Need clarification on path report term

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nene2059
nene2059 Member Posts: 270
edited June 2014 in Stage I Breast Cancer
Need clarification on path report term
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  • nene2059
    nene2059 Member Posts: 270
    edited December 2009

    I am doing this a little backward because I am already through treatment and had my implant exchange surgery last Friday but I just got copies of all of my Path reports today (first time I asked for them all) and I need some clarification.  I had BC in both breasts and  they were slightly different so they were easily identified as separate tumors.  In my right breast I was er+ 93% and PR/Her2 neg.  I had a high KI67 at 43%. In left breast er+ 83% pr+ 42% her2 neg. Ki67 interm. at 11%. Ok question one- what, if any, is the difference in prognosis for these two?  Both were grade 2.  Is it supposed to be better to be highly er+ or er/pr+?  I had assumed they were more similar than they actually were.  Also, there were no nodes involved and I know that is supposed to be a good thing but one said that there was no lymphovascular invasion IDENTIFIED and the other said none DEFINITIVE.  Am I splitting hairs here or do these mean two different things?  Thanks for any info.  I am trying to move forward from a year of BC treatments and I hope understanding these reports helps me to handle to future worries that surround us all.

    Thanks again.

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  • AnneW
    AnneW Member Posts: 4,050
    edited December 2009

    Nene,

    I'll try to help here--it looks to me like grade 2 is grade 2. There's really not enough reason to split hairs or lose sleep. And treatment is the same, regardless, and should be effective for both. Why there would be the semantics between "identified" and "definitive"--I don't know. Both, to me, should say "none identified". What's 100% definitive, anyway.

    Let go of this and focus on treatment and healing. I understand your worries, but there are some "definitive" subjectivities in our path reports. You've had what we presume to be standard treatment for your cancers. Take good care of your body, and your mind will follow.

    Also, you're at that really tough one-year-out point. It's a very vulnerable time. The wounds are still fresh. The negative node status and grade 2/3 are really things to embrace, not fear so much. Just give yourself some breathing room right now.

    Hope this helped a little!

    Anne

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  • otter
    otter Member Posts: 6,099
    edited December 2009

    Nene, IMHO, the main distinctions between your two tumors are their ER/PR patterns and the Ki67 staining.

    Generally, the stronger the ER+ staining, the better the response to estrogen-blocking or estrogen-suppressing drugs (tamoxifen or AI's) is supposed to be.  In your case, though, one tumor was 93% ER+ and the other was 83% ER+.  I don't know if that difference has a significant impact on prognosis.

    Generally, the higher the Ki67 staining, the more "aggressive" the tumor ... so, just speculating here:  I would think the tumor with the "high" (43%) Ki67 might pose the greater threat.  But, again, I don't know if the difference between 43% ("high") and 11% ("intermediate") is significant, and I don't know if all that much emphasis is put on Ki67 by itself.

    One of your tumors was ER+ PR- and the other was ER+ PR+.  My BC was ER+ PR-, too. When I met with a med onco shortly after my surgery, he told me the ER+ was a "good" thing.  I asked him whether the fact that my tumor did not have progesterone receptors was important.  He said it didn't make any difference -- as long as the tumor had either of the hormone receptors (ER+ or PR+), it was a good prognostic sign.  It meant the recurrence risk was lower than if the cells did not have either of the hormone receptors; and it meant estrogen-blocking or estrogen-suppressing drugs could be used.

    I had read some journal articles that suggested otherwise.  What I'd read said the prognosis was better (treatment was likely to be more effective, and the recurrence risk was lower) if the tumor had both ER and PR (ER+ PR+), rather than just one or the other.  So, I wasn't totally surprised when that med onco called to give me my Oncotype DX score (26) and recommended chemo, in part because of the Oncotype score but also because the tumor did not have progesterone receptors (it was ER+ but PR-). Sometimes I really hate it when I'm right...

    I fired that med onco for a multitude of reasons; and the 2nd med onco I consulted also recommended chemo.  After finishing chemo, I started on Arimidex.  That was 18 months ago.

    I saw in one of your other posts that you had neoadjuvant chemo (AC-T) and a bilateral mastectomy.  I agree with Anne.  You did what you could to reduce your risk of a recurrence.  Now you should stop re-playing that video in your mind, and move on.  There really is no point -- nothing to be gained -- in second-guessing things.  Anyway, I can't imagine what you could have done differently.

    otter 

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  • nene2059
    nene2059 Member Posts: 270
    edited December 2009

    Thanks Anne and Otter.  Those were exactly the type of replies I was hoping to get.  You both are very informed and I respect your opinions.  I don't know if I added it to my bio or not (I'll check after I post:)) but I also had to have an ooph because I could not metabolise Tamox and am now on Femara.  Doing ok on that except in the last month or so I have started to have the stiff joints and my bone density scan showed severe osteopenia and some osteporosis so I start Boniva on Jan 1.  Not at all what I expected at 37.  Otter, I don't know if this is in line with the articles you have read or not but you may find it interesting, the er+ only tumor disappeared completely with the chemo maybe because it was the higher Ki67 and therefore growing faster?  I don't know but was glad it responded to the chemo anyway.  The other shrank but did not go away but we got it all out with the surgery.  I am a little disappointed in myself that I am questioning all of this again. I am fine most of the time but I don't do well with things out of my control and this is the mother (I guess life is too) of that!  Thanks again for the replies and Happy New Year to you all. May it be a year FREE of BC.

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