Anyone with DCIS ER- & PR- grade 2-3

julz4

Hi I was just DX with ER- PR- grade 2-3 DCIS. This through me for a loop. I go in on Tuesday for a partial mastectomy & centinal node biopsy. My BS said it still could come back with a minor hormone receptor as they only tested a part of one of the 5 needle cores they took. But it looks like I could end up with Chemo & Rads for a 9 mm mass. Does anyone know what is the " Typical ". Chemo for Triple Neg BC? I'm lost!

BLinthedesert

Julz, chemo is not used for dcis, as it is confined to the ducts. The only reason you would have chemo is if your cancer is invasive. Because er-/pr- is fairly rare it is not known if it it is any more problematic. It is known that Tamoxifen does not help reduce recurrence in these tumors.



There is no "triple negative" dcis, since her2 has no demonstated utility for noninvasive cancer.



Good luck to you with your surgery.

julz4

"B" Thanks for the info.  I had an MRI before my DCIS DX as they had found AH in a needle biopsy.  He wanted to make sure nothing was lurking so he could hopefully keep it to one surgery.  The MRI lit up the Mass thus indicating CA of some kind.  Also another small area lit up near by.  That has not been tested but will be on the radar map of tissue taking so to speak when they do my surgery on tuesday.  Because of that, the negatives, & the agressive grade is why he brought up the possibility of chemo.  That & all the Path needs to be done for the final answer on the partial mastectomy.  He also will be looking closely at my nodes.  More waiting....

gumshoe

Hi julz - I had a large area of DCIS, Grade 3. 

I'm in Canada and they don't order hormone receptor tests for DCIS. They also don't routinely test lymph nodes. I have never had a breast MRI either! Just mammograms and ultrasounds. 

My treatment options were partial mastectomy (lumpectomy) + rads + possible Tamoxifen; or mastectomy. Chemo was never suggested. 

Good luck with the waiting, and I hope nothing else shows up... it's never easy. 

julz4

Thanks Gum....Because it's ER- & PR- the Tamox won't help.  It still is subject to change if the path report after surgery comes back changed to slightly +.  My BS said they only tested a small sample from 1 area for the hormones.  I just read the biopsy path report again in depth & there is the possibility of a Microinvasion.  So if a node or the Microinvasion come back positive there could be a good possibility of Chemo.  Rads for sure. That's why I was wondering what types of Chemo they use for Triple Neg.  So I can wrap my head around what I might be dealing with.

BLinthedesert

Julz ... I will be thinking positive thoughts for you. I also had a very large area show up on MRI (5cm). At the end of the day the cancer was small snd the other stuff was ADH and other benign things. MRI is not very specific.



Good luck to you.

Kim137

Hey Julz,



One thing you'll find out about breast cancer is no 2 cases are the same! Even when the cases are similar, 2 different Oncologists may use different treatments. Wish it was more clean cut

My DCIS was very large, grade 3 and only 2% ER +/PR-. Although the micro-invasion was never located, I did have micromets in my sentinel node so I ended up with chemo. (ACT)

Some Oncologists would consider 2% ER as a negative, but because of my age (32) my Oncologist is attacking those 2 out of 100 cells with Tamoxifen.

Your final path report will guide your docs in treatment. Best of luck to you!

Dooley45

I had a mastectomy for DCIS stage 1( 1.5cm) high grade,comedo necrosis grade 3 and it was ER-,PR-. I have been told it's "up in the air" as to whetherto take Tamoxifen or not to prevent cancer in remaining breast. I'm inclined not to - anyone with any other ideas or recommendations?

longislandmom

Julz4 --  i had DCIS/LCIS grade 3 and opted for a BMX because i wanted to avoid RAD/Chemo.  I chose an aggressive route for what i had.   Fortunately, my path came back as DCIS and so following the BMX no further treatment is necessary..SNB was clear.   If there is a microinvasion, your Doc may recommend chemo-- but i think if it is just DCIS -- no chemo, but usually RADS unless u have MX.

 Dooley45 -- just curious, is Tamoxifen helpful if your cancer is not estrogen sensitive?  I had BMX and don't need tamoxifen, but was told I would need it if I had LX or MX.   but each cancer is so different!

good luck to you both!!!!!!

Infobabe

longislandmom 

That is interesting.  I have been searching my path reports from biopsy and lumpctomy and though it said to test for HER by FISH there is no HER recorded. So you say HER status is no untility with DCIS. Not even for hormonal therapy after rads?  Thanks for this.  I couldn't figure why this was not recorded.

gumshoe

Fingers crossed for you, julz4!

Dooley45 and longislandmom - I am opting for mastectomy (UMX) also, partly because my two lumpectomies already took most of my breast, and partly because I did not want rads.

Even though they don't do hormone testing here, my oncologist said that taking Tamoxifen would only decrease my chances of getting cancer in the other breast by 2-3%. That didn't seem to be a good enough benefit to me (and she agreed). 

Dooley45

Sounds as if foregoing the Tamoxifen in my case is OK. Thanks for the input.

julz4

Sorry I have been busy with the Recovery & the Holiday weekend.  Surgery went well but my armpit really hurts, burns, & there is numbness even up my arm around to my back.

Well the Path report is in....

Ductal Carcinoma in Situ with lobular cancerization

Overall size of tumor: 2.8 centimeters

Architectural pattern: Cribriform & comedo necrosis.

Nuclear grade: 2-3/3

Necrosis: Present, involving 80% of spaces

Microcalcifications: Focally present

Microinvasion: There is 2 to 3 foci of microinvasion each measures less than 0.1 centimeter (less than 1 millimeter). There is also foci of pseudo invasion within an area of the previous biopsy site.

Margins: Negative for tumor.

Tumor marker: ER neg. & PR neg. Lymph nodes: 0/2

Pathologic tumor stage: pT1mi N0

I'm getting the appt. set up with the RAD Onc & Medical Onc today.  Definate RADS.  But we are not sure on the Chemo part.  I still have to wait 2 weeks for the Her2 testing to come back. I am seeing the Med Onc to see about possible Onc type DX testing.  There apparently is special testing for DCIS & subtypes.  As to what that & also with the Her2 results will decide whether I get Chemo.  

Kim I am 45 & pre-memo so that puts me more in your court.  But as of the Path I am still 100% negative.  So the Tamox won't help me.  As my BS said today I am still  young...many more years ahead of me ..... it's sobering when you think about it.  20 years & I will only be 65! I have lots of living to do!  

Marple

((((Julz)))) from Sharon50