IDC, 1.5cm, Grade 3, ER+/PR+, HER2-, Scared Husband

DHScared

My wife has been diagnosed with BC. Her initial biopsy is: Dx 3/31/2017, IDC, 1.5cm, Grade 3, ER+/PR+, HER2-. Her MRI did not find anything else. The comment section says:

- Invasive ductal adenocarcinoma, Nottingham grade 3 (3, 2, 3).

- Greatest linear extent of invasive carcinoma is at least 0.5 cm.

- Ductal carcinoma in situ, nuclear grade 3, cribriform architecture.

Her lumpectomy and SNB surgery is next week. For now, I am trying to learn as much as I can about the disease, treatment options, and possible outcome. After reading many posts on this board, I understand that the SNB result is critical in dertermining the next steps. My questions are:

- How long will we have to wait for the Path report? Can the surgeons tell us anything about margins and observation right after the surgery?

- How is a cancer stage determined? Based on SNB result?

- If SNB comes back negative, what would be the treatment options?

- If SNB comes back with half of the nodes taken being cancerous, what would be the treatment options?

- With her Dx, what are the chance of her SNB being cancerous?

- I saw many members bios whose diagnoses are very much identical to my wifes and did not have positive SNB or recurrences but their treatment include BM or BMX! Can someone explain please?

- Anything else that I should be prepared for?

Thank you very much for your answers and advices.

MTwoman

DHScared,

The wait for path reports varies will depend on the facility, her BS should tell you an approximate time; but typically the HER2 results come later as they are sent out to a specialty lab. Again, typically, margins or lymph node positivity are not visible with the naked eye, so you'll be waiting on the path report for those as well.

Staging is determined by several factors, including tumor size, lymph node involvement or spread to other areas of the body. The NCCN staging guide link is here:

https://www.nccn.org/patients/resources/diagnosis/staging.aspx

Treatment options will depend on the characteristics of the bc (ER/PR/HER2 +/-, KI67% etc), family history, possible genetic testing etc. Your wife's personal risk will be assessed and then that will be weighed against the risks associated with various treatments. Typically, lx or mx plus chemo and radiation, possibly followed by tamoxifen or an AI (if she's ER+) or Herceptin in addition to chemo (if she's HER2 +).

There is no way for any of us to say what her chances are of SNB being cancerous. Sorry!

I can't speak for other women here, and my bc was NOT invasive like your wife's, but I had mx (at age 38) as I had multi-focal disease, which means multiple tumors were found in different quadrants of my breast and they had to make sure they got it all. Many women have mx because of their ongoing personal risk and they want to reduce this as much as possible. I'm sure they will chime in.

As for what to be prepared for, there is a special forum for "family, caregivers, friends and supporters" that should provide many good threads for you; as well as support for yourself. I would encourage your wife to join us as this is a great place for her to find support and discuss things with other women who are going or who have gone through treatment.

mustlovepoodles

my cancer isn't exactly like your wife's It's just a tiny bit bigger. The reason I had chemotherapy was because my mass was grade 3 and pr-, evidence of any more aggressive cancer. The original plan was for me to have lumpectomy followed by radiation. But then my genetic testing came back positive for two gene mutations which, along with my terrible medical family history, pretty much required a BMX

ksusan

Even if I hadn't had a positive node, I'd have required BMX because of the placement of the cancers--they weren't situated in a way that could be addressed with lumpectomies. With no positive node, I probably would have had radiation and no chemo, but that's a speculation.

Tappermom383

I'm proud of you, DHScared, for reaching out here for information. I would also urge your wife to join the discussion, if she hasn't already. My DH thinks I'm a bit nuts, the way I keep reading these posts and take comfort from these "strangers." But I find it reassuring to hear from other women going through similar experiences.

My diagnosis was very similar to your wife's. I was able to have a lumpectomy, a week ago today. The surgeon also did an SNB because of the invasive nature of my cancer. I don't see him until next Thursday, when he should have the pathology report. As anyone and everyone will tell you, it's the waiting that really makes you crazy. I'm hoping for clear margins (meaning there are no cancer cells n the surrounding tissue that was removed) and no node involvement. If either is positive, I'm not sure what will happen. I'm taking this one step at a time. The surgeon did tell me he'll be referring me to an oncologist and to radiation (because they want to zap any cancer cells that remain).

Best of luck to you and your wife next week. Just your posting this message tells me how supportive you will be of her in this horrible new adventure. Let us know how it goes!

MJ

StaceyB

Hi Scared Husband,

It is really hard being in this waiting mode, and not having all the information available to make treatment decisions. I was very comfortable with a lumpectomy. I did go into my surgery already knowing I had a positive lymph node (showed up on ultrasound, and we could actually feel it). I expected more positive lymph nodes after surgery. I had 11 removed and only the 1 we knew about came back positive. They also reduced the size of my tumor after surgery from 2.4 to 1.1 cm. So try not to freak out too much. It is possible some things get better and you just have to go through the process. I had my initial pathology results in 7 days. Good Luck!

Just to address your other questions - If Sentinel Biopsy comes back positive, they will probably do an axillary lymph node dissection and remove more nodes to test. My husband did get feedback after surgery. Even though they can't tell you if there are microscopic cells, they can tell you if the lymph nodes are sticky and clumped together etc. I am not sure if they recommend chemo with a grade 3 (and no lymph node involvement). I have a low grade with LN involvement which is not very common. I sought two opinions on treatment. I had 2 oncologists who felt chemo was absolutely required - no choice, and another who wanted to do additional testing and potentially forgo chemo due to my low grade. At the end of the day, my husband and I felt we would not feel comfortable forgoing chemo with the positive LN (there was a significant amount of cancer in the node and there was some extension to it etc.) I have 3 kids and I am healthy otherwise.

bluepearl

It appears that your wife has a 5mm tumour with a 10mm DCIS, which is actually quite favourable, as is her ER+/PR+/Her2- status. She will likely be stage 1 and her new best friend will be an anti hormonal. As you can see, and we are all different, I had an 8mm, grade 3 like your wife's and my SNB was negative. Surgeon said they expected that. You might want to get an oncotypeDX done to see if she needs chemo or not. Radiation if she does a lumpectomy, not if she does a mastectomy (unless tumour is very close to chest wall). I chose mastectomies both times because that is what I was comfortable with, but lumpectomy + radiation actually has slightly better results. If her SNB comes back positive with such a small tumour, it would tend to indicate a sneaky, aggressive one which might mean chemo but again, go for the oncotype test. Even grade 3 tumours can come back low oncotype while grade 1's can come back high.....depends on the 21 genes examined in each woman's tumour. Generally, breast cancers less than 1 cm have an excellent prognosis so I think you should be prepared to live a long life with your wife!!!!!

ChiSandy

Got a “teaser" e-mail today telling me to look out for the April online issue of Clinical Oncology News—one of the lead articles posits that breast conserving surgery is indicated as superior to mastectomy for certain subtypes of bc. (Ironically, since so much DCIS is multifocal, despite being non-invasive, it more often than IDC seems to lead to mastectomy rather than lumpectomy—and bilateral for either prophylaxis or symmetry).

An earlier (2016) NCBI article cited a retrospective study indicating that most ipsilateral (same breast) recurrences of early-stage bc were true local recurrences (TR) rather than new primary (NP) tumors, and that TR was a factor indicating poorer long-term survival prognosis—along with young (<40) age at first diagnosis, tumor size >2cm, grade 3, and triple-negative phenotype. I'm willing to guess that the subtype the C.O. News article will say does better with lumpectomy is small, postmenopausal Luminal A. So I wouldn't be surprised to see a recommendation that premenopausal patients with high grade triple-negative tumors, even with no node involvement, opt for at least unilateral mastectomy. (Contralateral bc is much less common than ipsilateral—whether TR or NP, so BMX as opposed to UMX is more of a personal choice driven by either patient preference or genetic mutations/family history).

I know I vigorously defended (and still defend) my decision to have a lumpectomy + rads for my Stage IA 1.3cm postmenopausal Luminal A tumor. But had I tested positive for any of the known-risk genetic mutations, you bet I'd have gone for BMX and full hysterectomy with salpingo-oophorectomy.

ScaredDH

@Tappermom383, Yes, she has joined the discussion and read all the replies with my help since English is not her native language.
Thank you everyone! We really appreciate your comments and advice. God bless you all!

RoseMT

I wanted to share with others and their caregivers. Emotions are all over the place. It's all happening so fast! Here is an article my husband my rock, my caregiver wrote after my surgery there is no "I" in cancer. I cried my eyes out when I first read it, for one it made me realize I have cancer and the pressure agony he was going through as well. Hugs and much love my warrior sisters!

My husband wrote an article that explains how he dealing with a caregiver.

Will not allow me to post the link,

Go to NOU Magazine website and search for article "There's no I in Cancer"

Tappermom383

What a well-written article, Rose! I commend your husband for his understanding and his dedication to your care. Where would we be without this support?

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MJ