Biopsy results in

dju324

Hi everyone -

On March 7th, I got the call that the biopsy came back as stage 1 cancer. I met with a surgeon the same day which was nice. He didn't give me a copy of the results but I got them online through the portal the next day. When we met, I was so confused because at first he said stage 1 and then he said stage 0 and handed me a flyer about stage 0. He said it was very very treatable and I just needed a lumpectomy and then make appointments with a oncologist, radiology oncologist and a geneticist. It was too much at once.

So, of course, I went home and started to lookup the IDC grade 2 (0.3 cm) and DCIS grade 3 (0.9 cm) as shown in the results below and learn that they mean intermediate and aggressive. My appointments are next week.

If I want to get a 2nd opinion on the biopsy, how do I request that?

I keep reading about how women have lived long lives without messing with these spots. The core needle biopsy is like "poking a beehive with a stick." Also, how it's important to limit inflammation after these procedures (biopsy and lumpectomy) but none of the doctors do that. Overall, I don't have a lot of faith in the routine process of treatment. It feels like a money machine for the hospitals.

I'm thinking I'll do a lumpectomy with a limited radiation plan. Of course, I know I need to wait for results of the lumpectomy and lymph node. How often does the lumpectomy indicate a different diagnosis? Overall, I just don't want to follow the plan blindly. I don't want to be over-treated. I know you're not doctors but will you please let me know what to expect?

Thanks!

FINAL MICROSCOPIC DIAGNOSIS:
RIGHT BREAST, 9:00, BIOPSY:
1. INVASIVE DUCTAL CARCINOMA, GRADE II (SEE COMMENT).
2. EXTENSIVE DUCTAL CARCINOMA IN SITU, GRADE 3, CRIBRIFORM PATTERN WITH
CENTRAL NECROSIS AND ASSOCIATED MICROCALCIFICATIONS.
YCHI

COMMENT: The diagnosis of invasive carcinoma is confirmed by negative p63 and
smooth muscle myosin immunostains. The greatest dimension of the tumor as
measured from the slide is 0.3 cm. The case was submitted for intradepartmental
consultation with concurrence.

SCORE STAINING INTENSITY INTERPRETATION

ER 95% Strong Positive
PgR 95% Strong Positive
HER2 0 N/A Negative

blah333

You will probably next need to have an MRI to see more.... if the IDC and DCIS are in different spots or it's multi-focal, you will probably need to consider mastectomy. But it sounds like it's quite small. The MRI imagine will show more.. Your DCIS sounds like it is at the tipping point of being invasive (if you were to do nothing at all) but it doesn't matter, you already have IDC too. Not to sound like a jerk but you need to find a balance between your skepticism of hospitals/the need to advocate for yourself and accepting the standard treatments of care. It's very treatable now but neglecting to do this or that step can come back to bite you later on. Read as much as you can here.... Depending on your doctor, profit may or may not be an issue. I don't get the sense that they wish to overtreat people to make money but do profit on plastic surgery/reconstruction. Doctors usually get a set salary, it's not about hoping to get a Stage 1 person to do unnecessary chemo etc.

Also if you have both Stage 0 and Stage 1 in your breast, the higher isntance takes precedence. So although they found DCIS, they are going to be concerned with treatment of the IDC.

edwards750

I agree with blah now is not the time to be passing judgment on doctors being fixated on the cost and not your care. You are making assumptions prematurely. You do have 2 types of BC. The Path report that comes after your surgery is the tell all whether there has been node invasion, etc.

Also I’m not sure what you mean by limited radiation. Your oncologist is going to prescribe your treatment once your surgery is completed. You don’t have to take his/her advice - that’s your call. I think oncologists are making a concerted effort not to overtreat patients which is why a lot of them order the Oncotype test to determine if chemo is beneficial. I had the test and because my score was low I dodged chemo and just did radiation.

Good luck!

Diane

dju324

Thank you. Honestly, I think I'm in denial right now. It's coming and going in waves. I'm hoping for a low oncotype score then.

Is anyone familiar with the negative p63? Also, what does it mean when the ER/PR are "strong positives"? Do either of these give an indication of prognosis, or do I just have to wait for the results of the lumpectomy.

Ingerp

I'm a numbers gal, so what helped me make treatment decisions was how it would affect my probability of recurrence. 50% reduction? Easy decision. The "strong positives" means your tumor is highly sensitive to estrogen/progesterone--it feeds off those hormones. The good news is hormone therapy (tamoxifen for pre-menopausal women, an aromatase inhibitor for post-) would be more effective for you in warding off a recurrence. The HER2- means you likely will get something like an Oncotype test to see if chemo is warranted. As to a different diagnosis after a lumpectomy, I'm sure it happens but generally breast surgeons know what they're looking at, including whether or not the lymph nodes are involved. I never thought about getting a second opinion on any of my treatment. I've had common types of breast cancers with standard treatment protocols. I knew what would be recommended ahead of time, mostly from research on this site. I agree you should look at all of the recommendations from your medical team with a critical eye--you need to be on board with whatever treatment plan you agree to. That said, I think Western medicine is wonderful.

Salamandra

Hi dju324,

Strong positives on ER/PR are favorable for prognosis.

Negative p63 - I'm pretty sure this means that your cancer is just 'regular' and not the kind characterized with p63 - metaplastic - which tends to be much more aggressive. So negative p63 should also be favorable for prognosis.

I bet that your insurance will help you arrange second opinions if you want. They might even have some kind of navigator service for you. Cancer treatment is expensive and they'd rather pay a little more up front but get it right.

You should also be able to do it on your own, would likely just require some legwork with getting forms and faxing them to the right places and making phone calls.

dju324

Salamandra - thank you! I called my insurance and they confirmed that they would pay for a 2nd opinion. I ended up going to Rush University Hospital for a 2nd opinion. What a difference! I have confidence in the plan now.