Small Tumor with No Microcalcifications - No Need for Radiation

Thank you for the study. I have been told I will not need radiation, although I have not had surgery yet. I will have a double mastectomy on January 6. I was diagnosed on November 3. My tumor is on my left breast and is 2.9 cm and besides a pulling in my deep in my breast, the other symptom was an inverted nipple and a dent in my areola; however it is palpable. I was not concerned because I have dense breasts and have had many benign cysts in the past. I new I was dealing with a different kind of tumor because of the new symptoms. If I will not be treated with radiation, I am not sure what my treatment will be. How about you? Do you know what your treatment will consist of?

Hi Barred Owl. Thanks for responding. I have IDC of the left breast. I am Progesterone+ and Estrogen+. Ki-67 is 15% and P53 is also 15%. I had an equivocal HER2 result of 2+ and then they did the FISH study. I got a verbal report yesterday, and was told I am HER2-. My concern is that the tumor is HER2+ in some areas and HER2- in others. I read that somewhere. Treating for one when it is both is a thought that freaks me out, especially because I am not a doctor so my ideas are probably not even possible. Nevertheless, we are in vulnerable states and it is challenging to manage all these thoughts.

I still need to ask why they can tell me I will not need radiation without having done a sentinel node biopsy. The plastic surgeon will be doing the reconstruction on the same surgery day of the bilateral mastectomy, January 6. If radiation is needed, the reconstruction would not be possible. If I need post-mastectomy radiation, then I guess they would call of the reconstruction.

My tumor is 2.9 according to the sonogram done on November 3 and 2.5 according to the MRI done on the 23rd. It is on the left breast right at 12:00. I can feel it, and it is right above the nipple. My first symptom during the summer was a pulling in the chest or deep in the breast and it felt like a pulled muscle. I didn't panic because my breast are dense and I have had several biopsies done through the years as well as one lumpectomy which was benign.

A week before my sonogram, I looked in the mirror and my nipple inverted and the top of my areola caved in. Now, since this weekend, the pulling is suddenly worse. It is pulling all the way to my shoulder blade. Saturday I had lots of shock pains, like electrical shocks and throbbing. The doctor's nurse said not to worry. It is probably because the tumor is right behind the nipple. Easier said than done. I can't help but think tentacles are squeezing in through tissue and on the cancer goes.

I will be 52 in a few weeks. I am perimenopausal. I still get my period, although I am probably not ovulating. It has changed, but nevertheless, I get it every month without fail and it is heavy for a few days. I am not sure if this matters. Also, my family history of cancer is impressive. My maternal grandmother had Stage 3 breast cancer. My maternal aunt had breast cancer and died from it. My father had germ cell cancer, very aggressive, and he passed at 64. My mother died of a glioblastoma at he age of 69. My paternal cousin had aggressive tongue cancer and died at 50. My brother, age 54, has aggressive prostate cancer. Now, I am number seven. Lots of aggressive cancer. I have not had genetic testing nor Oncotype testing.

Looking at other posts, it seems like chemotherapy is not the treatment of choice for my type of cancer. On the other hand, maybe history will play a role in the treatment of choice. I know I have to wait and see if the nodes are positive and also if there is anything else that was not seen on the MRI. It happens often.

I have done well. I have been strong and positive. Knowledge is power, and I feel it is so important to learn all I can so I can advocate for myself. It's been about a month now. Five weeks to have surgery and however many more to heal and meet the oncologist seems a long time away. I was told by the surgeon the surgery would be next week, butI now have to accept the disappointment that I have to hold on for five more weeks. I am uncomfortable. I have so much pulling in my breast and it feels heavy. I feel my breast is now bigger than the healthy one, but the nurse said my tumor doesn't grow like that. It is hard to ignore. I get electrical shocks behind the nipple and some throbbing too. Put the pulling is tough. I feel at the mercy of this tumor, but I trust my doctor and have to wait. I can and will do it. I already am.

Marimucho

truper, I am new at this too. I just started digging into every resource I could find to help me with my current diagnosis. I have now narrowed it down to Breastcancer.org. I feel so lucky to have found this gold mine of imformation provided by so many women who share our experience. Although each is different, there is a common denominator among all of us. I cannot articulate it, but it is what creates beautiful bonds of human connection and healing.

Because the information is so broad and specific to each individual, it's like opening a can of worms. But, as I keep reaching out, I am getting answers. I won't stop. It's how I feel better, stronger and in some control. Making informed decisions is my goal. Of course, I want to be cured and live without fear for many, many years, but right now, I feel it is important to increase my chances of accepting whatever I am dealt knowing I made responsible and effective choices and decisions. This community is going to help me do just that.

I hope one day to be a able to help and support others on Breastcancer.org the way members are helping me. If I can be of any support to you, please post or message me. I hope your surgery goes well. I don't know how I am going to feel when my surgery gets closer.

Hi Marimucho:

Although my initial diagnosis was DCIS, I was also age 52 and peri-menopausal. I also had some family history and was referred to a genetic counselor, who recommended genetic testing. At some point, you may wish to request a referral to a genetic counselor to obtain a formal genetic and familial risk assessment, discussion about whether genetic testing may be indicated in your case, and if so, the recommended scope of such testing and whether it is right for you (you may elect or decline such testing). Although you are having a bilateral mastectomy already, some pathogenic gene mutations may increase risk for other types of cancers (e.g., ovarian, colon, etc), such that additional prophylactic surgery and/or enhanced surveillance might be recommended.

The Oncotype test for invasive disease is typically done on surgical samples, because "eligibility" for the test considers both hormone receptor-positive, HER2-negative and lymph node status. This test is used to inform the decision of whether to add chemotherapy to endocrine therapy.

Oncotype "eligibility": http://breast-cancer.oncotypedx.com/en-US/Professional-Invasive/OncotypeDXBreastCancerAssay/PatientEligibility

An "equivocal" result on IHC (IHC 2+) does not necessarily mean that tumor heterogeneity is present. Hopefully, the "reflex" FISH testing results will provide a clear HER2 status.

If you have not already done so, with IDC of ~2.5 - 2.9 cms, you may wish to consult with a medical oncologist prior to surgery to consider whether you are a candidate for systemic drug treatment prior to surgery, known as "neoadjuvant" (preoperative) therapy. Such pre-surgical treatment is more common with larger tumors and/or "triple-negative" (ER- PR- HER2-) or HER2-positive disease, but is sometimes recommended in other situations. Whether neoadjuvant treatment is recommended or offered, such consultation would provide an opportunity for you to discuss any questions you may have about HER2 test results (schedule any appointment for a time when the FISH result will be available).

Core-needle biopsies are considered to be sufficiently reliable for determining ER, PR and HER2 status for the purposes of neoadjuvant therapy, although you are correct that tumor heterogeneity (different regions of a tumor with different patterns of ER, PR and/or HER2 status) as well as technical or sample size issues may sometimes arise, as discussed in this article. NOTE: This 2012 article predates the current 2013 ASCO / CAP guideline for HER2 testing, and may not reflect current HER2 test practices in all aspects.

Hanna (2012): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3503664/pdf/conc-19-315.pdf

Once your HER2 results are in, if you still have concerns about the HER2 status, you may wish to seek an independent pathology review prior to surgery (a second opinion from an independent institution focusing on review of the pathology slides and associated tests). With HER2-positive disease (~2 cms or more) (if applicable), the question of neoadjuvant therapy prior to surgery should be actively considered in consultation with a medical oncologist.

Best,

BarredOwl

Hi Marimucho:

I am glad to hear the FISH result was a clear negative! Please confirm it with your team, but my layperson understanding is that an "equivocal" result is not considered to be either positive or negative. An IHC result is either "negative" (IHC 0 or IHC 1+) or "positive" (IHC 3+) or "equivocal" (IHC 2+). When equivocal, reflex testing by another method (e.g., FISH) is indicated to clarify the situation.

See for example, this 2013 ASCO /CAP guideline for HER2 testing:

Main Page: http://www.asco.org/practice-guidelines/quality-guidelines/guidelines/breast-cancer#/9751

PDF copy of Guideline: http://ascopubs.org/doi/pdf/10.1200/JCO.2013.50.9984

Sometimes, tumor tissue is retested after surgery, but not always. There may be local differences in practice, differences based on specific pathology findings, or other factors.

Regarding a referral to a genetic counselor (or other medical genetics professional with training in genetic and familial risk assessment), when conducting a genetic and familial risk assessment, a genetic counselor will collect all relevant personal medical and family history, including information about all types of cancers on both sides of the family, not just breast cancer. A growing number of genes that contribute to breast cancer risk are associated with other specific cancers. Thus, certain non-breast cancers, such as ovarian, Fallopian tube, and peritoneal cancers, uterine cancers, pancreatic cancer, colon cancer and others --and even some non-cancer syndromes as well as other considerations (such as ethnic heritage (e.g., Ashkenazi Jewish heritage); "triple-negative" status; bilateral disease; young age at onset; menopausal status)-- may increase the level of concern (versus if one considered only breast cancers) and reveal that genetic testing would be warranted. Observation of certain other types of cancers may indicate that particular genes should be included in a test panel (if testing is of interest). It is not possible to list all the relevant factors here.

Unfortunately, many surgeons, medical oncologists, gynecologists and general practitioners lack specialized genetic training and understandably are not current on the latest clinical consensus guidelines regarding genetic testing. Thus, they may not appreciate all of the relevant factors or instances in which a person should be referred for genetic counseling. Since it is not likely to affect your current treatment plan, you can take some time to do some further reading and research. Again, a Genetic Counselor should fully address the possible outcomes of proposed testing, and the pros, cons and limitations of testing. Whether to proceed with such testing or not is ultimately the patient's decision.

BarredOwl

Chi Sandy,

My dr is now saying I should have chemo because my tumor was 1.5 cm and my mamma print showed aki67 20% . Higher risk. I am her2 - and I now have scheduled an appt with a breast cancer specialist that I was originally referred to but she has always been busy. I am 66 and just don't think I want chemo.

I too am grade 2/3 stage 1a

Any thoughts words of wisdom for me

Positive

positive 2strong, I had 2 tumors each about 1cm, they were determined to be independent of each other. My er was 95% positive and Pr was negative less than 1%, her2 -. My oncodx was 34, I was 53 in great health post menopausal I decided to not do the recommended chemo and just AI therapy. I believe the AI drugs are better than tamoxifen. I am 5 years out no recurrence, I also had no node involvement. I did a mastectomy with DIEP and I'm happy with the results. The only thing that has happened is ringing in one ear and arthritis in neck and back. It is mild to moderate side effect from the AI therapy also I had a severe dry eye that is much better. I stopped my treatment about a year ago and feel good.

Next week I will visit my oncologist and discuss what I want to do now. It is hard to know what to do.

I should say one tumor was idc the other ilc, close to skin but no skin involvement Nottingham score 5 and 6.

meow 13 thank you

I still am learning how everything works and what it means. I am est + prog + and her-

He said the therapy possibilities for me would be anastrazole, or exmestane or legrozole

I think I must be distraught. It is prog - my visit with surgeon and fist visit with Mo both just thought lympectomy and rads nowchemo and high reacurrance rate has me shaken

You are so good at clear helpful info

Positive

I think you have to ask the Moderators if you wish to change the title of the thread. You can send them a PM. I will post some more information in your other thread.

BarredOwl

with your diagnosis....so early stage, I would Never do chemo!!!

Positive, What's most important is that you make the decision for what's best for you in your personal situation. It is helpful to hear what worked for others, but everyone is different and everyone's situation is different. What works for one person may or may not work for others.You and your doctors need to work together to decide what's best for you in your individual circumstances.