Help with my DSIC diagnosis

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Mckaylaleigh
Mckaylaleigh Member Posts: 90
edited January 2016 in DCIS (Ductal Carcinoma In Situ)

Hi all. New to the DSIC world and I am over the initial shock and have moved on to the educating  myself phase. I am hoping some of you can give me a little more insight into my diagnosis that will make it make a little more sense. I have scanned over things on this site, but I am so exhausted and stressed and I am not connecting the dots well.  Here is what my report from my biopsy says:


-High grade ductual carcinoma (4c) in-situ, solid, cribriform and comeo types in 5 of 5 cores.

-P63 and CK903 stains show positive staining for myopithelial cells.


I guess I get the gist of it all but the cribriform and comeo have me especially confused. Also, why is 4c a high risk for malignancy, can DCIS NOT be malignant or does that mean high risk for malignancy outside of the duct?   I am meeting with a genetosist before I make a decision on mastectomy or removal, I just want to make the best decision I can.  Thanks!


Kelly



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  • BarredOwl
    BarredOwl Member Posts: 2,433
    edited December 2015

    Hi Mckaylaleigh:

    Sorry about your recent diagnosis. I felt a lot better after I met with the breast surgeon for some reason, maybe because I finally understood from her explanations what DCIS is and that it has a very favorable prognosis.

    I am not sure what that "4c" is. Is it "c" or "cm"?

    Anyway, the pathology confirms the presence of DCIS, which is a form of breast cancer and is always "malignant".

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC358089...

    On this site, I found this page with illustrations to be helpful for understanding the difference between DCIS, which is confined to the inside of the ducts and is by definition "non-invasive" as opposed to "invasive ductal carcinoma" (IDC), which is the diagnosis after some cells break through the wall of the duct (sometimes called DCIS with micro-invasion (DCIS-MI) if invasive tumor ≤ 1 mm in greatest dimension). Also, there is an explanation of "Grades" and the terms that describe the appearance of the cells in the duct, such as "cribiform", "solid", and "comedo necrosis". You need to scroll to the bottom to find the pictures of these.

    http://www.breastcancer.org/symptoms/types/dcis/di...

    Many new members find these famous posts from Beesie to be extremely helpful. You may wish to bookmark them and read them over a few times.

    A layperson's guide to DCIS (scroll up to the original post):

    https://community.breastcancer.org/forum/68/topic/...

    Lumpectomy vs Mastectomy Considerations (see Jun 20, 2013 12:00PM Beesie wrote:)

    https://community.breastcancer.org/forum/91/topic/...

    Regarding the pathology (p63, CK903), the ducts are surrounded by an outer layer of myoepithelial cells. When the tumor cells are confined to the inside of the duct as in DCIS, the ducts have an intact layer of myoepithelial cells. When there is invasion, the cancer cells break through the wall of the duct breaching the myoepithelial layer. I believe that p63 and CK903 are immunohistochemical stains that were used to visualize the myoepithelial layer, and help determine that the malignant cells are confined to the ducts (DCIS) in your case (based on the DCIS diagnosis). Because you are just providing small quotes from the report, please be sure to confirm this information with your doctors and confirm that the current diagnosis is pure DCIS with no evidence of invasion.

    DCIS should also be tested for estrogen receptor (ER) and progesterone receptor (PR) status. If that is not in your report, please inquire about it.

    You will find a lot of information and support here. Stay in touch.

    BarredOwl

    Age 52 at diagnosis - Bilateral breast cancer - Stage IA IDC - BRCA negative;

    Bilateral mastectomy and SNB without reconstruction 9/2013

    Dx Right: ER+PR+ DCIS (5+ cm) with IDC (1.5 mm) and micro-invasion < 1 mm; Grade 2 (IDC); 0/4 nodes.

    Dx Left: ER+PR+ DCIS (5+ cm); Grade 2 (majority) and grade 3; isolated tumor cells in 1/1 nodes (pN0i+(sn)).

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  • Mckaylaleigh
    Mckaylaleigh Member Posts: 90
    edited December 2015

    Thank you for your reply. I did feel calmed today after talking to my surgeon, but it also made me want to ensure I am more informed before making any decisions.  I guess there are 4 stages of DCIS and then stage 4 has three stages, a, b, and c. C of course being high probability of malignancy. We are military and I think they do things a little differently than the outside world, haha!  That was literally all my paperwork/diagnosis said other than the description of my biopsy and what not.  I believe they are waiting on the ER and PR status results, they said those take longer. I have a lot of reading to do but for tonight, its New Years Eve and I think I am going to try and have some fun!!  Thank you and Happy New Year :)


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  • BarredOwl
    BarredOwl Member Posts: 2,433
    edited December 2015

    Hi:

    Maybe that is some kind of grading system. However, please note that although DCIS is "non-invasive", all types of DCIS are "malignant," and this is true regardless of whether the DCIS is high grade, intermediate grade, or low grade.

    As far as "stage", pure DCIS is always "Stage 0" breast cancer.

    The tissue removed during your biopsy was mounted on slides, stained, and examined by a pathologist. The pathologist has prepared a full written report of the tests, observations/impressions, and findings. It sounds like you have received a top-line summary only. In the US, you are entitled to copies of all of your medical records, including a copy of the original pathology report. Once your ER and PR results are in, you should request a copy of the original report of the pathologist plus any addendum or supplement thereto (which may contain ER and PR information). You should understand the implications of the pathology findings for your proposed treatment plan, and ask about anything you don't understand.

    You should also request copies of radiologist's report from all recent imaging, as the findings should be considered in making the surgical plan. "Trust, but verify."

    I like your plan. Enjoy your evening!

    BarredOwl


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  • LisaAlissa
    LisaAlissa Member Posts: 1,092
    edited December 2015

    Hi Kelly!

    I think you're confusing a few different scales...

    The breast cancer staging scale was originally Roman numerals "I" through "IV." However there was a certain lack of imagination in those who created the scale. So they added "Stage 0" for DCIS (which is a non-invasive cancer). So DCIS is always Stage 0. If it becomes invasive, it will then be a different Stage--which Stage will depend on it's other characteristics (size, node status, etc.). Take a look at this description of staging from the BCO website.

    The Breast Imaging--Report And Data System ("BIRADs") scale is used to communicate the results of various imaging modalities to others. It was originally used for mammogram reports, but in modified format is also used for USs, etc. The chart is from The Radiology Assistant website which describes the various categories further:

    image

    Based on what you've said, I'm guessing that one of your imaging reports said that one of the areas imaged had a BIRADs of 4C. Note that once you've had a biopsy where a pathology report shows cancer, then a newly issued imaging report would list your BIRADs score as "6." Note that it doesn't mean anything has changed! The change from 4C to 6 just tells someone reading the report that there is a biopsy pathology report around somewhere.

    Let me second BarredOwl's suggestion to read (and maybe re-read) Beesie's posts on DCIS. She's done a lot of research and is a very gifted writer. It's probably the clearest description of DCIS & the various treatment options. Separately, if your docs didn't already give you a copy of this pamphlet. (My doc didn't, but my Mom's doc did last year...YMMV), I'd print out the pdf. There are helpful places to fill in the information from your various reports, as well as questions you may want to direct to your docs.

    Finally, if you like books for information, Dr. Susan Love's Breast Book has been updated yet again, I understand (Sixth ed., Sept. 2015) and has lots of helpful info (as well as info that will be completely unrelated to your situation.

    Have a wonderful New Year's Eve! Think about all of this tomorrow!

    HTH,

    LisaAlissa

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  • LisaAlissa
    LisaAlissa Member Posts: 1,092
    edited January 2016

    Malignant means cancer, but not necessarily invasive cancer. DCIS is cancer (although at one time, there were a bunch of people/docs who didn't want to characterize DCIS as cancer, because it wasn't invasive.). But that's the basis for the Stage 0 designation.

    Your genetic counselor (or one of your docs) will be better able to help you interpret the local usage in the report.

    I'd read Beesie's posts, and then print out the pamphlet and fill out what you can before you go. Them take it with you and ask.

    Sorry I can't be more helpful.

    LisaAlissa

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  • Mckaylaleigh
    Mckaylaleigh Member Posts: 90
    edited January 2016

    Thanks so much everyone, I am understanding things a little more. That pamphlet is great and very informative in itself.  I still have a lot of research to do but I am very thankful to have found this forum and I am sure I will be spending a lot of time here. Happy New Year!


    Kelly

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