Just diagnosed and overwhelmed

Hi there. So sorry you have to be here but welcome. I know you will find this forum both informative and comforting. You are presently in the worst part of this process. The beginning is horrible. I promise you will feel better once you have all the facts and a treatment plan. So far the fact your tumor is very small is good. You will have more information once the path report comes back. Please feel free to ask me any questions. We are all here for you...

Hi natsera:

Sorry to hear of your recent diagnosis. Regardless of where you are located, you should have been told what the next step will be. If you do not know, please call the person who informed you of your diagnosis to inquire what happens next (e.g., appointment with breast surgeon), when it will happen, and what if anything you need to do to set it up.

Typically, once you have been informed of the result of the biopsy, the pathology report is released to you. In the USA, the reports are required to be released, because they are copies of your medical records. Unfortunately, the full report may not be available by patient portal, and you often have to request it. For example, I got the paper copies of the pathology reports from the "nurse navigator" at the center where the biopsies were done. Later, I obtained them via secure email from the administrative assistant to my breast surgeon. Another option is via the Medical Records Division of the institution. In the latter case, I had to call Medical Records ahead of time to request specific items, obtain information re when they would be ready, pick them up in person, show photo ID, and sign for them. Check with your facility for the best way to obtain a copy.

With invasive disease, it is possible that further studies are in progress, including additional testing for estrogen receptor (ER), progesterone receptor (PR), and HER2 statuses. If these are are not included in your pathology report, be sure to follow up and request any addenda or supplement(s) containing this information.

As others have said, this is one of the most disorienting times in the process. I felt much better after I met with the breast surgeon and had a better idea of what I was dealing with.

Best,

BarredOwl

I remember the overwhelming sadness and my mind spinning in ever direction May 2016. Diagnosed w IDC. Very small stage 1. I met w breast surgeon and nurse navigator. I even met w plastic surgeon to help w decision making. My plastic surgeon actually helped me get there in my mind. So I crossed the bridge of double mastectomy and did skin nipple sparing on non cancer side. I wanted to have as much of me as I could. I kno it was the right decision for me and my circumstance. I got immediate TE and had my exchange surgery in oct 2016.

The first 3 months were overwhelming to say the least but you will make it.

I creeped on this board for months reading and reading. Do NOT google stuff or do images. Just look for your friends and family support and support on here. This was the greatest source for me. Ladies asked questions I wanted to kno about and the ladies always answered. I felt better by reading posts from ladies that went through what I was about to.

It will get better.

I look forward to your posts and sharing our experiences, learning from others and getting past this initial phase of our diagnosis. I just turned 54 this month and it was the last thing I expected to hear just 2 weeks after my birthday, new job role, and new grand baby!!

Vicki-

We're so sorry you find yourself here, but we're glad you've joined our community. We know the first days and weeks are scary and confusing and overwhelming, but just know that you are not alone! We're all here for you.

Please keep us updated as you move through your appointments, and if you have any questions, please ask! That's what we're here for!

The Mods

Information is power, and you already sound empowered from even your earlier post. Good for you. Forward motion as you make your decisions with your team.

Lisey is correct.

Nodal status is required to distinguish between Stage IA and Stage IB.

Stage IB requires a certain level of lymph node involvement, specifically pN1mi (i.e., Micrometastases (greater than 0.2 mm and/or more than 200 cells, but none greater than 2.0 mm). Node-negative ("N0") disease cannot be Stage IB.

The confusion arises from the use of "B" in stage designations (e.g., Stage IA, Stage IB) and the use of lower case "b" in tumor size designations.

Under the currently used AJCC staging manual (7th Edition) summarized here, tumor sizes for invasive breast cancer are as follows:

https://cancerstaging.org/references-tools/quickreferences/Documents/BreastMedium.pdf

T1 Tumor ≤ 20 mm in greatest dimension - includes any of the following:

T1mi Tumor ≤ 1 mm in greatest dimension

T1a Tumor > 1 mm but ≤ 5 mm in greatest dimension

T1b Tumor > 5 mm but ≤ 10 mm in greatest dimension

T1c Tumor > 10 mm but ≤ 20 mm in greatest dimension

T2 Tumor > 20 mm but ≤ 50 mm in greatest dimension

T3 Tumor > 50 mm in greatest dimension

It is not possible to know the stage of a person who has an estimated "T1b" sized tumor, is clinically node-negative (prior to surgery), and has not yet had a lymph node biopsy. This is because the actual size of the tumor and the lymph node status are required to determine T N M status and accurately assign pathologic stage.

Mamasha:

Please confirm it with your team. If you were clinically node negative, and found to be purely node-negative (N0) on sentinel node biopsy, with an 8 mm tumor ("T1b" in terms of size only), and no evidence of metastasis, that would be pT1 N0 M0 or more specifically pT1b N0 M0, both of which are Stage IA as shown on line 2 of the chart below. Please confirm it with your team.

BarredOwl

Hi Mamasha:

I am glad you have an inquiry in. However, I think you will be reassured in due course. About half-way down, the report sets forth the T and N status:

AJCC Classification (7th edition): pT1b N0(sn)

In other words, pT1b - "p" on pathologic staging, the tumor size of 8 mm or 0.8 cm is pT1b, where T1b Tumor > 5 mm but ≤ 10 mm in greatest dimension

N0(sn) - node-negative (N0) by sentinel node biopsy (sn)

There is no "M" status, because the surgical pathology did not assess distant metastasis. Typically, with such early stage disease, scans are not recommended (in the absence of symptoms). In this situation, rather than assume "M0" status when not specifically assessed, some pathologists leave the M status blank (as yours did) or indicate this as "Mx". With no evidence of distant metastasis, pT1 N0 (or pT1b N0) disease would be generally be considered Stage IA.

BarredOwl

Hi natsera:

Those are components of the determination of "histologic grade" for invasive breast cancer using Nottingham Histologic Score ("Elston Grade"). See this page from Johns Hopkins:

http://pathology.jhu.edu/breast/grade.php

BarredOwl