Post-op Lab Results (Final Biopsy and Histopath)

edenzhia

Hi! We are in a difficult situation right now in our family.  My mom is diagnosed with a Stage II A Invasive Ductal Carcinoma and underwent mastectomy on the left breast just recently (last November 10, 2012).  We just want to ask for further opinion before we discuss the matter with my Mom, who is 70 year old, and is not willing to undergo chemotherapy and prefers medicine-based prevention (should there be any).

When we got to the doctor this morning for a follow-up check after the surgery, the results are as follows:

Final Receptor Status Interpretation:

Estrogen:  Positive

Progesterone: Positive

Comments: Triple Negative Tumors [ER(-) PRA(-) C-erb(-)] belong to subgroup of Basal Cell-like Carcinoma that tends to behave aggressively.

Immunohistochemistry Report:

Antibody                Extent(Score)     Intensity     Total Score

Estrogen ID5            80 (5)                Strong        8

Progesterone 2C5     70% (5)             Strong         8

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Final Receptor Interpretation:

C-erb:  3+

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FINAL BIOPSY REPORT

Specimen:  Needle Localization Biopsy, Right Breast Mass / Left Breast / Modified Radical Mastectomy, Left Breast

Gross Examination:

Received for frozen section is a rubbery, fairly circumcsribed, ovoid, light tan mass (8mm in largest diameter) with adjacent irregular tan tissue (14 mm in largest diameter) and sorrounding fibrofatty tissue totally measuring 26x23x10mm.  On sectioning, cut surface of the irregular tan tissue is tan and smooth.  Cut surface of the ovoid mass is light tan, smooth and whorled.  Frozen section diagnosis:  FIBROCYSTIC CHANGE WIH ATYPICAL DUCTAL HYPERPLASIA.

These are totally processed as A - irregular tan tissue; B-ovoid mass.

Received later is the left breast excised with modified radical mastectomy totally weighing 1,100 grams and measuring 240x220x50mm, the nipple is at midline and everted.  Tehre is flat linear scar measuring 50mm long at the lower outer quadrant 20mm from the nipple.  On multiple sections, there is no residual mass or necrosis or hemorrhage underneath the scar.  On serial sectioning, there is a firm, tan, nodular mass measuring 30x25x20mm at the lower outer quadrant, 25mm from the scar, 30mm from the nipple.  The mass is located 15mm from the skin and 25mm from the posterior margin.  The rest of the breast parenchyma is yellow tan and smooth.  The axillary tail measures 100x65x30mm.  There are thirty lymph nodes isolated ranging with a size from 5mm to 15mm in diameter.

Representative sections are processed as C-mass; D-tissue underneath the scar; E-random section; F-nipple and areola; G-superior margin; H-inferior margin; I-medial margin; J-lateral margin; K-posterior margin; L-lymp nodes.

Microscopic Examination:

Microscopic Examination of slide labelled A shows sections of breast tissue exhibiting few cystic ducts lined by benign cuboidal cells focally exhibiting usual ductal hyerplasia.  Few areas shows a nodular proliferation of ductules, some of which are compressed by a hyalinized fibrotic stroma.  There is no cytologic atypia noted.

Site of tumor: LOWER OUTER QUADRANT

Histologic type: RESIDUAL INVASIVE DUCTAL CARCINOMA WITH MUCINOUS FEATURES 

Histologic grade: NOTTINGHAM HISTOLOGIC GRADE I

ESBR grade: 5/9

Tubule Formation: 3

Nuclear Pleomorphism: 1

Mitotic count: 1

Tumor Size : 3.0cm

Peritumoral Lymphovascular Invasion: Positive

Status of Nipple and Surgical Margins: Clear

Lymph node status: METASTATIC INVASIVE DUCTAL CARCINOMA IN THREE OF THIRTY LYMPH NODES EXAMINED

AJCC pathologic TNM: pT2N1aMx

Proliferative Lesions: FIBROCYSTIC CHANGE WITH FIBROADENOMATOID NODULES

Oncologist said that my mom, before doing the chemotherapy, she needs to have a bone scan, ultrasound of the whole abdomen and various vaccinations.  

We are not medical people but I just want to know just in case my mom could not go through all these process, is there any other option aside from going to chemo?.  Anything but to invade the chemotherapy co'z honestly, we don't have much and it's very costly in the Philippines to undergo such.

I hope you could give us an insight about this.

Sincerely,

Eden

peggy_j

I'm sorry that your mom and your whole family are going through this. It's so hard. Every patient's diagnosis is different and they should consider your Mother's age and any other health conditions ( if there are any). I don't want to second guess the oncologist. I don't think anyone wants to have chemo and the doc should be able to discuss your mom's prognosis with and without chemo. Some patients do skip chemo but that's usually when the tumor is small and local (only in the breast). Unfortunately the path report seems to suggest it has spread to the lymph nodes, which may be why the doc is recommending chemo. Again, I'm no doctor. Some patients seek a second opinion. Also, at the beginning it can be overwhelming with so much info to learn before making a decision. I like these discussion forums, but the website has whole other sections of info too. I also found the Komen website to have good info too.

Varod

Hi there,

As peggy pointed out, chemotherapy is the standard of care for people with cancer that has already spread to the nodes.  It helps mop up any tiny cancer cells that couldn't be seen on scans or by the surgeon, and it has been proven to improve survival in this circumstance. However, it may be only a modest benefit in this case. It may be helpful for your oncologist to provide a measure of the benefit you can use to make your decision.  

There are some women who would say "I would do anything no matter what the cost or side effects for even a tiny reduction in the risk of cancer coming back", and some women who would say "For only a 5% reduction in the risk, I'd rather not make myself sick and spend a lot of money".  Both of these are completely reasonable options. Ultimately it is up to your mom, and the oncologist can help her make the right decision for her. 

If she does take medications like Tamoxifen or an AI that will be a sizable benefit in itself.