help with path report

silvermoon

Hi everybody, I'm new to this site....

Everyone here seems very knowledegable....wondering if anyone can help me with my pathology reports. Any insight would be greatly appreciated.

Over the past few months I have been having Mammos, Sonos, a Stereotactic Biopsy and last Friday a Surgical Biopsy. I am getting very disgusted and would just like some answers...I hope someone can help me.

Here are the results of my Stereotactic Biopsy:

Anterior:  In situ carcinoma, predominantly solid with rare cribriform areas low to intermediate nuclear grade and calcifications favor lobular but cannot rule out ductal

Biopsy not being clear if it is LCIS or DCIS....I needed a Surgical Biopsy.  Spoke to my Breast Surgeon yesterday about the biopsy results.  He told me he was confused.  Biopsy showed there were are signs of cancer present....this is a good thing...the cancer is gone.  Still unsure however if it was LCIS or DCIS. I still have to see an Oncologist.  I'm so upset...I would like to know which direction my treatment will be. I was hoping I would have answers by now....and I don't.

Has anyone experienced anything like this?

I would appreciate anyones help.

Thank You

leaf

I think some people can have BOTH LCIS and DCIS.  I have only seen 'cribiform' describing DCIS.  (I don't know that much about DCIS.) Maybe it occurs with other conditions too.  But I don't remember seeing 'cribiform LCIS' - maybe this is another of my senior moments.

If your oncologist doesn't give you a very clear answer, you may really want to consider sending your slides to a major institution for a 2nd pathology opinion.  (You may also want to ask your oncologist about a 2nd pathology opinion.) Your pathologist's report is a MAJOR FACTOR in determining your treatment. LCIS is treated differently than DCIS.  These diagnoses can be very, very difficult, and different pathologists can see things differently.

silvermoon

Thank You, Leaf... for your quick reply.

I have been following this forum for awhile and you seem very knowledgable.  I appreciate your advice.

My fear is.... being that my Surgical Biopsy was basically inconclusive... the Oncologist will treat the more extreme case... DCIS instead of LCIS.

leaf

This website has some references to LCIS with necrosis.  http://www.thedoctorsdoctor.com/diseases/lcis.htm .  Another possibility is something like pleomorphic LCIS.

silvermoon

Thank you very much for your help, Leaf.

You have been more helpful than doctors.

leaf

You're very welcome.  We all wish you the very best possible outcome.

mountainmomof3

Leaf, you are so knowledgeable!  I really appreciate your posts.  In your research, have you come across any info re: alcohol and plcis?  I've never been a big drinker (excluding my college years), but am thinking about cutting alcohol out entirely.  I only drink red wine, and usually just 3 to 4 glasses a week, but I heard somewhere that lobular cancers are heavily influenced by alcohol... not sure if that includes plcis or not. 

leaf

Well, the info is very scant.  This is not a study of PLCIS, but of DCIS and LCIS.  It only has slightly over 100 LCIS patients.

This 2001 study found no association with alcohol intake and DCIS or LCIS. http://www.ncbi.nlm.nih.gov/pubmed/11734598  DCIS patients and control subjects did not differ with respect to oral contraceptive use, hormone replacement therapy, alcohol consumption or smoking history, or breast self-examination. Associations for LCIS were similar.

In this very old study (1987) of 110 consecutive autopsies (of persons aged 20-54) done for medico-legal purposes, about 3% had LCIS (4 patients).  Malignancy was associated with alcohol abuse, in addition to other factors. http://www.ncbi.nlm.nih.gov/pubmed/2829956

So I don't think there's any real hard evidence either way for LCIS/PLCIS/DCS. It hasn't been studied enough and the studies haven't been large enough.

Alcohol abuse IS associated with invasive breast cancer, but alcohol is not among the most risky modifiable factors, according to this one study. Of the modifiable risk factors (hormone therapy (HT) use, physical inactivity, BMI, alcohol consumption), HT use and physical inactivity had the highest impact with PARs of 19.4% (15.9-23.2%) and 12.8% (5.5-20.8%), respectively, regarding overall invasive tumors.http://www.ncbi.nlm.nih.gov/pubmed/21159569

Risk factors are NOT necessarily additive.  In other words, obviously PLCIS is a risk factor, and alcohol is a risk factor, but for a person with both risk factors, you can't necessarily sum each of the risks together to get the correct  risk.

msippiqueen

LCIS was serious enough for me to chose a bilateral mastectomy. While it had not progressed, it might have. At it's most benign, it is currently considered a marker for cancers of various types in either breast.



High risk surveillance and a systemic estrogen blocker with it's possible attendant side effects is a way to go for some but not for me.



I worked as an oncology nurse way, way back in the day and was immersed in that culture personally off duty as well, giving me a good look at the disagreements among oncologists and a perspective that enriched my professional opinions. Fleshed out the why's, so to speak.



Professionally and personally I've been out of the loop for a very, very long time. This Camp Nurse a few weeks out of the summer couldn't have told you jack about the current state of affairs of breast bc until last spring.



What has not changed is so very much needs to be understood in the whole sphere of cancer care. It is ever evolving.



Based on my experience and situation, a bilateral mastectomy was a very easy choice.



You will have your own unique perspective, knowledge base and emotions. What choice you decide should not be dismissed as under/over treatment.

Anonymous

Final Diagnosis is finally in, and I am sorry to say I am going to need to move to a different board. AFter the first biopsy showed LCIS with removal of microcalcs, new breast specialist ordered an mri. This showed another small lesion right by the first one. Another surgical biopsy was conducted and just got the results. Stage 1 IDC. Waiting on the final pathology determination as to actual breakdown of type.

I am meeting with a plastic surgeon next week, and leaning heavily toward a bilateral mastectomy. It just seems like the long term risks are reduced significantly and I can still keep the radiation card in my pocket if I should need it at some point.

Plus, I hate worrying that it will show up on the right side, etc and I will be faced with the same thing all over again.

So, while not great news, it is an early stage, doesn't appear to be in the nodes (although that will be checked at my next surgery) and I finally have a diagnosis after two months. Thank heavens this specialist is attentive to detail or it might easily have been missed for a long period of time.

Anonymous

fluffqueen---I'm so sorry the news wasn't what you had hoped for. But I am SO glad they found it early, at stage 1, when it is more easily treated.  (I have been on high risk surveillance and taking preventative meds for LCIS for over 7 years, so I know the feelings you must be having right about now. I go for my next MRI in March and pray that everything is OK.) ( My mom had ILC stage 1 or 2, neg nodes, and had lumpectomy , radiation and tamoxifen--doing very well 24 years later without any recurrences).  Whatever you choose will be the right decision for you.

anne