Pathology Report

dcarpenter

In my report it mentions "Intraductal carcinoma forms less than 10% of total tumor volume"  My tumor was 1.3cm--so I take this as a good thing, only 10% of a 1.3 tumor--but not sure? comments?

valiossifova

Hi everyone, I'm just having some concerns about the characteristics of my tumor-it showed presence of focal lymphatic invasion even though the lymph nodes were negative. I started radiation but after getting to understand the surgical report, I'm considering chemotherapy as well. Would it be effective if done after radiation? Thank you

unklezwifeonty

Dear DCarpenter,

Is the remaining 90% invasive ductal carcinoma or something else?

jill323

Dcarpenter -

When I have seen that description in the past, it usually means that there is prescence of both DCIS and IDC.   So... it appears from what little you posted that the total tumor "mass" as 1.3 cm (in its greatest dimension) and 10% of it was IDC.  I suspect the rest was DCIS.  I had something similar.  So, yes, that is a good thing.   Look in the rest of the report to say if there is prescence of ductal carcinoma in situ.  If so, that is likely your answer. 

Valiossifova -  

 In regard to your radiation/chemo question -  whether to do chemo depends on a lot of factors including your age and the characteristics of your tumor.    As I see that you are ER positive and Her2 negative, did your oncologist offer up the oncotype test in order to determine your risks and whether chemo would buy you anything ?  That test basically is made for tumors "on the fence" and used as another piece of data to make a decision.   In addition, you can have your doctor model out your recurrence risks on Adjuvant to see exactly what the stats say it buys you.  However, this tool is more powerful with the Oncotype testing in front of it.  In addition,  I have seen some cases where radiation is done in front of chemo.   Usually it is up to doctor preference among other things.   It is possible that your doc may be just getting you started in radiation while other "data" (such as the oncotype) comes back.   To date, I have seen no magic to the order of things.  (I personally did chemo first, but could probably have just as easily done radiation first).

I hope that helps.

Jill

valiossifova

Hi Jill, how are you?

My oncotype came back as 13% possibility of recurrence.  My oncologist said that I'm in the intermediate zone, so there is no way of telling whether chemotherapy will benefit me. What worries me is that focal lymphatic invasion on the pathology report from the surgery. Otherwise, the lymph nodes are negative. Thank you

jill323

Valiossifova -

Hello again.  I am doing great these days (cancer wise, that is).  I got a bad bug, but don't think it is H1N1 as the fever only lasted a day.   Just had my one year out mammo and exam - and all clean.  This time last year I was in chemo.  Pretty much done except for Herceptin, which I will have until February or so.   Thanks for asking.

OK.. in regard to lymphatic invasion on the path report - I had the same thing.  Asked the doc, and she said if the nodes were clear, I was fine in that regard.   Evidently, that can be a determining factor as to whether to take nodes or not (my invasion was "discovered" in the initial biopsy).   

In regard to your oncotype, your doc can still "model" your benefit based on a number of factors, including the exact number gotten by the oncotype - even if your score was intermediate.   Your age, tumor size, grade, ER/PR status, Her2 status, Oncotype score, node status and current health all play into the assessment.   There is a program that can model out the benefit of chemo based on those factors.   That said, looking at your ER/PR and grade, I suspect that your doc is banking on hormonal therapy (Tamoxifen and/or AIs) playing quite a role in reducing your risk.   PM me if you want more information. 

The reason I ended up on the chemo train was largely due to my Her2 status and age (43 at diagnosis) - despite an apallingly little tumor (tiny but nasty little sucker).   My ER was also very low (only 20%), so she essentially treated me as if I were ER/PR negative - not a whole lot of benefit from hormonal therapy.

I hope that helps a little more.

Jill

weety

Jill, I have a question regarding your lymphatic invasion "discovered" in the biopsy.  Was it also present when they did your mastectomy/lumpectomy?  I ask because my biopsy found lymphatic invasion in "a few small angiolymphatic spaces" but then when the mastectomy was done, the path report stated NO vascular invasion present.  I am still trying to figure out how it could have been present in the biopsy but not the mastectomy.

Also, I didn't have any numbers to tell what my "weakly" positive ER means.  My onc seems to want to treat it as ER positive now (I think originally she said it may as well be negative--that's why I put ER negative in my profile below) and start me on tamoxifin after I finish chemo in 6 weeks.  So confusing.   Am I or am I not ER+?