Pathology report/treatment

Jbos

Hello, I just got my report back and it seems like my entire tumor was removed with negative margins. My question is has anyone had a similar pathology report with other similarities? If so, what was your treatment plan? I know it's unique to each situation, but I'm just curious. - triple negative - less than 2 cm - negative margins - grade 3 (Nottingham grade 9)

moth

Hi Jbos, sorry that you find yourself here.

That was my path and I had AC+T followed by radiation. BUT, you might also be looking at pembrolizumab (Ketruda) and/or capecitabine (Xeloda) on top - these are brand new therapies showing benefit to high risk early stage TNBC.

the NCCN guidelines are from 2020 and don't have the latest but still a good read. https://www.nccn.org/patients/guidelines/content/P...

Be sure to ask your oncologist about both pembrolizumab and capecitabine and get their advice on that. If they do not have info on these or good information for why they're not recommending these in your case, I'd see another MO because they're not up to date on cutting edge treatments for TNBC.

best wishes!

Moderators

Hi jbos, and welcome to Breastcancer.org,

We're so very sorry to hear of your diagnosis, but we're really glad you've found us. As you can already see, our amazing Community is full of helpful members always willing to offer advice, information, encouragement, and support -- we're all here for you!

In addition to the helpful info moth provided, you may be interested in these two research news articles Breastcancer.org posted yesterday on a recent approval of Keytruda for early triple-negative breast cancer:

Keytruda Before and After Surgery Improves Outcomes in Early-Stage Triple-Negative Breast Cancer

FDA Approves Keytruda for Early-Stage Triple-Negative Breast Cancer

We hope this helps and we hope to hear more from you soon! Please let us know how else we can help!

--The Mods

Jbos

Thanks. I think my last response got lost.

My next question is, “Why would chemo be necessary if the tumor was removed, there was no lymph node involvement, and the margins are clear?”

Is this because there may still be cancerous cells somewhere in my body that may metastasize? I am trying to stay positive, but educated as well. I don’t want to seem naive, but I haven’t found this answer clearly explained.

Thanks!

moth

Jbos, yes, it is exactly what you said. We do not have the imaging or testing capacity to see if any cells have escaped. A single cell might be all it takes - it just needs to get into the blood stream or into the lymphatic system and then it can linger and then come back as recurrence either in the breast, or worse metastasized in other tissue.

Metastatic (stage 4) disease is not curable. It's a terminal diagnosis. So the idea is to treat the cancer aggrressively in the early stage to reduce risk of a recurrence by hopefully cleaning up any cells that might have escaped. For hormone positive cancers, endocrine therapy and certain genomic tests like oncotype can mean that some women avoid chemo. But triple negative is considered aggressive and we cannot use endocrine therapy so chemo (plus possibly some immunotherapies like pembrolizumab) are the tools in our toolbox.

As you can see from my signature, even that doesn't gurarantee it = but we know from studies that it greatly mproves odds. (btw, I had clear margins, negative lymph nodes)

feel free to ask more questions!

MountainMia

Hi Jbos,

Yes, my description was just like yours: "triple negative - less than 2 cm - negative margins - grade 3"

I was diagnosed at age 58, 2 years ago. I had lumpectomy, no lymph node involvement. I had 4 rounds dose dense of AC, followed by radiation. [ Edited to say: that's actually unusual. Most patients would also have 8-12 rounds of Taxol, for a ACT program. Or a different set of chemicals, depending on their personal factors. ]

Yes, you have chemo for triple negative because there can be tumor cells in other places in your body. Chemo is a systemic treatment -- it treats your entire system. The surgery is local. Radiation, if you have it, is local.

Triple negative doesn't have other options for treatment/prevention. You won't be doing hormonal treatment, as people with ER+ cancers would. Chemo is a standard part of treatment for triple negative.

I'm not being very articulate here. Others can explain far better. Please also discuss with your doctor.