Infiltrating Invasive Ductal Carcinoma Grade 1

Amber, Welcome to the BCO community. We are sorry that your breast cancer diagnosis brought you here but we are very glad that you found us. You have joined a unique group of caring and knowledgable others who can lend you support and helpful information. You can also read some information on our site about Your diagnosis .  We will be thinking of you in the days to come. Please keep us updated. The Mods

Hi Amber,

Sorry to hear your going through this as well. The size can differ because when they do the intial biopsy they don't always get the "clear margins" that are required. They like to see a certain amount of normal tissue surrounding the tumor so they're sure they got the whole tumor. Sometimes you get lucky and they get it on the biopsy. Sometimes they go back and do it during the lumpectomy. In my case my biopsy was done as a lumpectomy but she didn't have clear margins so she was going to go back in to take more but because of other factors(ie. family history, history of lots of benign disease) I had a bilateral mastectomy. When the pathology came back they actually had gotten all of the tumor with the lumpectomy so the size didn't change. As far as symptoms with lymph nodes, usually no symptoms. In very advanced disease you can have a node that swells but not usually in very early stages. Hope that helps a little.

I'm also puzzling about tumor size and lymph node involvement.  My tumor was just 5 mm and all doctors assured me that it was highly unlikely that it would have spread to lymph nodes. And yet when path report came back, there were cancer cells (micro) in one node.  Treatment plan on hold and waiting oncotype results.  Anyone know how often a very small tumor has lymph node involvement?

Smallchange,

I am so sorry that you find yourself in this situation. There is a lot of good information on this site. Have you had surgery to remove the tumor yet or did you have the sentinel node biopsy before you were going to have surgery to remove the tumor? The grade of the tumor is important and if it has estrogen receptors and if HER2 is negative or positive. All of these come into play in deciding a treatment plan.  I had the oncotype test as well but I had pretty much already decided on a treatment plan which then was up in the air waiting for those results. My score was 16 which is considered low risk and I had no lymph node involvement. I can't speak with any expertise but I thought that even if one node was involved there was usually a recommendation of chemo. As far as micro cells I don't have any knowledge of what that means. If there are any cancer cells in those sentinel nodes then there is a possibility that the cancer can spread throughout your body from my understanding. That is the reason that chemo is recommended even if there is only one node involved. I hope you can find out results on your test. Mine came back sooner than the Oncologist said so hopefully yours will too. I hope things go well for you. I know the beginning of this journey is a shock but once you get a treatment plan in place it helps.

Bandwoman

Hi Amber,  Your pathology report looks very encouraging!      YAY for clear lymph nodes!!    Low Ki-67 and ER and PR Hormone Receptor Positivity and HER-2 Negativity are very good things to have!!!     (If you have to have a breast cancer, this is usually the nicest kind to have.) Just that info by itself is a strong suggestion that you will likely NOT need, chemo, and that chemo, in fact, wouldn't help you at all.      Here's hoping your Oncotype test confirms that!!     From what I've been able to understand (and I've studied and thought about this a lot, since I'm in a similar situation), the chances are very very very good that you will get either a low Oncotype (meaning NO chemo) or an intermediate Oncotype (meaning they just can't predict things based on Oncotype and they need to rely on your other data and clinical picture to make a decision).        

http://www.nature.com/bjc/journal/v105/n9/full/bjc...

http://www.genekor.com/userfiles/files/St%20Gallen...

(Note that in the second study, where they did find a few low Ki-67 people that ended up with a high Oncotype score, the cutoff rate for being considered "low" Ki-67 was 14)

How can the docs assume that if you get a low Oncotype score you realy don't need Chemo?   If your Oncotype is low, your tumor cells WILL NOT RESPOND TO CHEMOTHERAPY, so you would be taking highly toxic drugs fo NOTHING!!!    If your Ki-67 is truly very low, also this suggests all by itself that your tumor cells would not respond to Chemotherapy.    The Ki-67 measures the proportion of cells are in the act of replicating.      Chemotherapy drugs ONLY act on cells when they are in the process of cell replication.     That's why they kill cancer cells more than all the rest of your cells-- because cancer cells replicate faster.     But if your cance (despite being a cancer and dangerous anyway) replicates slowly, as evidenced by a very low Ki-67 value, the Chemotherapy drugs just won't work to kill it in a regimin that wouldn't be too toxic for the rest of you.      

But don't worry!   A low Oncotype and  low Ki-67 doesn't mean that your cancer can't be cured!!!      If your cancer has lots of ER receptors, meaning it is driven to replicate by the estrogen in your body, you've got a fantastic and very low toxicity way to block your cancer.     Just like you were guessing, taking away that hormone drive has been proven to be very very effective in dramatically reducing the probability of reoccurance or apearance of new breast cancer.   It's a great alternative to chemotherapy, and you're lucky that in you it will work!

The fact that you are HER-2 negative is great, because that means your tumor cells aren't being excessively driven to replicate by the human epidermal growth factor in your body, so you don't need to take additional drugs to block that and kill the cancer.  HER-2 positive cancers are typically more aggressive, faster replicating,  and harder to cure, so it's a good thing to be negative for that.    

By the way, Also I live in a country where the Oncotype testing is not done.     It is hardly ever done here, because the costs of it are not covered by the public health system here, and we do not have private insurance.     Doctors usually don't even mention to patients the possibility of having it done by paying out of pocket.      I was all set and ready to insist with my doctors that I wanted to have that test done and pay for it myself, for that same worry that you have (Thinking "What if I really need chemo after all?").        But after thinking about MY SPECIFIC pathology results, I realized that my very very low Ki-67 (mine is 7%) indicates all by itself that chemotherapy would be useless in me, and my hormone receptor positivity and HER-2 negativity indicates that hormonal therapy should work just fine, and I actually have a very low reoccurance rate that way and very good prognosis.    So I didn't even insist to get the test done.      I did talk to my oncologist about it, and he totally agreed that it wouldn't add any information IN MY CASE.       Since you are having it done, I would very much appreciate hearing from you when your Oncotype result comes in, to know what score you got, what your exact Ki-67 value is, and what therapy your docs eventually advised you to do.   

I don't know why some pre-menopausal women are treated with Tamoxifen alone, while others are given Zolodex in addition to the Tamoxifen to reduce the estrogen stimulation even more.     Maybe your docs feel that your fairly large tumor size (and medium grade) needs the stronger, combined treatment?    

I'm post-menopausal, so I'm getting an aromatase inhibitor instead.      

Good luck with your treatments-- May they do their job perfectly and give you minimal or no side effects!     And I hope you heal up quickly from your surgery!   

I'd missed that you'd said that you were only 40 years old.     That may have something to do with why you're getting Zolodex in addition to the Tamoxifen.      The docs tend to give more aggressive therapy to younger patients, because statistically cancer that hits younger people is more aggressive.      

Hi all, new to the group and thankful for finding it! Had my surgery Fri Oct 3rd.  Lumpectomy and sentinel node removal.  Still waiting for the final pathology.  Thank you for being here.  It's hard not having anyone to talk to that understands. I'll post again when I know my pathology report. 

Smallchange,

I am so glad you have a treatment plan in place. Congratulations on being able to do a boat trip four days after surgery. You are doing a whole lot better than I did. That's awesome. Your oncotype score is excellent. What a relief to not have to have chemo. I have a feeling you are going to do just fine. You are smart to take it one day at a time. Radiation is really not horrible. Follow the directions they give you religiously. When they say to use the lotion 2-3 times a day go for the 3 times. It will pay off in the end. The waiting is the hard part but what you will find is that this journey you are on now that feels like it is consuming your thoughts and your life is only temporary and before you know it you'll be looking in the rear view mirror at it getting on with your life. I wish you all the best.

Bandwoman

joni - were you advised to take a 10mg Claritin (not Claritin D) prior to your injection? It helps with the bone pain associated with the Neulasta injection.  The antihistamine is supposed to alleviate the edema in the bone marrow.  Here is the study info linked below.  I took a Claritin at least an hour prior to the injection, and then every 24 hours for the next few days.  There are some oncologists that advise taking it every 12 hours.  The first Neulasta can sometimes cause the most discomfort - subsequent injections may not cause as much - kind of like when wearing a pair of shoes for the first time, then when you wear them again they are not as tight - the marrow has already expanded to produce white cells, so the next time it does so it is not as painful.  Some people also take Aleve and find it works well for this type of pain.

 http://clinicaltrials.gov/show/NCT01311336

Hi Amber, my name is Angie and I was just diagnosed with Invasive Ductal Carcinoma on October 8th and had my mastectomy a week ago my tumor was 7.8 cm I'm not sure what stage I'm in yet won't know until next Wednesday. 

How are you feeling physically and mentally?  Did you have a lumpectomy or a Mastectomy? Did you have to have chemotherapy or radiation