A small lump was found during a recent mammogram. A lumpectomy was performed. Results of the 1.5cm x 1.5cm lump came back positive for a .6 cm malignant IDC encased inside this hard (marble like) lump. No cancer cells were found in surrounding tissues. All reports show this tumor inside lump as being the least invasive and very small. A walnut size tissue was removed and no cancer cells were found anywhere else. I was told that the lymph nodes could not possibly have any of the carcinoma, so there are no plans to check the lymph nodes. Are radiation and hormone replacement therapy called for or is the doctor suggesting these treatments to cover all bases? What are the chances of IDC returning without any treatments?
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Q: Can IDC return if all is removed during lumpectomy and no treatments are done?
Answers (1)
9/19/09 5:19am
This sounds like an unusual diagnosis; I've never heard of an invasive tumor that was "encased" like this. Usually, invasive means it had left the milk duct and gone into surrounding breast tissue, so not quite sure I understand this. And I'm surprised they didn't at least do a sentinel node biopsy, to make sure the cancer hadn't somehow left your breast. I've never heard of a doctor categorically stating that an invasive cancer can't possibly have spread.
Nevertheless, sure, you can go without further treatment. It's estimated 40% of breast cancers might disappear without any treatment at all - including surgery (though who wants to test to see whether or not they're in that 40%?) You are quite possibly putting yourself at higher risk for a return of the cancer, if you don't do radiation/hormone therapy. But it's up to you to assess how great the risk is, and whether you want to trade it for further treatment.
Bottom line - if I were you, I'd get a second opinion about testing the lymph nodes, as well as a second opinion about your chances for recurrence, with and without treatment. Considering this is a life and death issue, literally, and you're considering foregoing standard treatment, I believe it warrants more research. Good luck - PJH
9/27/09 10:22am
OK, let’s go through this step by step – it’s so confusing, isn’t it? But you sound like you’re doing a really good job with researching, and trying to understand your situation.
You’re ER/PR positive, which is a good thing. Since they’re recommending Arimidex, you’re post-menopausal; an aromatase inhibitor (e.g., Arimidex) is now the standard of treatment for hormone-receptive, post-menopausal women. You take the Arimidex after everything else is done – it’s a long-term mop-up action, and you’ll probably take it for 5 years or more; the data about its period of maximum effectiveness just isn’t in yet, as it’s still relatively new. I’ve been on it over 4 years; my oncologist said I can quit it at the 5-year mark, as he feels that’s a good cutoff point (he’s also a researcher).
Your HER2-neu is negative – yes, a positive score of 1 is actually negative. And that’s a good thing – HER-neu positive usually signals a more aggressive cancer.
Ki-67 is a “proliferation index” – and no, it’s not the same thing as the Oncotype test, which “reads” your genes and predicts how responsive they’ll be to chemo. Ki-67 basically refers to how aggressive your cancer cells are – how likely they are to want to keep growing. As you said, your score puts you at the high end of neutral, with 0%-10% being not aggressive, 10%-20% borderline, and 20%+ aggressive. If I were you, I’d ask the new doctor you’re seeing about chemo; and about whether you’re a candidate for the Oncotype test, which would help you make up your mind, if s/he thinks you’re right on the edge of being a chemo candidate.
Don’t worry about the sentinel node – they know where your tumor was, and they can easily figure out where the sentinel node is. They simply inject dye into the tumor site, and then watch where it travels. They then remove the sentinel node, plus 1 or 2 others closest to it, to examine for cancer. If they’re cancer-free, that’s a really, REALLY good indication that the cancer hasn’t spread.
Sounds like you have a copy of your pathology report; please read and study our Guide to Understanding Your Pathology Report. It’ll demystify most of that “Latin.” pT1b refers to the size of your tumor, which was under 1cm (that’s the “1” in that jumble of letters/numbers). And your scores of “1” on those other indicators are all low (good).
Finally – in general, breast cancer is VERY slow growing. You absolutely have time to do some research, see another doctor, and make your decisions in a sensible, informed way. I was diagnosed May 10, had a lumpectomy June 6, a mastectomy July 17, didn’t start chemo till Aug. 15 – and my cancer was considered fairly aggressive. So don’t worry too much about taking your time (within reason, of course - wouldn’t want you to go months and months without starting treatment).
This is a very confusing and distressing time for you. But you’ll be amazed how strong you are – and at the love you’ll feel from those around you: friends, family, co-workers. And the community here at HealthCentral is here for you – please stay in touch. Best of luck - PJH
P.S. One more thing: Check out our list of Comprehensive Cancer Centers, which are government-designated as the best in the country. If there’s one near you – you’re lucky, use it!
9/27/09 7:13pm
Thank you so much for putting my mind at ease. I am in Missouri, in a small podunk town in between Kansas City, Springfield & Columbia. Unfortunately, St. Louis is a bit too far for me to travel to. I do have an appointment at Ellis Fischel Cancer Center in Columbia with an oncologist who studied at Washington University in St. Louis. I have a bone disease and have had 18 surgeries just on my bones, so I don't tend to jump into anything. I have read the information on how to decipher my pathology report. It seems that I don't have a whole bunch to decipher. There are more "can't assess" than any concrete information. I will go into my appointments well-informed which is what I want and need. Thank you for all the information you have given me. You have helped more than you know.
Bless You
9/27/09 9:05pm
I'm glad you're feeling more sure of your course of action. A bunch of "can't assess" readings on your pathology report clearly calls for more diagnostic tests and/or a better read from the pathologist. I hope your appointment this week goes well, that you hit it off with the new doctor, and that you get on the path to good treatment - and from there, to health. Good luck to you - and please check back in, OK? P.S. - I like your screen name! - PJ
9/28/09 11:53pm
The screen name I've had for years. I am shocked that I very seldom have to choose another when registering with a site. Many years ago, I used to follow the pow-wows around selling my art work. I am not Native American but have always said I am One With The Spirit.
Today's doctor appointment was definitely unexpected. The radiation oncologist I met with seems great. I was very comfortable with him and he took time to answer all my questions, but not before informing me that the reason the report had alot of "cannot be assessed" is because the cancer was not found on the lump or in an area that had been "inked" but, in a part of the surrounding breast tissue. Talk about me having good luck. If a biopsy had been done instead of going straight for a lumpectomy, the cancer would not have been found. Now the plan is to go in and take more tissue out to be tested along with testing the nodes. He was a bit shocked to hear that the medical oncologist had stated that the cancer could not be in the nodes, especially when I played my recording of what he had to say.
The doctor today informed me he knows the new medical oncologist I have an appointment with and thinks very highly of him, so I am feeling much more confident about any treatments that will be decided. I am very glad that I had done my research and understood what he was talking about. I return to the surgeon on Wed. to schedule the re-excision. Unfortunately, I have been dealing with an infectiion inside the breast where he removed the tissue and am hoping I won't have to wait too long before moving on. This doctor said something about being able to clean up the infection once inside. I am sure many more of my questions will be answered once the new pathology report is in hand. I tend to be impatient at times and do not like having to wait for results.
I will definitely keep in touch as you cannot imagine how much help you have been to me. I was unable to find anywhere else that answere my comments as quickly as you. Plus you kept me grounded. Thank you so much. But the time I am through, you'll probably be ready to get rid of me. 
9/29/09 7:50am
Thanks for letting me know - I feel a lot better compared to your first question where they weren't even going to test your nodes - clearly just WRONG. I'm glad you've found a medical team that sounds like they'll take good care of you. And - I'll never want to get rid of you! Tha'ts what we're here for, to help.
Hey, have you ever been to any PowWos in the Northeast? We have a huge one right in the town I live in... PJ
10/ 1/09 7:15am
Great Morning to you.
I haven't been to the Northeast since 1977. Although I am an Air Force brat and spent my elementary years in Europe, I did do my high school years and some college in Massachusetts. In high school, some girlfriends and I used to go up to New Hampshire to a pow-wow. If I'm remembering correctly, it was somewhere around the Lost Caves. If I'm remembering the caves name correctly. I guess some would consider me a woodstock child because of the way I acted and the attempt to completely burn every brain cell I had. I left in '74, but went back to Mass. in '77 for a visit. I would love to get back to New England. In all my travels I still believe that is where some of the most beautiful country in the continuous states is. Also spent a lot of time in Maine & Vermont camping and I used to go to Nova Scotia every summer for a month with my Aunt. She lived in Boston and used to write for the Globe. Unfortunately, I lost her about 5 years ago. As far as selling my wares, that was done from Missouri to Arizona and up to Colorado and Utah. I settled down about 12 years ago - I now just want to stay in one place so I live out in the woods down dirt roads near the Osage River. I have no neighbors that I can see and I love it. The only downfall is the lack of sunshine in the little "ditch" I live in, I can only grow rocks.
I saw the surgeon yesterday. He wants to talk to the oncologist before setting a surgery date, so they said they would call today with that date. He didn't seem to like the idea of taking more tissure, he thought a mastectomy would be better. The only thing I could figure out was he thought the breast might be too disfigured. I figure I'll wait to see what this pathology report shows before making that decision. I am glad they are going to check the nodes. I'm actually very lucky that a biopsy wasn't done before the lumpectomy. They wouldn't have found the cancer.
10/ 1/09 8:46pm
Well, oftentimes surgeons don't want to do additional surgery on a breast rather than simply removing it; as you said, they're afraid of the cosmetic results, as well as possibly not getting all the cancer. Still, it's ourbreast, yourbody... and the decision is yours.
Not sure about Lost Caves, though I've heard of Ruggles Mine... I live in Hanover, NH, home of Dartmouth College, where they have a big PowWow every year. And indeed, it's beautiful country up here. Hope you can come back sometime.
Best of luck with your treatment, whichever direction you decide to go. PJH
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By onewithspirit— Last Modified: 11/16/10, First Published: 09/19/09
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I have taken your advice and made an appointment with an oncologist who specializes in breast cancer. I have also been doing some research as I want to be able to understand completely what is being said. On that note, I have a few questions. My cancer shows ER pos 96%; PR pos 96%; Ki-67 pos 18% with a 1+ score for HER-2/neu 4B5. I understand the ER and PR and have been given arimidex. I have not yet started this medication as I want to see this new doctor first and get his input on everything. I am confused on the Ki-67 test and the HER-2/neu 4B5. Is the Ki-67 the same thing as oncotype? What I have read says that a score of 19% and higher usually receive chemo. With a score of 18% - it being the high on the low scale, should chemo be suggested as an option? Can you explain to me what my score on the HER-2 test means? Also, since I had a lumpectomy already, with no previous biopsy, will they be able to locate the sentinel nodes to check. After reading your response to my previous question and doing a bit of research I am in agreement that I need to have the nodes tested. I am in shock that the medical oncologist told me that since my cancer is so small that there is no way it could be in a node. I have been taking my camcorder with me to my appointments - using audio only - so I can refer back to all the doctors have told me. It has amazed me how often I have had to listen to the tape in order to remember exactly what was said. Also, can arimidex be taken while receiving chemo or is it started after any chemo treatment. I have been told that the cancer is slow growing, it was rated pT1b. Tubule formation, nuclear pleomorphism, and mitotic count were all scored 1. All that is latin to me. Do I have the luxury of taking some time to make a concientious decision or should I worry and jump right in line and do what my doctor wants done now? I see a radiation oncologist tomorrow morning and I do not want to make a decision until I see the new doctor on Oct. 7th.
Thank you for any information you can give me so I will be prepared for my next appointment.