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Tuesday, September 07, 2010 al asks

Q: We know this much about my wife's breast cancer.It is stage III, IDC.

We know this much about my wife's breast cancer.
It is stage III, IDC.
There is a primary site on the top of the breast above the nipple.
Two lymph nodes are also affected - one axillary node and one supraclavicular node.
An ultra sound assisted FNA biopsy of the primary site was done, a CT scan was done days later. 
Cell grading and molecular classification of the cells WAS NOT done.

 

Meeting with the Oncologist provided this information.
He planned four chemo cycles, intended to kill each tiny growth at the two metastatic nodes, and then surgery for the primary site. The surgery to be folowed by 4 more chemo cycles and then radiation. Each Chemo cycle is to be a single intravenous delivery of a drug, then 3 weeks off, repeated 4 times. 

 

There are many types of lymphoma and many chemo drugs serving different purposes. These are my questions.
1. Can a single FNA biopsy of the Primary site and a CT scan provide sufficient information to:
a)  determine the cell grade.
b)  determine a molecular classification of the cells involved.
c)  decide the drug choice for Chemotherapy.
2. How important are a) and b) to an Oncologist in relativity to c).

3. I am interested in an opinion of what has been done.

 

Thanks, Alan.

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Answers (2)
PJ Hamel, Health Guide
9/ 7/10 12:28pm

Hi Alan - We're not doctors here, just well-read survivors. But I'll give your questions a try.

 

In general, a lot more informaiton is obtained via a complete pathology report of the excised tumor. However, since it sounds like they want to shrink the tumor before surgery, this isn't possible. Ask your oncologist if he/she was able to get enough information for a Scharff-Bloom-Richardson score; this is usually key to determining chemo type. And yes, it's my impression that the cancer grade, if not "molecular classification" (not sure what that broad term means in this context) are key to determining the optimal chemo drugs. On the other hand, since she's starting chemo prior to surgery, they'll be able to tell if the drugs are working once she has surgery; if not, they can switch to another "cocktail" post surgery.

 

If you have any doubts at all about her treatment plan, how about getting a second opinion? A Comprehensive Cancer Center (government-designated top cancer facility) would be the best place to do this. Best of luck - hope things work out well for you both. - PJH

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Phyllis Johnson, Health Guide
9/ 7/10 5:47pm

Alan, your wife's situation sounds similar to what I faced when I was diagnosed in several important ways.  The doctors had enough information to know that the cancer was aggressive and that chemo first was indicated, but they didn't have enough of the tumor in the biopsy to check for estrogen status and Her2neu status.  We could tell the chemo was working when the swelling in my breast went down, and we found out the additional information from the pathology report that came back after the mastectomy.  The "chemo first" route seems to be more and more popular, especially when there is a chance that some of the cancer has already escaped the breast (as indicated by her positive nodes).  While it would be nice to have more information NOW, the doctors have enough to make the most important treatment decisions right away.  It's been 12 years since my Stage III diagnosis, and I'm doing fine now.  As PJ says, if you are want to be sure that this is the best treatment plan for your wife, a second opinion, preferably from a comprehensive cancer center is a good option to ease your mind.

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By al— Last Modified: 12/27/10, First Published: 09/07/10