pathology question

2timer

I saw my BS for my pathology report yesterday.  Two weeks ago I had a bmx with immediate reconstruction.  I was originally dx’d seven and half years ago with a small low grade DCIS.  I had a lumpectomy, radiation and did 5 years of tamoxifen.   Last October the radiologists doing my annual mammogram saw some things that were suspicious and they biopsied some calcifications which turned out to be benign.  They also saw some “shadowing” which they didn’t biopsy.  I was supposed to return for a 6 month followup.  I didn’t go back until June when I saw my BS and they said the radiology people felt I should get the MRI that I had suggested getting but that BS’s PA said I should just skip.  I got the MRI, and a quick call back and a biopsy and was DX’s with 3.6 cm of IDC.  After 6 years of being watched “closely”.  That path report said it was low grade and ER, PR positive.

During the surgery they took 8 nodes all of which were negative.  But on examining my breast after surgery they found a node with 2.5 mm of cancer – just a bit too high to be considered a micro met and Lympho-vascular invasion was present (catching absolutely no breaks here).  The cancer was also found to be grade 3 (8 out of 9).  On top of all of this I have something called neuroendocrine carcinoma with a small cell carcinoma component.  I used Dr. Google on this term and it’s rare and doesn’t sound positive.  The “good” news was that the actual tumor was measured at 1.5 X 1.2 X 1.2 which I think means it’s much small than on the 1^st path report, it’s ER+ and (weakly) PR+ and I’m still considered stage IIa so I didn’t get upstaged.  Also my reconstruction is going well I’m told and my margins were good.

Maybe someone here can help me.  My meeting with the BS was very short and he is taking my case to a meeting of doctors to discuss whether or not I should have more nodes removed.  I will see him again in two weeks along with an oncologist.  In the mean time I am a bit depressed and confused about the path report.  I know it is what is is but I NEED to know more about this type of tumor.  I’d also like to know how it affects my prognosis.  It bugs to no end that that one node kept me from being downstaged to a stage I.  Thanks for any help.              

vlnrph

Sorry I don't have much knowledge regarding prognosis with your specific pathology. Sounds like you have had quite a time.

If you had DIEP and they insist on taking more nodes, be sure the plastic surgeon gives advice on where to cut. Mine marked me up and stayed in the OR for the ALND which was 2 weeks after my original mastectomy/reconstruction.

I attended an excellent lymphedema seminar at Ohio State last year so hopefully you have learned a little about those risks from staff at your clinic. At a minimum, there should be baseline dimensions of your arms & wrists on file in case any swelling develops.

It will be hard to focus on healing (without getting terribly concerned over what could happen) but that should probably be your primary task right now. Chemo may be in your future - it is doable, try not to worry.

I'm not on line frequently so might not respond again soon, however will check in to see how things turn out.  

bevin

HI 2timer, you could ask the Oncologist and BS to order the Oncodx test. That will give you a risk of  distant recurrence and help determine if Chemo is beneficial for your type of tumor. Perhaps that will help with making decisions?

Good luck, and keep us posted. I'm sorry you need to deal with this again.

bluepearl

The most concerning factor is your LVI. I would think that and + node, chemo would probably be a given, but I am not an oncologist. LVI can often be divided into focal, intermediate and extensive. The first two, according to one journal paper, doesn't impact survival whereas the last one does...so it isn't all doom and gloom. It is small and hormonal + and that is good news. If I were you, I would steer towards chemo as apparently this guy is a bit aggressive. The missing point in your grade 3 is hopefully the mitotic rate. I had the same grade 3 with a 2 for mitotic rate which isn't ideal but better than 3. But you know, I have heard some grade 3 actually have low oncotype.......searching this out for myself, being a grade 3 and not getting that test. Ki67 is also a factor.....the lower the better. It is SO complicated, I just run with the good news, whatever it is. Best wishes!!!!

bluepearl

BTW...I just read a journal paper that says you have a good prognosis WITH chemo, etc. with your very rare type of breast cancer which is still EARLY stage!