Extensive DCIS with scattered multifocal IDC

Anonymous

Extensive DCIS with scattered multifocal IDC

Axolotl

Hi, I'm new here and trying to make sense of my pathology reports.

I had a unilateral mastectomy with clear nodes. Er+/pr+/her2- (FISH). The pathology report says: "The lesion is formed of extensive multifocal high-grade DCIS. Within this there are multiple infiltrative foci of a grade 3 IDC (grade scores T3, P3, M2). These infiltrate between the DCIS, and this carcinoma is not forming a single mass lesion." The DCIS is appx. 7cm and the report says, "the maximum overall dimension of the invasive carcinoma has to be assumed to be between 5 - 7 cm." Later in the path report it says the diagnosis is extensive high-grade DCIS with scattered foci of IDC. TNM stage: pT3, N0.

The earlier biopsy, which was done on the main tumor, reported 6mm of DCIS with 2mm of IDC. Predominately DCIS, with IDC grade 1. I realize the biopsy is only a small sample of the whole, but I was surprised at the variation between the reports.

My question is, considering the clear nodes and earlier biopsy report, why did the pathologist report 5-7cm of IDC? How did he calculate it? My understanding is that true T3N0M0 cancers are very rare and typically low-grade. It seems that 5-7cm might be an overstatement, no? I wonder why the pathologist did not give the measurement for the IDC in the main tumor, or state the percentage of IDC within the DCIS? 5-7cm of IDC is 70-100% of the 7cm DCIS, so why give a diagnosis of extensive DCIS with scattered foci of IDC at all if it going to be counted as mostly IDC? Is there a lot of variation in the way pathologists report on multi-focal IDC? What is the standard?

The bs is sending for the oncotype dx, hopefully that will give more information regarding treatment. I'd like to avoid chemo (of course, I'd also like to avoid dying. I'm 37).

Thanks for any information you can give!

Georgia1

Hi Axolotii. I'm not sure how helpful I can be, but you're right that the variation between the initial biopsy and the final pathology report is because the biopsy was based on just a small sample of cells. When conducting an examination of a full tissue sample after surgery, I believe most pathologists cut the tissue into slices and examine each one. That procedure might easily make it hard to estimate the overall size of the IDC or calculate the overall percentage of IDC vs DCIS.

I hope someone smarter comes along to answer your question. But looking forward it will be the Oncotype DX score that helps determine next steps. And yay you for no lymph node involvement! That's great.

edwards750

I’m with Georgia. Not educated enough about your reports except to say my BS was surprised when my Path report came back showing a micromet in the SN. He was positive there was no lymph node involvement. He said they must have dissected and re-dissected because it was so small. He also said it would get me chemo. Not his call and it didn’t.

Regardless it promptedmy MO to order the Oncotype test. So glad she did. Score came back at 11 so I dodged chemo. Small tumor and 8% chance of recurrence.

I would def direct your questions/concerns to your doctor. Be your own advocate and don’t let them dismiss your concerns.

It’s difficult to translate all of that medical jargon so it’s always good to have it explained in layman’s terms.

Try not to be overly alarmed. It’s scary to be sure but it’s also treatable.

Diane

Axolotl

Thanks for your feedback! 5-7cm of grade 3 IDC is very scary, and I'm hoping the pathologist is just being cautious. I'm relieved that all along my lymph nodes have seemed clear, and that was confirmed in the path report. I just have to remind myself that regardless of the size, there is treatment. I was also strongly er+/pr+ also (near 100%), so the doctors seem confident that I will respond to tamoxifen. I'll talk to my MO soon.

Georgia1

That sounds like a good plan. Best of luck and post again with an update if you have time.

beauz

Hi Axolotl. My understanding from reading your post is that your IDCs were scattered in an area of dimension 5-7 cm, not a single mass of 5-7cm. The main feature of your lump is DCIS with IDCs scattered around in an area of dimension 5-7cm. Because IDCs spread apart, it's difficult to estimate the percentage. But I would think the majority of your lump is DCIS.Hope this will help. Best wishes for your up coming treatments.

Axolotl

Thanks beauz! The way the path report is worded it definitely sounds like it is mostly DCIS, but based on the pT3, N0, M0 that does put it at a higher stage than if he had tried to quantify the percentage of IDC alone.

I have the impression that multifocal IDC is less common. I'd love to know more about multifocal IDC, and/or hear from others who have been treated for it.

beauz

Hi Axolotl, I found the following topic in stage III forum. It was started by kathleen1966.

Topic: multi-focal tumors.....and survival

Axolotl

I recently spoke with my MO about why the pathologist chose to report 5-7 cm of IDC, even though it doesn't represent a solid mass. She said that for surgical purposes it was important to have a measurement of the extent of the IDC to be certain that it was contained within the DCIS had all been removed. This makes sense to me. So beauz, you're correct, 5-7cm represents the area.