A little help with Pathology Report

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SnufflesMom
Regular Member


Date Joined Apr 2005
Total Posts : 69
   Posted 4/29/2005 6:19 AM (GMT -7)   
Hi Ladies,
 
Here is what my path report says:
 
Invasive ductal carcinoma, poorly differentiated (bloom-Richarson garde 3 of 3), 2.8 cm by gross measurement.
 
         - No lymphovascular invation or in situ carcinoma is present
         - Mitotic rate is hight (44 per 10 hpf)
         - Invasive carcinoma is present 0.1cm from posterior margin and is greater than
           0.5cm from all other margins
 
Estrogen Receptor - Positive
Progesterone Receptor - Positive
HER2/neu -  Indeterminate (2+)
 
NOte:  the invasive carcinoma is wsell circumscribed mass which abuts the posterior margin of the specimen.  Anterior to this carcinoma is a fibroadenoma which abuts the anterior and medical aspects of the specimen.
 
NOW IN ENGLISH.....................
 

MiaB
Regular Member


Date Joined Feb 2005
Total Posts : 205
   Posted 4/29/2005 6:48 AM (GMT -7)   
Well I can't understand all of it but here's what I could make out.
The size was 1.1 inches. As you mentioned in your update post it was hiding behind a fibroadenoma.  From the margins they mention it would seem that they were small in the one area (0.1 cm. from posterior) but as it states there is no in situ carcinoma present they must have gotten clean margins and that of course is good.  The estrogen and progesterone receptor positive ratings make this a better cancer to treat.  Mine was hormone receptor positive also and that means the tumor was "feeding" off hormones.  With tamoxifen they can block the hormones from being absorbed by the breast tissue.  Unless you are post-menopausal then they have other medicinal treatments that I can't remember the name of.
 
All of this with the fact that there was no lymph node involvement means you are a good candidate for the Oncotype DX test.  It will help to determine the need for chemo.  It is a genetic test that can help to predict the chances of a recurrence.  Please ask about this with your oncologist.
 
Sorry I couldn't be of more help.  This is such a difficult time trying to learn all you can and be informed to make the "right" decision.  Keep in mind that we are all different with what works for us.  I felt very comfortable in going with the results of the Oncotype test and not having chemo.  others may feel the need to attack in everyway possible.  No one is wrong in what works for her.  Just follow your gut instinct and don't look back.
 
With love and comforting hugs,
Mia
 
Snowflakes are one of nature's most fragile things, but just look what they can do when they stick together.


-Vesta M. Kelly


SnufflesMom
Regular Member


Date Joined Apr 2005
Total Posts : 69
   Posted 4/29/2005 6:59 AM (GMT -7)   
Thank Mia,
 
WE dont' know for sure if there is no lymph node involvement, they did not check them in the first surgery, I now have to have a second surgery to check the lymp nodes and remove the cancer mass, they only removed the fibroadenoma, and not the cancer.
 
My doc said the same thing I might not have to have chemo.
 
I have chosen to have a lumpectomy instead of a masectomy, my doc told me that to have a masectomy would be overkill, that a lumpectomy would have the same results.
 
Thanks.

Tavish
Veteran Member


Date Joined Jul 2003
Total Posts : 2272
   Posted 4/29/2005 7:19 AM (GMT -7)   
Hi Randi-
My path report was very similar. I am pretty sure they will recommend chemo, since your tumor was nearly 3 cm (mine was 2.5, grade III, high mitotic rate, ER/PR+. Her 2 2+). They say that 1 cm seems to be the cut off for having a choice on chemo...your cancer is at best a stage IIA (if no nodes are involved and no mets). Plus the tumor was an aggressive little bugger....poorly differentiated is worse, it means the cells were really mutated and irregular....high mitotic rate has to do with rate of cell division.
I asked "the expert" on the Johns Hopkins site recently on whether they could re-test my tumor for the oncotype DX and he said it would not matter, that the test is geared for smaller tumors....standard of care for a tumor of that size, I am betting, means chemo.

Noting that the cancer was .1cm or .5 cm from margins has to do with getting a clean circle of tissue that surrounded the cancer. I forgot what, but there is a certain measurement that they look for to be clean....if they cannot get clean margins, for example if there is vascular invasion, they tend to do a mast.

I had all margins clear at the first lumpectomy but 1 was "close". It was advised to have that resected and take another hunk of breast tissue, plus rads.

Hormone receptor positive is a good thing, it means you will probably get to take Tamoxifen or other hormonal med for a few years, to offer continued protection against recurrance. Lymphovascular invasion (mine was clear too) refers to whether the cancer cells are seen trying to make an escape...negative is good. I have read that having little to no in situ (encapsulated) is a good predictor, that an invasive carcinoma with high presence of in situ can mean higher chances for recurrance.

There are some good books, including Dr. Susan Love's Breast Book and Dr. John Link's Breast Cancer Survivor Manaul...both have great resources on how to read and interpret path reports.

But seriously, I think yours is identical to mine in nearly every aspect.

L&H,
Lori


SnufflesMom
Regular Member


Date Joined Apr 2005
Total Posts : 69
   Posted 4/29/2005 7:24 AM (GMT -7)   
Lori,
 
Thank you.  So let me ask a couple things.  First they are not sure if the lymp nodes are clear as they did not check them yet, they will do that when I have the lumpectomy on May 5th.
 
So, how old were you when you got your DX.
What have you done for treatment.  Chemo?, Rad?  What has this been like for you.  What is in store for me.  I'm at stage II, that is what the doc said.
 
What else can you tell me.
 
If i'm asking to much, I'm sorry don't mean to.  Just trying to figure out what life in the next few months is going to look like.
 
Many Many Thanks.
RAndi

gma
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Date Joined Jul 2003
Total Posts : 2921
   Posted 4/29/2005 7:40 AM (GMT -7)   
Hi Randi, Lori and Mia can help you much more than I can with all the details. I was an old chicken and said do a mastectomy and got away with that. I don't know all the path information. I just wanted to say we are with you and will be here for you, whatever you encounter. Lori has been doing great for over five years, so if your path report is like hers I think that is a real positive. Hugs MK


Tavish
Veteran Member


Date Joined Jul 2003
Total Posts : 2272
   Posted 4/29/2005 7:42 AM (GMT -7)   
Randi-
No problem on the questions, that is what we are here for!

Lymph node involvement is different than the vascular/lymphatic invasion. There are tiny vessels that transport lymph fluid and should be the path that the cancer takes if it is going to travel to the nodes. From the path report, they are looking at the vascular system that was feeding and draining the tumor...which is different than the lymph node surgery. (BTW, are you going to have a sentinel node biopsy? It sure sounds indicated in your case and much better than a full node dissection).

They can say you are stage II, but there is more to learn. They will probably run some tests to make sure it looks clear in your lungs, liver and bones...which would indicate stage IV if cancer had spread. And the stage II can be IIa or IIb, depending on node involvement. We'll keep our fingers crossed for IIA, which means no node involvement.

I was diagnosed a week before turning 31. I had a lumpectomy in November 99, and in January I had the re-excision and sentinel node biopsy. In February, I began 4 rounds of chemo (adriamycin and cytoxin, called AC). They were 3 weeks apart. Protocols have changed a little since then, so there could be some variation. Last chemo was 4/11/00, then a month later I did rads to left breast. That lasted till mid June and I started Tamoxifen the next day.

Chemo impacts us all so very differently. I was very lucky and felt that I had a pretty easy time of it. I took a couple days off work each chemo cycle and really never missed a beat. I worked through the whole thing, and managed to take care of my house and then even start the yard work in the spring. I have a desk job and no kids, so some things were to my advantage. I was determined to be as "normal" as possible and not miss anything due to cancer. I never felt sick from cancer and sure was not going to let treatment make me feel sick....although my hair did fall out, leaving me to "look" like I had cancer. And now....I have about 7 weeks left of Tamoxifen and did well on it too. My periods continued but I packed on about 20-25# during these past 5 years. Well, small price to pay if it kept me cancer free.

Your prognosis should be really good! I was told that i had something like 85-90% chance of being cured, with chemo, rads and tamoxifen. Those are pretty good odds, and I am counting on being in the majority this time.

L&H,
Lori


Post Edited (Tavish) : 4/29/2005 9:13:21 AM (GMT-6)


SnufflesMom
Regular Member


Date Joined Apr 2005
Total Posts : 69
   Posted 4/29/2005 7:49 AM (GMT -7)   

OK now I'm scared, 20-25lbs, I'm 30lbs over weight now and trying to lose.  That was my biggest fear getting fat, how vain, but thea t is what I worry about.  Plus I will have to stop smoking to be on the Tamoxifen, is there anything else beside that, that I could take.

Chemo, yuck.

 

Oh well whatever I have to do I will.  I work in an office and have no kids at home, just a great husband, and my dog.  So I plan on working and staying as active as possible.

I think the only thing they are going to do in the surgery is the lumpectomy and check the lymp nodes.  I have a meeting with my doc on Tuesday before the surgery.


Tavish
Veteran Member


Date Joined Jul 2003
Total Posts : 2272
   Posted 4/29/2005 7:56 AM (GMT -7)   
One step at a time...just because I gained weight does not mean you will.....and it was slow for me, I did noot gain weight all at once.

My opinion is that the mindset is part of the battle, and you are there. Planning to stay active is key too...if you plan to sit home and be sick, you will. And even if you feel punky for a couple days during chemo, you will rebound and be fine for a couple weeks. Yes there are other drugs besides tamoxifen. There are new drugs called aromatase inhibitors, but one must be post menopausal for it, and I am not.

Ask what procedure they are doing to look at the lymph nodes....if they say they will just take a few, then probably a sentinel node bx. But if they say a full node dissection, please ask about the SNB or seek a second opinion. Your recovery will be faster and much less risk of lymphedema that way.

And not all chemos cause you to lose your hair, but most do. You should set an appointment with an oncologist once they get the lymph node report. Even if the surgeon thinks you dont need chemo, the surgeon is a surgeon. He cuts, he does not treat cancer with chemicals. Let the onc make that call.

After I saw the surgeon with my path report, I saw an onc and a rad onc, also had bone scan and chest xray. THen I took all my films and slides to U of M for a 2nd opinion and met with their team, stuck with that oncologist and surgeon.

Lori


SnufflesMom
Regular Member


Date Joined Apr 2005
Total Posts : 69
   Posted 4/29/2005 8:16 AM (GMT -7)   

Ok, I'm in information overload.  I am going to ask the surgeon what she is going to do as far as the lmpynodes go, then after I have all the information, I'm going to meet with the top oncologist in Boston to see what my treatment plan is.  Dr. Burstein (the onco) has my first pathology report now, and will get the second one as soon as I get it.  I will then go from there.

I have to keep a good attitude to beat this and keep my sanity, which is now starting to slip. 

Ok bring it on, with all of you I can do this.

Randi


Tavish
Veteran Member


Date Joined Jul 2003
Total Posts : 2272
   Posted 4/29/2005 8:17 AM (GMT -7)   
Forgot to mention....that my nodes were negative. My first surgeon expected them to be positive, based on the tumor traits. It sometimes seems like "luck of the draw"....some who have larger aggressive tumors remain cancer free with negative nodes...and others with smaller tumors end up with cancer in the nodes. Just wanted you to know it is possible, with that path report, to have negative nodes...and I am still NED!
Lori


Tavish
Veteran Member


Date Joined Jul 2003
Total Posts : 2272
   Posted 4/29/2005 8:20 AM (GMT -7)   
Randi-
Take it easy....information overload is normal! And just wait till you meet these other doctors, you will have more to process (which is why a taperecorder is so good!). Feel free to email me if you want to talk "off-line"....

The sentinel node biopsy involves injection a radioactive tracer and or blue dye to find the sentinel node, and they take just that one or the surrounding ones. Less invasive than taking a whole bunch out.

Lori


SnufflesMom
Regular Member


Date Joined Apr 2005
Total Posts : 69
   Posted 4/29/2005 9:05 AM (GMT -7)   

Thanks Lori,

Just one of those days, I guess it is finally sinking in.  But I will fight this with all I have.  I have a great husband and he will be my main support along with my family. 

I can't worry about little things like getting fat and going bald, I have to look at the big picture and that is getting heatlhy again.

Like I said I will have my good days and bad, got to keep the chin up.

I will continue to keep all you wondeful ladies posted as I move along this new path.

Thanks

Randi mad


Luci
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Date Joined Jul 2003
Total Posts : 892
   Posted 4/29/2005 9:15 AM (GMT -7)   

Dear Snufflesmom,  I won't comment on your path. report.  I had enough difficulty figuring out my own.  I'll just say that it does have some very positive factors in your favor.

What I am concerned about is that your dr's opinion that a mastectomy would be "overkill."  My question is "overkill" for whom??  I know that sounds harsh, but my point is this.  Your dr. needs to guide you factually, not make a statement using emotionally overcharged words like "overkill."  Have you researched both options?? Only YOU can decide which of the two options is best for you.  You need solid factual information before you make a decision about what's going to done.

I KNOW you're on overload now AND that emotionally you're spinning around.  Try to take some deep breaths and relax for just a few moments.  Then get a piece of paper, either fold it in half up and down or draw a vertical line down the center.  Label one side lumpectomy and the other mastectomy.  Write down every positive OR negative you can think of for each one.  You may also want to do some add'l research on both topics.  You'll be surprised at how much info. you'll be able to find.  Once you've got real facts, then you're ready to go back to your dr. armed (and I use that word in its most literal sense) and discuss what's to be done.

One thing we've all learned here on this board is that "knowledge is power."  In the midst of this tremendous emotional blow you've rec'd, you're expected to make a logical decision on the type of surgery you'll have.  It will take some real will power on your part, but YOU will decide the best course for YOU.  

We have all been exactly where you are at this moment in time.  Whatever decision you make needs to be yours and yours alone.  I hope this helps.  Hugs, Luci 


In the depth of winter, I finally learned that within me lay an invincible summer.  Albert Camus


debbiR
Veteran Member


Date Joined Feb 2005
Total Posts : 730
   Posted 4/29/2005 9:44 AM (GMT -7)   
Hi Randi! I'm a little late in answering your post. First, I am sorry that the news wasn't good but it sounds as though you have caught it early. Your path report sounds good and your mental attitude is awesome.
 
I have to agree with Luci. A surgeon cuts and an onco treats the cancer. Please get all of your facts, check with the onco that you have chosen and get his opionion before taking your surgeon's word. When I had my mastectomy, my surgeon consulted with my onco before anything was scheduled.
 
One last thing, please remember to take care of YOU. Most of us feel that we are superwoman and don't allow ourselves the luxury of honoring our feelings...joy, exhaustion, anger, relief, etc. Please listen to your body. It will tell you what you need.
 
Deb
 


Lmmackey
Regular Member


Date Joined Mar 2005
Total Posts : 316
   Posted 4/29/2005 11:50 AM (GMT -7)   
Hi Randi,

All good advice from the ladies in the previous posts. I would like to add that one great resources is by Dr. Susan Love call The Breast Book. She also has a website with great information: www.susanlovemd.org.

One thing that came to my mind in your posts was that you said the cancer was not yet removed, but that the fibroadenoma was removed. Are you sure about that? That's a large mass already removed and to have a cancer that is still in there means more surgery. I would also look into the pros and cons of a mastectomy. I'm 40 and will be undergoing a bilateral mastectomy next Friday. I had the option of more surgery to try to chase the margins, but besides the IDC, I have extensive DCIS. MY choice, MY decision to go for the mastectomy. I also chose bilateral because I am very large sized and want to balance things out and I don't want reconstruction.

The first few weeks are loke a roller coaster. In my case, getting all of the facts really helped me feel in control of an out-of-control situation. We're here to help in any way that we can. I hope you'll be able to get a copy of that book. It is now my BC bible.

Take care and remember to do a few things that will take your mind off of the BC for at least a short while!

Hugs,
Laure'
The finger of God touches your life when you make a friend.
----Mary Dawson Hughes---


coopfesta
Veteran Member


Date Joined Sep 2003
Total Posts : 1373
   Posted 5/2/2005 3:33 PM (GMT -7)   
Hey Randi:
 
Sorry it took me so long to write you.  You have been in my thoughts.  I am sorry your news wasn't b9, I was waiting to read your post that day, and my prayers were with you when you didn't respond during the day.  I'm glad you're back and I definately relate to the info overload. 
 
Dr. Love's book was the best one for me.  I spent a small fortune a couple of weeks after being diagnosed on books, (watch the spending right now, you're vulnerable and the bills still come, even if you have cancer), but I could have gotten the one book and it would have been fine.  I also liked the fiesty woman's breast cancer book.  Don't remember the author's name.  She had a great attitude. 
 
All the thoughts, especially when you have a child, are overwhelming right now.  I'm glad you have us to talk to about it.  Sometimes family can't handle it the way we can.  Mine couldn't.  I probably handled it better than they did!!! 
 
I did very well on the Chemo.  I also did AC, for six treatments, three weeks apart.  I spent a lot of the time trying to get to know my reactions and achieve a colon-friendly medication formula.  My colon would shut down, and I couldn't go unless I had a lot of laxitive and stool softener.  That was the worst part of that.  THen came Taxotere, which caused body aches.  I was able to work, though.  Straight through, not too many days off.
 
Write back when you need....
"Our greatest glory is not in never falling, but in rising every time we fall." -Confucius

Ellen

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