seeing RO; trying to understand pathology report

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tarry
tarry Member Posts: 156
edited June 2014 in Radiation Therapy - Before, During, and After

I'll see the RO on Friday morning and the MO Friday afternoon.  I'm trying to find out about the options available to me, so I need to understand the pathology report better than I do.  In particular, I want to see if I'm a candidate at all for internal partial breast irradiation or partial external radiation.  If none of that works, I think I'd like the Canadian protocol.

If would be great to get some idea of what might be ruled out in my case.  First of all, I don't know if the comedonecrosis just rules out everything but extended full breast radiation.  And secondly, I don't know what to say about the size of the tumor.  In fact, I think the BP said I didn't really have a tumor, but I had a large area of various involvement.

Here's the diagnosis of the path report:

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What they took out was pretty big, btw, and then they took out more:

A 10.5 x 7.5 x 6.6 cm lumpectomy specimen with two guide wires, one on the medial aspect and the other on the lateral aspect.

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RIGHT BREAST, SEGMENTAL MASTECTOMY:

INVASIVE DUCTAL CARCINOMA, NUCLEAR GRADE 2, NOTTINGHAM HISTOLOGIC GRADE 2, MULTICENTRIC.

INNUMERABLE FOCI OF INVASIVE CARCINOMA MEASURE FROM 1 MM TO 5 MM IN LARGEST DIMENSION.

EXTENSIVE DUCTAL CARCINOMA IN SITU (DCIS), INTERMEDIATE GRADE, SOLID AND PAPILLARY WITH COMEDONECROSIS.

DCIS MEASURES 4.5 CM IN LARGEST DIMENSION.

INVASIVE AND INSITU CARCINOMA EXTEND TO WITHIN 1 MM OF THE ANTERIOR MARGIN.

All other margins are widely free of tumor.

No lymphovascular space invasion identified.

Previous biopsy cavity site changes.

One intramammary lymph node, no tumor present (0/1)

(B) RIGHT AXILLARY SENTINEL LYMPH NODE #1, IN VIVO 17, EX VIVO 61, EXCISION:

One cauterized lymph node, no tumor present on initial review.

Cytokeratin immunohistochemical stain is negative.

(C) ADDITIONAL INFERIOR MARGIN, CLIPS MARK TRUE MARGIN, EXCISION:

Breast tissue, no tumor identified.

(D) ADDITIONAL SUPERIOR MARGIN, CLIPS MARK TRUE MARGIN, EXCISION:

Breast tissue, no tumor identified.

(E) ADDITIONAL ANTERIOR MARGIN, EXCISION:

Skin and breast tissue, no tumor present.

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Comments

  • LisaAlissa
    LisaAlissa Member Posts: 1,092
    edited September 2011

    Hi Tarry,

    Sounds like you're going to have an "exciting" Friday.  Do you have someone to go with you?  If not, you may want to call and ask if they mind if you record the sessions (if you do this, make sure you understand how to operate the recorder)--some offices will record it for you!  You may well want to review the discussion later...

    Generally (as I understand it), when there is IDC, the DCIS becomes irrelevant.  Needed to be removed, but the on-going treatment will be dictated by the IDC.  So the comedonecrosis identified on the DCIS won't matter in terms of deciding further treatment (Although fyi, I had DCIS w/ comedo necrosis and had Mammosite radiation). 

    You've got one narrow margin, but I don't know if that will affect the advice you get.  

    If I were you, I wouldn't make decisions on Friday, I'd get advice, and then consider it...possibly get a second opinion if I didn't feel comfortable.   You didn't say where you're being treated, but if it isn't at a NCI-designated cancer center, it can be good to seek a second opinion at one of them.

    Hang in there.  

    LisaAlissa 

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  • tarry
    tarry Member Posts: 156
    edited September 2011

    Lisa, thanks.  Your advice about taking someone along is so good.  I'm very fortunate to have my husband going with me.  He's very good at asking questions and remembering.  Of course, he's also under a huge strain too.

    Do you have any idea what I should put down for size?

    And how did you feel about your radiation.  I hear stories of discomfort, but they could be worth it to keep the time and damage low.

    Did you start with a simulation?

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  • treeskier
    treeskier Member Posts: 52
    edited October 2011

    I had brachytherapy in late August. My situation was pretty different because of smaller tumor and a lumpectomy with good margins. I can't say if brachytherapy would work for you, but if the docs say it would, I say go for it. It was not a fun 5 days (okay, day 1 was un-fun enough to balance out the other 4) but it was fast, efficient, the docs tell me equally as effective as the external radiation, and did no damage to healthy  tissue. That last one counted a lot for me. I didn't want my skin burned and all my lymph nodes irradiated if I could just get the rads focused on the breast tissue near the tumor. If you do go for brachytherapy (mine was Contoura, not Mammosite, but very similar) feel free to PM if you want more info about how it went.

    I wish you the very best as you go through this tough time!

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