggressive/fast-growing the cancer is; so high would mean it's fairly aggressive, which is why I imagine you're having chemo first - to determine exactly what chemicals are going to work against your particular cancer. Good luck on your journey, and please stay in touch here - we can help. PJH
I was diagnosd today, 11/18/2009 following a lumpectomy. I have the path report and not clear about some of this. It reads:
two foci of invastive ductal carcinoma, no special type
Nottingham grade 3 (tubule formation -3, nuclear pleomorpism 3, mitotic activity 2 for total score of 8/9
The larger tumorinvovles 6 contiguous slices and measures 2.4 cm
the smaller tumor involves 3 contiguous slicese and measures 12.2 cm
Ductal carcinoma in situ (DCIS) nuclear grade 3
Th einvasive carcnoma extends to the unoriented margins.
Estrogen negative
Progesterone negative
HER-2/NEU negative score 1+
Ki-67 result high, index 30%
Surgeon is recommending mastectomy and sentinal node biopsy. Does this sound appropriate?
Yes, Cathy, a mastectomy definitely sounds like the way to go; with a fairly aggressive cancer like yours, you'd want to have a mastectomy to vastly lower your risk of recurrence. And you definitely want a sentinel node biopsy, to see whether it's spread outside the breast; this will help determine your treatment. I'm sure next time you speak with your surgeon, s/he will be able to explain this diagnosis to you more fully. Good luck, and stay in touch here - we can help. PJH
Just to give you an update, I had the mastectomy with sentinal node biopsy, all margins were clear. Follow up bone scans are all negative. Now I start with chemotherapy. Thanks for clarifying what I should do. Surgeon did indicate that he didn't think he could have gotten it all with just a lumpectomy. Thanks again. Cathy
Hi,
I just finished my fourth chemotherapy treatment with Cytoxan and Adriamycin and am now scheduled in a clinical trial of Ixempra for 12 weeks at 21 day intervals. My question is, I just realized what being triple negative means and it can recur and it is difficult to try, and is the Ixempra a good thinng for me?
Thanks.
Cathy
Cathy, Ixempra has shown good results for triple negative breast cancer patients, so that's probably why your doctor suggested trying the trial with it. Ixempra has already been approved by the FDA, so ask your doctor what the goal of this study is. It may be to find the best dosing or to see how it works in some subset of patients that you fit. Your own oncologist will be much more knowledgeable about whether this is the drug for you than someone who doesn't know the details of your medical history. If you have reservations, getting a second opinion from a doctor at a comprehensive cancer center would be a good idea. As far as the dangers of your triple negative status, keep in mind that all types of breast cancer can recur. Because triple negative patients have a higher recurrence rate, your doctor is being aggressive with your medicines now, to try to make sure that you are not in the group that recurs. I also had a type of breast cancer with a high recurrence and metastasis rate, but I've been fine for 12 years this month. Studies cannot predict what will happen to you, so live in hope that this treatment will kill every last cancer cell and allow you to put cancer behind you.
So glad to hear from you, Cathy. I'm glad things are going well and you're back on the road to feeling good again. It does take awhile, doesn't it? Stay positive, and little by little, you'll put the bad parts behind you, and carry the good with you - how strong you are, how much people care, and how good it feels to give back. Take care- PJH
We love to hear from people as they finish treatment and move on with their lives. It helps us catch up with people we've gotten to know, and it encourages folks who are just starting treatment and who are wondering how they are going to cope with it all. I'm so glad you are doing well. Thanks for the update.
Hi, It's been almost 28 months since my initial diagnosis of triple negative breast cancer. I have a question. Is it appropriate to get a PET scan? My oncologist seems to think that it's okay to wait, he has a more or less wait and see attitude. I don't feel comfotable with this. I would rather be proactive and would like your opinions. It's reall nice to have someone to go to when I'm not sure what should be done. Thanks so much.
Hi, It's been almost 28 months since my initial diagnosis of triple negative breast cancer. I have a question. Is it appropriate to get a PET scan? My oncologist seems to think that it's okay to wait, he has a more or less wait and see attitude. I don't feel comfotable with this. I would rather be proactive and would like your opinions. It's reall nice to have someone to go to when I'm not sure what should be done. Thanks so much.
Cathy, so good to hear from you again! We're glad you're doing well.
Unless you've identified a new issue - a lump, some pain – the protocol would be to not do regular scans. Each time you have a scan you're exposing your body to more radiation, and this cumulative radiation isn't a good thing. Also, by the time anything would show up on a PET scan, it's likely you would have already begun experiencing other symptoms. Please read Phyllis' post on follow-up care for an excellent explanation of why you don't need regular scans.
Thanks for reconnecting here - and I hope you continue to feel better and better each day. PJH
I have been diagnosed with stage 2anomx clean margins etc oncologist wants chemo, but I also have osteoporosis -3.5 is there an adjudavant therapy better for me.
Hi - There's no better therapy than chemo - anything else probably won't be as effective. I don't believe chemo will increase your bone loss, though; ask your oncologist about that. If you're simply against chemo on general principles, then ask your oncologist what your risk of recurrence would be with or without it - if it's just a few percentage points' difference, you might very well decide it's not worth the side effects. Also, if your cancer is hormone-receptive, you can take hormone therapy for it - though you'd probably want to stay away from an aromatase inhibitor (e.g., Arimidex), as it would encourage bone loss. Hope this helps - PJH
i just received a biopsy report that has a diagnosis of Grade 3 Invasive Ductal Carcinoma.
In the report there are notations that aren't in the document referenced above.
Under Diagnosis there is a TS/sv
Under Gross Description it says MC/mrs
Under QA it says
QA;
A
eh
Can someone help me understand these designations? I don't see the surgeon for 6 days.
Hi Sandy - TS would seem to be tumor size; and MC might be microcalcifications? But this is too "shorthand" for a real answer. How about calling your oncologist (do you have one yet?) or surgical nurse and asking what those notations mean? Grade 3, if that's your Scharff-Bloom-Richardson score or Elston grade, is good; it means a less aggressive cancer. Sorry I couldn't be of more help to you here - PJH
PJ,
I also just stumbled onto this site while trying to interpret my pathology report, and it has been extremely helpful. I had a lumpectomy last Monday and the report came back positive for invasive adenocarcinoma and DCIS. My tumor size is 0.2 cm with a Nottingham Grade of G1, a nuclear grade of 1, but the margins are not clear. I am strongly positive for both estrogen and progesterone receptors, and HER2 is 1+.
Now here is where I need some advice....I have a strong family history of breast cancer and because of this, my surgeon has recommended a mastectomy, but will not rule out only performing a lumpectomy with radiation, but then says I will still have to monitor myself with a breast MRI every 6 months to keep an eye on things. I have read and researched and I still don't know what to do. Having gone through so much yourself, what is your feeling?
Thanks for your help -
My opinion is you need a second opinion, especially if this first one didn't come from an oncologist at a Comprehensive Cancer Center. You need to make sure your family history is actually strong enough to warrant the fairly aggressive treatment of a mastectomy. You'd also want to see if twice-yearly MRIs are really required with a lumpectomy, as MRIs are notorious for false positives, so I can see you having multiple, and I mean many multiple, biopsies going forward. Not a pleasant thought.
I have no medical training and can't advise, but with such "good" scores (and what seems like a quite early cancer), for myself I'd opt for the lumpectomy + radiation + perhaps clinical exam every 6 months, mammogram once a year?
Good luck - PJH
what do these mean on my report?
Histologic type: high grade with apocrine differentiation
Nuclear grade: 3
microcalcifications: present in involved ducts
AJCC Pathologic Stage: pTismuz
Hi - Please ask your doctor to explain all of this to you fully. Basically, you have a fairly aggressive cancer (nuclear grade 3, high grade histology); but beyond that, the medical shorthand's not making sense to me, so you'll need to ask your doctor exactly what you diagnosis is. MANY women get a diagnosis of aggressive cncer, and recover just fine; don't think of this as "I'm doomed," because you're not. Best of luck to you as you go through treatment, and stay in touch here, OK? We can help. PJH
This is the first time on this site. I read the above report and found it immensely helpful. I had a large needle biopsy with 7 specimens. It turned out to be HIGH Grade, Farmingham total score 8-9 with other aggresive findings. I have a question: does anyone know what cribriform architecture is? I haven't had my surgery yet, and have not received the prognostic report yet. I will be using this site in the future. I need all the support I can get. Am grateful for prayers and positive visulalization. Thanks so much.
Hi Laurie - you've come to the right place. This site has a wealth of great informaiton and, more important - we're here for you. Visit often, and bring your questions... Take a look at this short explanation of cribiform architecture at our sister site, breastcancer.org. Hope this helps - PJH
I recently had a mastectomy and was diagnosed with a stage 1 ductal carcinoma. The oncologist wants to start me on anastrozole. Along with this she says I need to have a bone density test yearly----as I have a much greater chance of getting osteoporosis--(I am 70 years old---very healthy--take no medication). My cancer was detected by mamogram---it was less than .6 cm. My question is: Is the SERM medication great enough protection that it is worth osteoporosis???
My mother was recently diagnosed with Stage 3 Infiltrating ductal carcinoma. She had a lumpectomy last week and when she went in today the pathology report noted further cancer so she is scheduled for a masectomy next week. The surgeon said this almost never happens. Now we are going to wait another 3 weeks to see an Oncologist. Is this typical?
I do have a copy of the pathology report and have a few clarifications, please:
* At the top of the diagnosis it states "Sentinel lymph node, single lymph node negative for malignancy by H&E stain". Then directly underneath it lists the grade 3 IDC with subsections a. b. c. Lymphatic invasion is present. They only checked 1 lymph node. So which is it positive or negative?
* Her DCIS is EIC positive - What is EIC positive?
* Tubular, Nuclear, Mitotic counts are each 3 for overall Grade 3
* Pathologic Stage [TNM] is listed as an M - multiple foci of invasive carcinoma and pT2 pN0. The Distant Metastasis states N/A. Could you explain this to me as I am feeling it is stating it has metasized?
Thank you so much, what a blessing this resource has been!
Hi Angie - Glad we can help - or try to, anyway!
I'm with you, it's confusing. The sentinel node was negative, which is good. Perhaps the other "lymphatic invasion" referred to the breast itself, which includes many lymph nodes. The sentinel node is outside the breast, usually in the armpit. So it's spread to breast nodes, but not outside the breast - a good thing.
EIC is "extensive ductal component." It simply means the cancer is diffuse, and spread throughout much of her breast. Thus the mastectomy. I had this same issue myself; first a lumpectomy, but it was so diffuse I had to have a mastectomy shortly after.
pT2 means her tumor is between 2-5 cm. pNO means no lymph node involvement outside the breast (good, confirmation of that). Distant metastasis N/A means they don't know if it's metastasized, I'd guess. MX would mean they don't know; MO, no metastasis; M1, identified metastasis.They may want to do more tests (CT scan, PET scan) to determine if the cancer has spread ourside her breast., thus the N/A for the time being.
Other key indicators of her prognosis would be whther it's ER/PR receptive (positive); HER2-neu positive; and her Scharff-Bloom-Richardson score. She might be a good candidate for the Oncotype-DX test, which would indicate how much her risk of recurrence would be lowered by chemo. So if they haven't mentioned that test, you might want to.
Best of luck to you both - and come visit again if there's anything more we can try to help you with. PJH
Thank you so very much for your prompt reply! :)
Her ER/PR is 0% positivity
The HER2 test is pending and we don't have the results
They used the Nottingham Modification of the Bloom & Richardson Scoring System stating is Grade 3 Infiltrating Ductal Carcinoma w/foci number of 2
The other score you mentioned was an 8, I believe.
Do you feel it is appropriate for her to wait so long to see an oncologist?
I can't tell you how much you have helped us. It feels like we are living a dream and this isn't really us.
Blessings! Angie
So, she's having the mastecomy next week, then seeing an oncologist 2 weeks after that - sounds like a pretty normal schedule. They'll need to work up another pathology report, given the new tissue they'll be removing. And they're still waiting for the HER-2 results.In general, breast cancer is a slow-growing cancer; she's probably had it for years without any symptoms, so waiting another couple of weeks is probably OK (and if they felt it wasn't, they'd get her in to see someone sooner).
0% on the ER/PR means, I believe, that her cancer is NOT hormone-receptive; better that it would have been (about 75% of breast cancers are), as she would have been able to take hormone therapy to help prevent recurrence. So, she probably won't escape chemo...
Have you checked out our pages on diagnosis and treatment? I thnk you'll find them helpful. Take care - PJH
I have stage 1 or 2 Invasive Ductal Carcinoma. I'm the biggest chicken in the world, so I don't want to do repeated surgeries to see if they've got all the cancer. They've scheduled an MRI. Will this be good enough to tell how far it's travelled and whether to do a mastectomy or a lumpectomy. My #1 priority is pain reduction. 1 surgery is less painfull long term than 2 or 3. But a mastectomy is more painful than a lumpectomy. What do you think?
Monica, they won't be able to tell with the MRI whether the cancer has spread outside your breast; you'll need to have lymph node testing when you have your surgery to determine that. If your tumor looks small, I'd suggest you have a lumpectomy - which, as you say, is less aggressive/less painful than mastectomy. Might you have to go back for another (still less painful) surgery? Yes. But there are other considerations with mastectomy, e.g., reconstruction, shoulder issues, possible lymphedema, etc. Why not start with the lesser surgery, and believe you won't have to go back for more? Hope this helps- PJH
Here's my pathology report:
ER = positive, 99% of cells
PR = positive, 71% of cels
Ki-67 = positive, 51% of cells (greater that 20 % is regarded as unfavorable)
FISH for HER-2 = report said FH10-20817 the average HER-2 count is 2.7 with an average CEP 17 count 1.7, this gives a HER-2/CEP 17 ration of 1.6. This is interpreted as HER-2 UNAMPLIFIED.
*******************************************************************
Can you please explain my pathology report? Is ER, PR and K1-67 good coz they're all positive?
The HER-2 is really confusing to me.
Do you think that I will be on chemotheraphy with this result?
Thanks.
Maxi
Hi Maxi - The ER/PR being positive are good; the Ki-67 being positive means your cancer is more aggressive than normal, so that's not positive. It appears the HER2 is positive, though it's hard to tell exactly - you'd need to check this with your oncologist.
Often whether or not you'll have chemo is determined by whether or not the cancer has spread to your lymph nodes. I'd guess that if it has, then yes, you'll have chemo. If it hasn't, then you might have another test, the Oncotype-DX, to determine whether/how much chemo would help you; then take those results, and make your decision.
Since the ER/PR are positive, you'll be taking long-term hormone therapy drugs (either tamoixfen, or an aromatase inhibitor), to help lower your risk of recurrence. That's why ER/PR+ is "good" - you have more ways to fight the cancer. If the HER2 is positive, it signals a more aggressive cancer; but again, there are drugs it'll respond to: you'll be taking Herceptin for a year.
Once you have your complete test results, including lymph node assessment, you'll have a better idea of where your treatment will be heading. Best of luck to you - PJH
Here's my Pathology report after my mastectomy surgery:
A) left sentinel lymph node number 1, sentinel lymph node dissection - 2 lymph nodes, negative for carcinoma by H&E stain and keratin stain (0/2).
B) right breast, simple mastectomy
-no evidence of invasive or in situ in carcinoma identified.
C) left breast, simple mastectomy
- invasive ductal carcinoma
- SBR histologic grade:II (tubules 3 points, nuclei 2 points, mitosis 1 point)
- invasive tumor size - 1.9 cm in greatest dimension.
- tumor location - 2 o'clock, unifocal
- high grade ductal carcinoma in situ with comedo necrosis, representing approximately 25% of tumor mass.
- margins negative for carcinoma
- distance of closest margin to both invasive carcinoma and ductal carcinoma in situ: posterior = 0.5 centimeters
- nipple involvement: absent
- lymphovascular invasion: absent
- additional findings: fibroadenoma
- AJCC stage: pT1c N0 (i-) MX.
- ER/PR positive
- KI67 positive
HER-2/NEU by FISH - not Amplified
D) Left low axillary lymph nodes, excision - 2 lymph nodes, negative for carcinoma (0/2).
I'm still waiting for a call from my breast surgeon, she told me she will call and explain this report to me but I want to know before she calls. Oncologist appt. will be 2-3 weeks after surgery. My surgery was 12/30/10.
Thanks for your help.
Maxi
Hi Maxi - Bottom line, looks like you have a fairly straightforward breast cancer: 1.9cm tumor (fairly small), no spread to the lymph nodes (excellent!), hormone-receptive (excellent!), no HER2 (excellent!), grade 2 (medium grade), combination of IDC/DCIS (standard), no metastasis assessed (excellent!). Hopefully this diagnosis will allow you to avoid chemo, though your oncologist will have a lot more information than what's here to base that decision on... Good luck at your apopointment, and stay in touch - we can help. PJH
I just got a call from my breast surgeon and the oncologist office and they want me t o order the Oncodyx to determine if I have high or low risk of the cancer coming back. They said this will determine, if I will have chemo theraphy. Are you familiar with this test?
Thanks for your quick response.
Maxi
Yes, Maxi, the Oncotype-DX is a really useful test to determine whether or not chemo would work well for you. Glad you're going to have it - it'll help you make the chemo decision, if you're on the fence. Good luck - PJH
Hi PJ,
My oncotype dx came with 20 as a result. My oncologist will put me on chemotherapy for 4 sessions in 3 months then tamoxifen for 5 years after the chemo sessions. Honestly, I wasn't very happy with the chemo part, I was trying to avoid that but the onco result wasn't too low. I know that I wil have better preventive treatment plan with these two. I guessed I am still processing the idea of chemo but I'll be okay. My first chemo is Feb. 1st.
Do you think I have to do both of the treatments?
I just want to feel good and share this feeling to someone (not my husband :)
Thanks,
Maxi
Hi PJ,
My oncotype dx came with 20 as a result. My oncologist will put me on chemotherapy for 4 sessions in 3 months then tamoxifen for 5 years after the chemo sessions. Honestly, I wasn't very happy with the chemo part, I was trying to avoid that but the onco result wasn't too low. I know that I wil have better preventive treatment plan with these two. I guessed I am still processing the idea of chemo but I'll be okay. My first chemo is Feb. 1st.
Do you think I have to do both of the treatments?
I just want to feel good and share this feeling to someone (not my husband :)
Thanks,
Maxi
Hi PJ,
My oncotype dx came with 20 as a result. My oncologist will put me on chemotherapy for 4 sessions in 3 months then tamoxifen for 5 years after the chemo sessions. Honestly, I wasn't very happy with the chemo part, I was trying to avoid that but the onco result wasn't too low. I know that I wil have better preventive treatment plan with these two. I guessed I am still processing the idea of chemo but I'll be okay. My first chemo is Feb. 1st.
Do you think I have to do both of the treatments?
I just want to feel good and share this feeling to someone (not my husband :)
Thanks,
Maxi
Hi PJ,
My oncotype dx came with 20 as a result. My oncologist will put me on chemotherapy for 4 sessions in 3 months then tamoxifen for 5 years after the chemo sessions. Honestly, I wasn't very happy with the chemo part, I was trying to avoid that but the onco result wasn't too low. I know that I wil have better preventive treatment plan with these two. I guessed I am still processing the idea of chemo but I'll be okay. My first chemo is Feb. 1st.
Do you think I have to do both of the treatments?
I just want to feel good and share this feeling to someone (not my husband :)
Thanks,
Maxi
Hi PJ,
My oncotype dx came with 20 as a result. My oncologist will put me on chemotherapy for 4 sessions in 3 months then tamoxifen for 5 years after the chemo sessions. Honestly, I wasn't very happy with the chemo part, I was trying to avoid that but the onco result wasn't too low. I know that I wil have better preventive treatment plan with these two. I guessed I am still processing the idea of chemo but I'll be okay. My first chemo is Feb. 1st.
Do you think I have to do both of the treatments?
I just want to feel good and share this feeling to someone (not my husband :)
Thanks,
Maxi
Maxi, it's all a roll of the dice. Will chemo lower your risk of recurrence? Yes. Does going through chemo mean you won't have a recurrence? No; there's just no telling what'll happen. You give it your best shot, and hope for the best. I'd suggest you ask your oncologist what your risk of recurrence is with chemo, or without; if the difference between the two is just a few percentage points, you might try risking no chemo. How lucky do you feel? That's what it comes down to, unfortunately. There's no right answer - only what your heart tells you to do.
So, make your decision, based on your best information, and your intuition; then don't look back. No second guessing. And come back here anytime - to vent, ask questions, or just to connect. This is a good, safe, place, full of supportive women; welcome, and may your journey be as smooth as possible. PJH
first my biopsy report:
Infiltrating Lobular Carcinoma with minor in situ present, no definitive lymphovascular invasion is identified; Immunohistochemical ananlysis of tumor: (+) for CK903; they displayed weak to moderate cytoplasmic positivity and focal incomplete membrane positivity for E-Cadherin. These results support the above diagnosis of infiltrating lobular carcinoma. Prognostic marker studies follow: ER: >90%; PR: approx. 80-90%; Ki-67 approx. 5-10%; Her-2-neu: 0; Additional findings: Fibrocystic changes with assoc. microcalcifications. Reactive fibrosis, siderosis, focal fat necrosis, and nonospecific mild chronic inlammation.
Mastectomy Pathology Report:(R)breast:prophylactic; (L)breast: ILC Pleomorphic variant; Path stage: pT2;pN2a;pMX; greatest tumor dimen: Approx. 3.8 cm.; in situ component: lobular carcinoma in situ and atypical lobular hyperplasia are present. Margins: inked deep resection margin appears free of tumor; Lymphovascular invasion: no definitive is identified; Perineural invasion: none identified;Additional findings: Fibroadenoma(1.3cm) focally involved by lobular in situ; fibrocysitic changes including ductal hyperplasia, aprocrine metaplasia and associated microcalcifications.
Another pathology report additionally identifies the first biopsy tissue as being Grade III. What does these reports tell you and is there anything missing from either of these reports that I should know? Is it important to get a second opinion of your pathology reports? If so, how do you do this? In July '08 I was 49 years old, premenopausal and have since had Chemox, RADx, and started on Tamoxifen, switched to Femara as I am now Chemo induced menopausal.
Hi This sounds like a straightforward diagnosis, and your treatment sounds typical and matches the diagnosis. I assume, since you're on this page, that you've read our Guide to Understanding your Pathology Report, which can explain most of the terms you detail above.
A pathology report isn't usually something you'd need a second opinion about, since it's all data - not opinion. The opinion comes in treatment decisions, but as I said, your treatment sounds typical and appropriate. Best of luck as you continue your hormone therapy; and write back with any specific questions you have after going through the guide, OK? PJH
Thanks for your reply. Yes, I went through the guide and that is when I had questions because it seems my pathology report is not as detailed as I have read others are. I failed to tell you about the the axillary path report it is as follows. Sentinal node#1 Metastatic lobular carcinoma present in 2/2 with focal direct extension of tumor into perinodal fat noted. Axillary lymph nodes: metastatic lobular carcinoma is present in 1/15 nodes. A microscopic focus of benign neval cells is noted in the capsule of one of the lymph nodes. Sentinel node #2 metastatic lobular carcinoma is present in 1/1 node. Sentinel node #3: no tumor identified in 0/2 nodes. Sentinel #4 no tumor identified in 0/1 lymph node.
After my biopsy I had a second opinion and it was them that gave me a grade to my cancer.
After my mastectomy I met with my oncologist and asked him what grade my tumor was and he said it is pleomorphic but we could ask the pathologist what grade if I wanted to know! I thought this is something HE would want to know. I am more concerned with recurrence than I was with the initial diagnosis. At the time it was just, "ok, tell me what I should do next," and I just took it all in stride. I can't help but feel like, "what is waiting around the corner?" I get obsessed with researching and wanting to know all I can.
Truthfully, none of us can know whether our cancer will come back; and research, while it may be interesting, will only provide you with the information you need to determine survival statistics - which are averages, and not YOU. Even those averages rely on data that might be flawed, or skewed; cancer research and trials are never an exact science.
Now, if you don't quite trust your oncologist, you may want to consider getting a different one; you'll have a long-term relationship with whomever you have, and you want to be comfortable with him/her. But taking a deep dive onto the Internet to try to determine your chance of recurrence... well, you'll never be able to nail that down, and in the meantime, you might find yourself obsessing over it - as you say.
I've found that gradually, cancer starts to play a secondary role in your life, rather than being that big gorilla in the corner. Time heals, it really does; and maybe research is part of how you heal yourself. But understand that your worry over recurrence, while totally natural, doesn't get you anywhere; you'll have a recurrence, or you won't, and other than trying to live a healthy lifestyle (which may lower your risk some), there's nothing you can do about it. So validate your worry - it's OK, it's expected - but then try to let it go and move on, OK? Our post on fear of recurrence might help you do this. Best of luck to you - PJH
Hi PJ,
Thanks again for your insightful reply. I seem to once again leave out the important info. I did find another onco. I stayed with the original one until my treatments were complete, for convenience to proximity of my work place. Afterwards, I (through researching the internet) found a clinical trial for the metabolism of Tamoxifen. I traveled from PA to NC to participate and also found an instant connection to the onco there. I now travel the 8 hrs. one way first every 4 months and now every 6. It's true the relationship will be long so I might as well have the trust and compassion I deserve. My team is now complete with wonderful, caring doctors that I can call or e-mail and speak directly to them instead a nurse or answering service any time I may need to. I am very blessed to have all of them and I know that. Now I can add you to the many blessing for which I am thankful! Obviously your knowledge and compassion for us, breast cancer survivors, is something you are committed to sharing and your willingness to do so is very much appreciated.
Good for you, joining a trial - those trials are SO important to all of us in the cancer community, and giving of yourself like that... well, it's just priceless. It sounds like you've got your treatment plan under control; so, if you can gradually lower your stress level over recurrence, you should be well no your way to feeling really good. It takes time, it really does... but you'll get there. I'm so glad you found us - please come back and visit (ask questions, vent, share - anything) whenever you like. Take care - PJH
Hello again!
I totally agree, clinical trials are SOOO important! I have joined breastcancertrials.org and am willing to help their efforts any way I can to encourage others to do so as well. We all wouldn't have the benefits of the present treatments if not for those before us giving of themselves this way!
I have moved on...I am going to graduate as an PN in Nov., I work full-time, go to school full-time and have been honored with the Nightingale Award Scholarship of PA which entitles me to be one of their guests at their Gala, also in Nov.
However, I have this nagging feeling in the back of my head that tells me not to be ignorant but to keep searching out as much info as possible, not just for myself, but for my 3 children and 5 grandchildren as well as other family members, friends, acquaintances, and people I don't even know. I have had the genetic testing I think necessary: BRCA1 (-), BRCA2 (-) and CDH1 (-) as my mother died at the young age of 41 from gastric CA. I have registered and sent a blood sample to Sloan Kettering for their Early onset gastric CA research as well.
I think alot of my hesitation in letting go comes from my first biopsy six months prior to diagnosis when the doctor biopsied a spot "somewhat distant to the lesion" as was found on my 6 month f/u mammo. The trust I put into my first surgeon while rejecting my own gut feelings is something I can't forget.
I also know that things happen for a reason and by changing doctors, I got the benefit of finding the right (best) one for me.
If nothing else through this whole journey I know that the MOST important person is the one who is reading your mammo. The fact that I had stage 3 breast cancer that was totally missed by him (the first surgeon) and his radiologist reading his mammo seals that for me.
I am so glad I returned for my f/u to the site of the previous mammo instead of returning to the surgeons imaging site. I have since contacted my first surgeon and asked that he reevaluate my sterotactic biopsy with the mammo immediately following to see what, if anything, he could have or would have done differently to avoid this for others.
The radiologist who found my cancer (both times), has also been very good to me and someone I can call directly with any questions or concerns I may have. The two "scares" of recurrence I have had in the past three years have been quickly addressed through his efforts and expertise. I will say it once again, I am so blessed to be surrounded with good, caring professionals. This is my wish for all to have this HUGE benefit as it is extremely empowering!
Thank you once again for your replies as it is also so important to have someone to connect with who understands and can put perspective to all my thoughts and feelings.
I'm confused and scared. Lumpectomy and lymph node biopsy 2 weeks agao, labs are back and show a Nottingham grade 9/9 I know is bad, but margins are clear, lymph nodes are negative both good. no lymphovascular invasions, skin is negative. all good. tumor was 2 x 1.3 x 1.1 cm, pT1c pN0(sn) pMX what does all that mean? pT1c I guess is pretty good. what does poorly differentiated mean?
Not Estrogen or Progesterone - Her2 is not back yet.
so do I have a really bad cancer caught early and what is next? Chemo i think.
thanks.
Amy, it's confusing, isn't it? All those numbers/letters mean you have a fairly small tumor (2cm or under); no node involvement (which, as you say, is good); and no spread, so far as they can tell without having done a lot of tests. With no node involvement, it's usually assumed the cancer hasn't spread outside the breast. "Poorly diferentiated" is part of what goes into the Nottingham score - it means the cells aren't acting like normal cells; they're acting like cancer cells (which they are).
Your cancer is aggressive in nature, and being hormone-negative, that means yes, you'll almost surely have chemo. For hormone-negative cancers, they like to throw a lot of treatment at you right up front, as you won't be taking long-term hormone therapy. If the HER2 comes back positive, then you'll also be taking the drug Herceptin for about a year.
Your assessment sounds right on - an aggressive cancer, caught early. Best of luck with your treatment - and come back here whenever you have questions or need support, OK? We're here for you. PJH
Apparently, I posted this question to the main board when I really wanted to post it to the comments section. The size of the tumor is 4.8 cm with margins abutting to one edge and clear margins otherwise. It is topping the charts for fast growing (9/9). Because it was thought to be an infection or cyst, lymph nodes were not taken, but they show no signs of inflammation. It is hormone receptor negative and Her2/neu tests are not back yet. My oncologist is saying that no matter the status of the lymph nodes, chemotherapy is a given. I worry more about chemo than anything else because I am very sensitive and tend to have side effects to many medications. Does this seem to make chemo necessary?
Unfortunately, Donna, this does sound like a situation where chemo would be pretty much a given. It's a large, aggressive tumor; and it's hormone-negative, which means long-term hormone therapy to prevent recurrence wouldn't help. If you're also HER-2 negative, then you'd be what's called triple negative - and chemo is ALWAYS a given with that diagnosis, as it's the only line of defense beyond surgery.
Please don't stress too much about chemo at this point; take things one at a time. If you need chemo, share your concerns with your oncologist (and his/her nurses). There are all kinds of ways to help counteract side effects - not all involving additional drugs. So, one way or another, you'll get through this - millions of us have, and we're here to offer the wisdom of our experience, and a helping hand, as you travel this path. Take care - PJH
P. J.
I am just getting ready for my second chemo treatment. I had an unusual thing happen and wondered if you or any of your sources have heard of it. The lump was removed about a month before chemo. A port was placed on Monday, Chemo was on Wednesday and then on Saturday, I started to bruise where the IV had been put on Monday for the surgery (nothing before) and I also had bruises show up at the surgical site from a month before. Any ideas what is happening?
Thanks,
Donna
Sorry, Donna - NO idea at all. But then, we're not doctors here, just well-read breast cancer survivors. I do know this - we each have our own cancer experience, and often women have side effects no one has ever heard of (I had a few with chemo myself). As with any change during chemo, definitely tell your oncologist, see what s/he says. I hope things are going well so far, other than that. Take care - PJH
Linda, you've been diagnosed with the most common type of breast cancer: IDC (infiltrating ductal carcinoma). Please read our IDC FAQS for lots of good information. The good news is, there's a lot of research and data connected with this diagnosis, since it's so prevalent; so your oncologist will have had plenty of experience dealing with it. The not-so-good news is, the cancer is fairly aggressive (8 on the Nottingham scale). But that's just one small part of the whole picture, so don't get too stressed. You'll know a lot more once you've had surgery, and your oncologist gets the final pathology report.
As for the ductal carcinoma in situ (DCIS) and microcalcifications, don't worry about those; the surgeon will take them out along with the main tumor. DCIS is considered by many doctors to be a "pre-cancer," and microcalcifications are just evidence that you have DCIS; so it's not invasive, and is very much secondary to the IDC.
It's really hard to understand that you have cancer, isn't it? It was always so scary... and now you have it. Welcome to the club no one wants to join! As the days go by it'll gradually sink in, and you WILL get your head around it, never fear. Millions of us have gone through this, and are living happy, healthy lives, years later; chances are very good that this will be the case for you, too. It's hard to wait for appointments and results, I know, but hang in there; once you get going with treatment, you'll feel better emotionally. Please come back here anytime; we're here to support you on this journey. Take care- PJH
Hello Everyone! Here is an article that every woman should read. I have had my suspicions for quite sometime about the validity of certain diagnoses. Some doctors stretch the diagnostics for money making purposes. We trust them with our lives but, unfortunately, our lives may not always be their first priority. Please read this very informative article, published by The New York Times: http://www.nytimes.com/2011/11/22/health/cancer-by-any-other-name-would-not-be-as-terrifying.html?_r=1&scp=1&sq=Cancer%20by%20any%20other%20name&st=cse
JP
Thanks for posting the link to this thoughtful essay. We've written here in the past about over-treatment of DCIS; a recent Norwegian study estimates about 60% of DCIS diagnoses may never develop into anything dangerous. On the other hand, 40% WILL become invasive. The critical question is, how do you decide which DCIS to treat, and which to leave alone?
At this point, oncologists tend to treat all DCIS the same: as potentially invasive. Perhaps in the future, diagnostic screening will advance to the point where doctors will be able to identify which DCIS should be treated, and which can safely be left alone. Until then, I believe the responsible choice is to treat DCIS - and not as a money-making scheme, but for reasons both ethical and moral: to possibly save a woman's life. Thanks again for connecting here - PJH
Microscopic Description
Diagnosis:
Left breast mass, excision.
-Invasive Ductal carcinoma,gradeIII
-Tumor size 2.2x1.5x1.4 cm.
-Presence of lymphovascular invasion
-Not free resected margin at long silk mark
My question:
1.What is the meaning of diagnosis?
2.What staging of breast cancer?
3.How to treatment? (My sister'doctor advise operation of breast mass(reservation surgery)and remove lymphnode at close area of mass ,combination radiation therapy. Do you think that is a good treatment for my sister and appropriate for CA breast staging?
4.Is it neccessary to examination of ER/PR receptor include HER2,CXR x-ray and Ultrasound of whole abdomen for evaluate metastasis?
5.What is your recommend if you are a doctor?
My sister is very sad . I hope your answer is helpful my sister has morale to resist with disease.
Sincerely yours
phittaya
Hi - I'm very sorry your sister has been diagnosed with breast cancer; and I'm glad she has you to support her, both emotionally, and with the research you're doing.
It looks like your sister has a cancer that's invasive (invasive ductal carcinoma) and fairly aggressive (grade 3), but the tumor isn't particularly large, which is good. Lymphovascular invasion means it's spread to the lymph nodes within her breast, which is fairly typical of most IDC diagnoses. "Not free resected margin" means, I believe, that they've determined there are still cancer cells in her breast, and she'll need surgery - which she'd have anyway.
From the information you've given, it looks like her cancer would be somewhere between stage II and stage III - until she finds out if it's spread to the lymph nodes outside her breast (most typically in her armpit), the oncologist won't be able to "stage" her cancer accurately.
Treatment - typically, treatment here in the U.S. would include surgery (either breast-conserving surgery, or a mastectomy). Depending on the surgery type, she might need radiation. And depending on the status of the lymph nodes under her arm, and other considerations, she might need chemotherapy.
And yes, her tumor should be tested for ER/PR status and HER2-neu status, both of which will determine what long-term drugs, if any, she should be on to prevent recurrence. In this country, they probably wouldn't use ultrasound or anything else to search for other areas of cancer, unless there's extensive involvement of the underarm lymph nodes.
We're not doctors here, but in my opinion, her next step would be to find out if the cancer has spread to her underarm lymph nodes, and to determine its hormone receptor and HER2 status. Once she gets those results, her oncologist will be able to recommend the best course of treatment. Best of luck to both of you - PJH
Hi PJ,
Thank you very much for your reply.It seem to be a gift from God that make my sister feel better and strong-minded to fight with breast cancer.
My sister's doctor plan to surgery her breast on 05/16/12 and combined with radiation therapy.
Do you know the oncologist will test ER/PR and HER-2 before,during or post radiation therapy given?
How can I do,If the oncologist does not test ER/PR and HER-2
How do you think about using herbals to treatment breast cancer before radiation therapy or chemotherapy given? (for treatment better)
Sincerely yours
pitthaya
Hi - Once your sister has her tumor removed, the ER/PR and HER2 tests should be done ASAP on the tumor; the results should be available within a week or so, and should guide what kind of treatment she has. If she's HER2+, she'd have a different type of chemo.
Herbals may or may not help. There's no scientific evidence either way, really. However, please do have her check with her doctor before using them; you wouldn't want anything interacting negatively with whatever other drugs she may take. Good luck - PJH
I have been diagnosed with DCIS Grade 3. On the bottom of the report it reads: An equivocal microscopic component of high nuclear grade invasive carcinoma is also present. Does this mean that they are not sure if invasive cells are present or not?
It sounds to me like they've identified a very tiny number of invasive cells - not enough to diagnose you with an invasive cancer, but to move the DCIS up to grade 3. (Does that make sense?) Please ask your oncologist for a better explanation; we're not doctors here, simply well-read breast cancer survivors, so you'd want to hear an exact explanation from someone with medical training. Best of luck to you - I hope your treatment goes well. PJH
comments: immunohistochemical stain CD34, positive for vascular markers.
comedo pattern cancerization of the lobules
I had 2 biosies done on my right breast at 1B and 3C
both nuclear grade III, angiolymphatic invasion present
1B is at least .6 cm
3C is at least .5 cm
help????
It sounds like your tumors are fairly small because each is less than a centimeter, but Grade 3 suggests that they may be aggressive. After your pathology report comes back, your doctor should set up an appointment to explain what it all means and to suggest a treatment plan. Make a written list of questions you want to ask and take a friend or relative with you to listen to the doctor's recommendations. It is hard for one person to absorb all the information that comes your way after a cancer diagnosis. I hope all goes well with your treatment. Let us know what other questions you have.
Hi Marsha - I'm sorry, we're not doctors here; simply well-read breast cancer survivors, skilled at putting into laymen's terms a lot of the medicalese you might encounter. So I can't give you percentages of gain from the chemo - that would be up to your oncologist to explore with you. S/he should be able to give you figures for risk of recurrence with or without the chemo. Ask for absolute, in addition to relative; in other words, "Your risk of recurrence with chemo is X%, without chemo Y%," as well as "Your risk of recurrence with chemo is reduced by Z%, compared to no chemo." This will give you a more complete picture.
Your diagnosis sounds serious, but straightforward. Please read our post on AC + T (which should be close to, if not identical, to the regimen you'll be getting; perhaps differing in the schedule of delivery.) This should help you prepare for what's ahead; knowledge is power, right? I wish you all the best, and please come back here over the course of your treatment, if you have any questions or simply want to share or vent; we're here to help. PJH
Marsha, the chemo drugs you mention are standard for triple negative tumors because you won't be eligible for the hormonal drugs like Tamoxifen or the targeted therapies like Herceptin. This is the trio of drugs I had 14 years ago although it sounds like my dosing schedule was different. Since they saw that tiny bit of cancer in a lymph node, they want to be aggressive in treating you. Don't let that scare you. I had 16/24 positive lymph nodes, and I have done well since treatment. Let us know what other questions you have. As PJ says, we are not doctors, but we can help from the point of view of people who have lived through this and who have done a lot of reading on the topic of breast cancer.
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PJ, your suggestion about double checking to be sure that the report is really about YOU is so important. As a person with the last name Johnson, I have had way too many experiences when the doctor was looking at the wrong chart or lab report when treating me. The funniest time was when I had to carry my mammogram film from the hospital to a different radiologist. He put Phyllis Johnson's old film up next to my new film. It was all too clear that the pictures were of two completely different breasts. Once again the hospital had pulled the file for the wrong Phyllis Johnson!