Mixed Type BC

vickilind61

It's nice to know I'm not the only one with so much going on!  In Feb, I was diagnosed with DCIS in the rt breast.  During the lumpectomy, the BS discovered 2 tumors that had NOT shown up on any of the mammos.  THey were small, .8 and 1.1 cm.  When the pathology report came in, both were IDC, plus more DCIS on all the slides.  So, one month after the lumpectomy, I had a mastectomy on the right side.  They found a third tumor, 4 cm, more DCIS AND LCIS.  Now, of course, I'm starting to re-think my not getting a bi-lateral.  When I had my lumpectomy, I had a mastopexy/reconstruction and on the left side, there was no cancer, but there was atypical hyperplasia.  Knowing that I came back HER2+ makes me REALLY paranoid.  My BS is pretty aggressive about NOT going bi-lat, as is my PS.  My Med Onc is aggressive the other way, but I think the BS kind of told her to tone it down. 

I have an appt with me Med Onc on Monday to talk about all this junk.  She is my fave on my team.  THere is just so much to wade through.  My port bugs the heck out of me, and almost 2 weeks out from 2nd surgery, I am still filling my drains-over 70 cc per day!

hugs and thanks for letting me vent. 

Laural136669

I am a 25 year survivor of acute leukemia and secondary MDS. I was diagnosed with IDC last August 2011. During testing to help in decision making, an MRI of the other breast showed a questionable area. Within a week, I was able to palpate the area found on the MRI. They did an ultrasound biopsy, but were nowhere close to the area I could feel. Even though I told the nurse this and the biopsy doctor, they decided it was nothing. I held to having a bilateral mastectomy with sentinel node biopsy on the left. The path report came back with the IDC on the left, and ILC on the right. That earned me a second surgery to take the right axillary lymph nodes. Oncotype testing was moderate risk (the tumor on the right being the more concerning of the two), so ended up with a round of chemo (TC X 4). Over the past month, I have begun to feel an area on the lower ribs that has the same moveable lumps that I had in the right breast. CA 27-29 testing was at 27 so within the normal range. I have never had scans during this whole process, but wonder if I should push for more testing. I would just like to know that the lumps are benign, as I otherwise feel good and would like to start enjoying my summer vacation. In many ways, the leukemia was easier for me to deal with as the numbers were concrete and the cancer cells did not hide out as easily. Breast cancer seems a whole lot more like hide and seek right about now.

Anonymous

Hello all and thanks for sharing. I just discovered this forum for us 'mixed' girls.  I've been researching my eyeballs out for the past 2.5 years and only started looking at this aspect of my cancer. My path report says: IDC with ILC features, grade 1, with tiny amount of DCIS grade 2 within the 2 cm tumour which had a sister (.6 cm) nearby. 

Bluecowgirl, here is a bit of research I've found.  From what I can see, a mixed tumour(s) is not a bad prognosis, in fact, it has a slightly better one.

'Tumor characteristics and patient outcomes are similar between invasive lobular and mixed invasive ductal/lobular breast cancers but differ from pure invasive ductal breast cancers.
Patients with IDC had the poorest 5-year (80%) and 10-year (61%) survival compared with patients with ILC (87% and 68%) and mixed (84% and 69%) cancers (P = .029).

Conclusions:

Although patients with ILC and "mixed" cancers are diagnosed with more advanced disease, their survival is superior to patients with IDC"

http://www.ncbi.nlm.nih.gov/sites/entrez/19800459?dopt=Abstract&holding=f1000,f1000m,isrctn

"Patients with mixed ductal/lobular histology tumors and ILC were more likely to have low grade and hormone-receptor positive tumors, but also more likely to have stage III disease. The 10-year long-term survival, however, was better in patients with ILC (69%) and mixed ductal/lobular histology tumors (68%) than in patients with IDC (61%).

The behavior of mixed ductal/lobular tumors seemed to demonstrate some important differences from their ductal counterparts. The rate of distant metastatic spread was much lower at 8% compared to a rate of 19% for the ductal tumors. The sites of spread were the lungs and bones, and mimicked the pattern of metastases by IDC. The rates of local/regional relapse were identical between the pure ductal and mixed ductal/lobular histology tumors, with both histologies demonstrating a 6% rate. However, the rate of second primary breast cancers was much higher at 30% compared with a rate of 11% with ductal histology. The rates of hormone-receptor positivity and age of onset were similar between the mixed ductal/lobular histology and purely ductal histology and did not differ from historically cited data in the literature[26]. However, unlike ILC, the rate of synchronous contralateral breast cancer (0%) was much lower, mimicking the ductal histology. This value was highly significant and suggests a different pattern of recurrence and different tumor biology. The literature also indicates that the mixed ductal/lobular histology, like ILC, is more likely to be associated with hormone replacement therapy.

For most of the reproductive factors considered, the relative risks for mixed ductal/lobular carcinoma were intermediate between those found for ductal and lobular cancer

Conclusions

Our data suggests that mixed ductal/lobular carcinomas are a distinct clinicopathologic entity incorporating some features of both lobular and ductal carcinomas and representing a pleomorphic variant of IDC. It appears that routine breast MRI to screen the contralateral breast for an occult mammary malignancy is not warranted. However, clinical vigilance for the emergence of a second primary breast malignancy is mandated given the excessive rate of a second primary breast tumor."

http://www.wjso.com/content/8/1/51

OVERALL SURVIVAL CHART http://www.wjso.com/content/8/1/51/figure/F5

DISEASE FREE CHART http://www.wjso.com/content/8/1/51/figure/F6

Hope this helps, blessings to everyone

ETA: the two links above will only work if you highlight and then copy 

mamabee

Maud, Thank you so much for posting those links! My pathology came back as "IDC with lobular features" and when I asked my MO about it, she said, "oh, that doesn't mean anything different for you" - ie: I'll still treat you as if you had just IDC. But these studies seem to indicate we have a much higher chance of getting a secondary cancer so should I consider having my good breast removed too? I guess I'll talk to my MO about his when I see her after rads are done, and I'll bring these studies with me.  

JFV

Hi !

  I'm a mixed girl too.  Left breast was ILC with LCIS. I opted to have the right breast removed also and there was IDC there.  My ILC was stage 3, grade 3 with a really, really high KI 67 ( can't remeber the number).  The IDC was stage 1, grade 1.  All ER/PR + HER2 -

They hit me with everything.  Dose dense ACT, radiation and now aromasin.  

Two years later I am still here !

cacrew

Brand new to this site & post...diagnosed in May with idc Stage 1 ER/PR+/HEP- BC.  lumpectomy & sentinal node removal surgery just done the end of June.  Surgical pathology report came back as Stage 2A-mixed idc/ilc.  1/2 nodes taken tested positive.  My first oncology appointment is scheduled for tomorrow.  I'm asking for a Oncotype DX test be done to see if Chemo will be beneficial.....glad to be part of this post...any recommendations greatly appreciated. 

bgirl

cacrew - I too had mixed.  They just treated it as IDC.  My oncotype fell in the indeterminate range, so I did not do chemo.  If you have a positive node it may tip the onco towards a higher score.  I felt I was in a big hurry, but later understood I had the time to make decisions on good info.  Was glad I waited for onco score.  Otherwise it would have been 6 rounds of chemo that might not have helped anyway.

Be good to yourself and get all the info you need to make a decision you are comfortable with.

MrsCich

Hi all....I'm 33 y/o and was diagnosed this past Monday with DCIS, intermediate to high grade with focal necrosis in my right upper outer breast mass and IDC, Grade 2 with DCIS, intermediate grade in the right upper inner breast mass.  I am scheduled for a BMX with expander placement next Wednesday, Aug 29.  I don't think it's all filtered through me yet.  I met with the PS yesterday and it completely threw me through a loop. Mainly the whole "how do you want your nipples" talk.  BLAH! 

LoriKnous

Mamabee, I could never figure out just where I belonged since my surgeon told me my bioposy indicated ductal carsinoma w/lobular features. I just figured it had gone from one into the other. I was not told originaly (5 years ago) that I would have more of a chance of reocurance. In fact, I asked my dr about having my ovaries removed because I worried about it showing there. He said, "I don't see any reason for that, it's only a 2 to 4% chance. Well, low and behold I seem to have a mets mass involving my ovary/bladder fused together. Where the H#!L did that come from! I still hear some hesitation and question in their voice as to weather it is still the bc or is it ovarian? Just makes ya wonder, this stuff has a mind of it's own for sure.

Anonymous

Lori, were you stage four from the start? Or did your mets just show up five years later? I drive my Onc crazy wanting him to scan. My ob/gyn says he will do a vaginal ultrasound every six months since I am on tamoxifen, but I have fibroids so ovaries are harder to see.

LoriKnous

Sorry I haven't been on here in a few. Ya know, to tell the truth I never knew last time what my stage was. I did chemo, surgery, radiation. My surg told me I had clear margins and 15 nodes removed that were clear. My tumer had shrunk from 5cm to .02cm from the chemo so I assumed from what they told me that I was in the clear. Fast forward to now and the Onc told me that they just assumed from the size of my tumor at onset that it had already gone to my lymphnodes. I surely never had that incling. I had asked (in 2008) about having a historectomy and was told it wasn't nessasary, the chance was only 2-4%. In hind sight I have to wonder. Even if I had had it done, would it have just sprung up somewhere else. I would inquire about staying on the herceptin though. There is also a new drug that works in conjunction called Perjeta, not sure how to spell the proper name. I get confused with all of the diff treatiments that I hear about. Hope I didn't complicate things even more for youLori

mamabee

Lori - I just saw your reply to me. I'm so sorry you're stage IV and I appreciate you sharing your experience with us. No one's mentioned to me about having my ovaries out (I'm 48 and was premenstrual at diagnosis). I think I'm going to get a second opinion from another MO as my current doctor doesn't seem terribly interested in differentiating my IDC with lobular features (which actually may be more like ILC) from a garden-variety IDC.

Thank you and take care of yourself! 

w6uqfcgomeo

Hi Everyone:  I am new to this topic.  I appear to also have a mixed type of bc.  But just found out I have the LCIS.  The "associated components in situ" were Cribiform and Micropapillary.  Apparently the "micropapillary" is considered very aggressive and the cribiform (which I read earlier) is considered low for aggressive.   The micropapillary is not responsive to hormone therapy....

Unfortunately, the pathology lab made mistakes on my pathology testing and we could not get Oncotype DX or Ki-67 tests done.  However, I had a very low Vitamin D level (13), high C-Reactive Protein, High Estradiol level, High CD 4 and Low CD 8 levels.  My MO did nothing for me (treatment) other then hormone adjustment (vit D and Estradiol) so I just got a new one, but it looks like it is too late for the type of treatment I should have had.  I wonder how many of us have had problems with our oncologists?

It is my understanding that the "sub-type" is very important and helps determine what type of treatment.  I NOW discover that I should have had chemo in the beginning due to the micropapillary and other factors that point to more aggresive bc.  New Oncologist said it is too late now.....

I am interested in whether any of you have had your Vit. D levels, C-Reactive Protein levels, Estradiol and CD4 & CD8 levels checked?

  Love to hear from anyone.. Mary

Fiddledeedee

This is an "older" thread but I have a new DX. My biopsy came back IMC.....invasive mammary cancer. I believe this means it has ductal and lobular components? It is also only er+

Trying to find someone with a similar DX for any information. I feel like an idiot every time I visit my surgeon as don't get around to talking about this.

Anyone?

Lenn13ka

I have the same thing. Mine was ductal , lobular with micropapillary features. It is treated as IDC, although research is currently being done on which hormone treatment works better on these types of tumors. You are correct, it is called a mammary cancer.

Fiddledeedee

Lenn

You've done rads? And now on tamoxifen? Are you pre menopausal?

I'm post and I'm thinking it will be an AI for me.

Do you have any other info re:IMC ?

Thanks for the response.

Lenn13ka

Fiddle,

I skipped chemo based on the opinion of one of the top Drs. at Dana Farber. I had a positive node but an oncotype of 17. I did rads (of breast and lymph nodes) with a 7 day boost. I am post menopausal but, both my MGH Dr. and the Dana Farber Dr. want two years of Tamoxifen first. The Dr. I saw at Dana Farber is following all the research on IMC and which aromatase inhibitor is working best in the clinical trials. Do you treat it as lobular or a ductal? I am going to meet with her in January to get additonal information and see where the research is leaning. Mine is a true 50/50 mix...

I noticed you are PR negative. What stage are you? 1?? Your nodes were negative and your tumor small. Are you doing rads? I don't no if you can have an oncotype with PR negative. What is your MO saying?

Anonymous

Good Morning Ladies, I am fairly new to these boards and I was hoping to find someone with a similar diagnosis. I have two tumors in my left breast pretty close to each other. One is tn and the other is HER2+. So far I have not been able to find anyone with the same diagnosis. I apologize if I am in the wrong area. I wish you all strength with great outcomes.

RHGSR

not sure how active this discussion is, but I have several different types of cancer too. DX in Oct. with IDC 3.5cm and DCIS in R breast. Surgery on 11/20 pathology showed 3/21 positive lymph nodes on R plus ILC on R and LCIS in L. I'm hearing it is not common to have mixed like this. Anyone with better info? I'm afraid to google it.

Thanks.