pathology change after surgery?

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ForHisGlory
ForHisGlory Member Posts: 64
edited October 2014 in IDC (Invasive Ductal Carcinoma)

just wondering how many people started out stage 1, grade 1 and then after surgery had things change? I am 43 years old and the dr seemed surprised that my cancer tested grade 1 and I'm wondering if I should mentally prepare for changes in pathology?  Seems like several people have had some change after surgery. I do better if I prepare for the worst. Also did anyone's pathology change in hormone receptors? Thanks!

Still waiting for my surgery date which has been postponed until November 3. I'm sure the cancer is a little larger but still hoping for clear nodes. 

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  • Tomboy
    Tomboy Member Posts: 3,945
    edited October 2014

    There is clinical and there is pathologic staging. It is not unusual at all for clinical pathology to change after surgery. Usually it has more to do with stage than grade, though. Clinical pathology is just what they can palpate or image, and when you do the surgery, the pathologist can tell much more, and will factor in what hopefully ISN'T in your nodes! Good luck to you, Maryland.

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited October 2014

    It is important to note that sizing on imaging is an estimate - imaging is imperfect and sometimes does not show true size, or other things that are too small to see.  That is why you will see staging changes after surgery.  Also, tumors are not homogenous - meaning that you can have differing grades and receptor info depending on which part of the mass has been biopsied.  When something is surgically removed they take a much closer look at many more slides for a more comprehensive assessment.  This information is taken as a whole and treatment decisions are made off the surgical pathology, unless biopsy information indicates that neoadjuvent chemo is the more sensible choice - this is being done more frequently for triple negative and Her2+ patients when this is revealed on the pre-surgical pathology, or when imaging reveals a large mass that needs to be made smaller for a better surgical outcome.

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  • jeanelle
    jeanelle Member Posts: 179
    edited October 2014

    The only real change I had in mine was the size of the tumor, which in turn pushed me from Stage I to Stage IIa.  They did find that there was DCIS along with the IDC but, from what they told me, that is very common.

    Good luck with your surgery!

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  • momand2kids
    momand2kids Member Posts: 1,508
    edited October 2014

    yup-- thought it was stage 1 1.2 cm--turned out to be stage 2 and 2.5 cm---- but doing well!!!

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  • jenjenl
    jenjenl Member Posts: 948
    edited October 2014

    my biopsy was er+ but after surgery pathology was er-

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  • tangandchris
    tangandchris Member Posts: 1,855
    edited October 2014


    I think it is very common for there to be changes. Prior to surgery they only saw 1-2 nodes and 1 larger tumor and another smaller one right next to it. After surgery I had 6 positive nodes and one extra smaller tumor. It didn't change my staging or grade though.

    Right now you just need to be ready for things to change as they come. None of these things are the same for any of us and alot of this is the unknown. It is uncomfortable for sure and maybe some of the worst of going thru BC is the feeling of things being out of control. Just know that this forum is a great place to come because we ALL get it.

    ((hugs))

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  • wrenn
    wrenn Member Posts: 2,707
    edited October 2014

    When my doctor felt my lump in June she thought it was about 1.5cm. Ultrasound and mammo had the same size estimate. Surgery 2 months later showed it to be 1.5cm with grade and hormone status the same as Bx.  The only thing that was a surprise was that 5 nodes "lit up" according to surgeon but pathology found them to be benign.

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  • Kay_G
    Kay_G Member Posts: 3,345
    edited October 2014

    The oncologist told me that if the tumor is large enough, it is likely to have all three grades of tumor involved.  Mine was grade 3 from biopsy.  I had neoadjuvant chemo and what was left after surgery was grade 2.  I suspect the grade 3 (in general, I think grade 3 responds best to chemo) part was eradicated by chemo.  So in that respect, I think it is better to have a grade 3 tumor.  Take it one day at a time, and best of luck with your surgery.
     

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  • Blessings2011
    Blessings2011 Member Posts: 4,276
    edited October 2014

    I did prepare for the worst prior to surgery. 

    I had seven different diagnostic procedures and biopsies in the left breast, and they all confirmed multi-focal IDC and multi-focal DCIS. The Radiologist was concerned that my right breast was "suspicious", and my mom had been dx'd with BC at the same age I was, so I opted for a BMX with recon.

    Going into surgery, I was prepared for chemo, if the nodes were positive or if the tumors were larger than seen on imaging, and rads if the tumors were located too close to the chest wall.

    Imagine my surprise when my final path report showed clear nodes, clean margins, and NO EVIDENCE of IDC in the tissues, just DCIS. When I asked the surgeons about it, they said that the biopsies probably got all the IDC, as it was small and early stage.

    So yes, my pathology changed after surgery, but in a good way.

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