Inv papillary carcinoma - ki67 12% will chemotherapy work

InvPapCarcinoma

dear friends

Er+/PR+/her-ve/ki67-12%

Tumor size 8cms. Spread to 3 lymph nodes. One doctor said before surgery 4 months hormone therapy is the best start. Another doctor said chemotherapy is best start. Can someone please guide.

I read that for chemotherapy to work ki67 must be 50%+ and her2 must be positive.

Thanks

obsolete

Hi InvPap,

Sorry you find yourself here. Please don't be too alarmed that your papillary tumor is large because invasive papillary can be known to grow large very quickly due to their cystic content, said my doctors. (My invasive papillary carcinoma grew to 3 cm in just several months.) What's more critical is your invasive component(s).

PLEEEEEZE get a 2nd opinion on your pathology. Your doctors need to define the "invasive component" first, which would be your primary cancer. You will find this in your pathology report. With invasive papillary, the invasive component could possibly be mucinous carcinoma (25%), conventional IDC-NST (25%), OR mixed (25%) or even rarely tubular or endocrine types. Rarely is invasive papillary considered truly "invasive papillary" unto itself, unless there's a primary invasive type present. DCIS is often present. Papillary is a highly controversial rare type of cancer which confuses many pathologists and doctors. We had needed to get 4 different pathology labs involved to figure out my dx (mucinous, IDC, invasive papillary, DCIS, cysts, etc.) It can present in a variety of combinations sometimes.

For example, Oncotype has not yet been strongly validated for invasive papillary itself due to less than 1/2 of 1% all breast cancers with too few cases to collect data. Nor is oncotype really strongly validated for pure mucinous carcinoma, so this is why it's critical that you know what your invasive component is. Neither papillary or pure mucinous are typically responsive to chemo, which is why patients usually rate low Oncotype scores, and both are usually highly ER+ & PR+. If your invasive component is traditional IDC-NST, then the oncotype would likely very much benefit you, but it's largely dependent on your invasive component exclusively. What are your ER and PR percentages?

Also on your 3 positive nodes, please ask your doctor if the infiltration in the nodes is of a papillary architecture? Or if it's conventional IDC cells infiltrating your nodes? That's important to know.

Papillary isn't usually known to be responsive to chemo, which is why I'm asking, and usually averages an oncotype score of 9 or below. Also papillary is known to occur in multiples, hidden multiples. They would usually test your invasive cells, not the papillary cells, for oncotype. Please be sure your doctors do an MRI on both breasts, but bear in mind that papillary under 5MM doesn't always show in MRI imaging, my surgeon had said.

Please check the invasive papillary thread for more information here. Best wishes to you. {{{HUGS}}}