Diagnosed with IDC and have lots of questions

leerose

I was diagnosed with IDC this week. I have three masses in my right breast and all came back as IDC, with one also DCIS. They are small - all around 1 cm, although I'm told they span a 6 cm space all in one quadrant. Two of the three are well differentiated and one is moderately differentiated. I was told the Ki-67 for the three are 5%, 3%, and 16%, respectively. All are ER and PR positive and HER2 negative.

I am scheduled for an MRI this week and I have appointments on Tuesday with the surgeon, genetic testing, and radiology/oncology. So, all this information is from the nurse, who is very positive. In fact, so positive that she's making me think this is a no brainer and a minor thing. Maybe she's trying to make me feel better and maybe it is no big deal, but in some ways, I feel like she's minimizing my concerns about my health. Its been such a rollercoaster through all of the waiting, and now I feel deflated. Don't get me wrong - it is GREAT to actually know, but all of the positivity is making me feel like I won a prize. I know it could be so much worse, but it is still cancer, right??? I have a right to be a bit upset.

So, now for some questions. She told me all three masses were slow growing ones, based on the information provided above. But, in reading through lots of posts here, it looks like the last one is actually a bit more concerning, although still small. Is there any real meaning behind these numbers? What exactly is the purpose of the MRI? Once I see the surgeon on Tuesday, how fast am I likely to be scheduled for some sort of surgery? And finally, what are the factors that determine whether radiation or chemo are necessary? I know that its very individualized, but I was just wondering what the triggers are to make those determinations.

Thanks for any insight.

moth

Sorry you find yourself here.

Do you have a Grade for the masses? Ki-67 is a controversial measure - some MOs won't even test for it (mine doesn't) but Grade is universally used in staging and prognosis studies.

The MRI - is it a breast MRI or an abdomen? If it's breast, they want more images and maybe are wondering if there are some more hidden masses. Dense breast tissue is often referred for MRI. If it's an abdomen MRI, they're screening for metastatic spread.

Surgery times vary...I had mine a week after meeting the surgeon but some people do more like 3 or 4 weeks. I believe there was a study a while back that delaying more than 6 weeks had some adverse consequences. So it's urgent but not an emergency, kwim? You have time to think it through & there might be decisions about what kind of surgery &/or reconstruction.

The surgery takes care of the cancer in the breast right now. Chemo & radiation are prescribed to reduce risk of metastatic recurrence in the future. So the decision to recommend chemo or rads is made based on a model of how likely it is to recur. There are several different ways of getting at this but generally (very very generally) speaking, the larger the tumor, the younger the patient, the higher the grade, the more likely chemo would be recommended. The other systemic treatment for ER+ is some sort of hormonal treatment which you would start taking after chemo (if you have any) and continue to take for 5-10 years. The hormone treatments have their own side effects and risk factors.

Predict is one tool which shows risk of recurrence in populations with similar cancer to yours. You can enter the data you have now to get some ideas but final decisions are usually made after surgery as the surgical pathology is more accurate than biopsy pathology. Also you need to know if there are any cancer cells in the lymph nodes and that is generally not known until surgery. So any data you get out of Predict now is just very preliminary but I found it helped me to understand what the general prognosis might be. https://breast.predict.nhs.uk/

OncotypeDX is a lab test which can be done on tumor cells to determine from their genetic makeup how likely the cancer is to return. You might qualify for that after surgery & it would help your oncologist determine the benefit of chemo.

In the meantime, I recommend you do some reading in the info section of this site, as well as reading through the forums for IDC and multifocal (that's your type - when you have more than one mass in one quadrant). Just reading through lots of threads you will learn tons and have good questions to ask your surgeon.

hth a bit! best wishes

leerose

Thank you, moth. Two of the tumors are grade 1 and one is grade 2. The MRI is of the breasts. I will definitely continue reading and at least I only have a few more days until all of my initial appointments.