help to understand report and treatment options

carlite

I have had R lumpectomy 7 days ago and got  path ( that were DIFFERENT than the biopsy path results) results this AM:DCIS, high grade3, comedo necrosis, HER-@ +++,  ER3+  90%,  PR3+  20%,  margins clear >1cm. unsure of the meaning of it all

 I am wondering what the treatment option are...herceptin?

 I have a hematoma, so i assume rad (i was hoping for APBI) is on hold..My md appt is a week away

thanks

Moderators

Hi Carlite and welcome to Breastcancer.org,

You may be interested in checking out the main Breastcancer.org site's section called Your Diagnosis, which walks you through what each part of our pathology report means. You may also find it helpful to read up on the DCIS section while you wait for the advice from others here.

Hope this helps!

--The Mods

mj12

Carlite, I know you included your new dx (which is basically the same as my dx I rec'd on 10/1 but my PR+ was higher--othewise the same)...but can I ask how it differed from your original dx? 

I'm too new and far from the medical field to offer advice but wishing you the best in your recovery.

Beesie

Carlite, 

Herceptin is not approved for women with DCIS, although it is being testing in a couple of clinical trials. More importantly, HER2+ status for DCIS has not been proven to be of the same concern that HER2+ status is for invasive cancer.  A number of studies have looked at what HER2+ status might mean for DCIS but the results are all over the map - some suggest that HER2+ DCIS is more aggressive but others suggest that HER2+ DCIS may actually be less aggressive. Most of the studies found no difference between HER2+ DCIS and HER2- DCIS.

In any case, all DCIS, whether it's HER2+ or HER2-, is pre-invasive.  This means that DCIS cancer cells can't spread into the nodes or the body.  So a "more aggressive" DCIS simply means that it's more likely that the DCIS might evolve to become invasive cancer within a shorter time period. This is very different than the risks faced by someone who has an aggressive invasive cancer. With IDC, the concern with an aggressive cancer is that some of the cancer cells may have moved beyond the breast into the body prior to surgery; that could result in the development of metastatic cancer.  But that's not a concern with DCIS. So if all your DCIS has been removed and no invasive cancer was found, and if you have good surgical margins that reduce your risk of recurrence, then it really doesn't matter how aggressive the DCIS was. Once it's out of your body, you don't have to worry that it might have been more likely to become invasive while it was inside of you.  The pathology says it didn't become invasive, and now it's all been removed.  That's what is important. 

Often HER2 testing isn't done on DCIS.  Not having the HER2 result isn't really a bad thing, since it's one less thing to worry about and there isn't anything that's done differently from a treatment standpoint based on the result. 

As for your pathology, even with the HER2 results not being relevant, with grade 3 DCIS that has comedonecrosis, you did have an aggressive DCIS.  But the really good news from your pathology report is that your margins are all larger than 1cm.  1 cm is considered the "ideal" margin so that's a great result.  Having 1cm margins means that even though you had an aggressive DCIS, your recurrence risk should be quite low, particularly once you are done with rads. 

Having such a strong ER+ cancer means that Tamoxifen is likely to be recommended to you. Tamox will also reduce your recurrence risk, and it will provide a level of risk reduction for your other breast as well.    

Hope that this info tides you over until your appointment next week.  And do read the section on DCIS that the Mods linked above.  It will give you a lot of good information. 

carlite

in the inital THREE pathology reports they said intermediate grade(not High), 5mm size, ( it turned out to be 2.5cm which is 25mm) not  comedo...thank you and good luck to you too

carlite

Thank you Beesie, appreciated