some answers, but more questions....

Options
Dodes
Dodes Member Posts: 50
edited August 2017 in IDC (Invasive Ductal Carcinoma)

so. finally today, i got my results and they are as follows....

Core Needle Biospy- IDC

estrogen 95%\ progesterone 75%\ HER2- negative

ki67-10%

tumor score 4/9

Luminal A, Nottingham score 2+1+1, Grade 1

eRS- 13.5

Indolent, sensitive to endrocrine treatment; may experience late recurrences; may be adequately treated by hormonal therapy alone.


Pathology- in the left breast, there is biopsy clip artifact anterioraly in the approximately 3 O'clock subareolar region, with an indistinct, mildly enhancing focal area of architectural distortion, measuring 1.8 cm in maximum dimension. This demonstrates only, mild, gradual enhancement without evidence for rapid wash-in or wash-out. no other mass or area of abnormal enhancement in the left breast are seen. No evidence for enlarged or suspicious left axillary lymph nodes.

BS said my pre existing condition (sclerosing mesenteritis) might preclude me from being a candidate for radiation, and i have had a borderline (1:180) ana in the past. i have fibro and Raynaud's as well. I understood her to say (and i could have completely mis-heard) that chemo depended on the sentinal node.

i take wellbutrin and i am so incredibly stable on it, but i've heard that tamoxifen and wellbutrin don't play well together. the rub here is that tamoxifen is one of the few drugs that works for some people with sclerosing mesenteritis.

I am not remotely interested in reconstruction, and i'm scheduled for a lumpectomy 8/21.


so. here's where i'm at and my questions.... i am a long time smoker (quit again yesterday!). let's say RO gives the green light for radiation - if i can only be radiated there once, i'm thinking i should save that for potential lung cancer. or maybe i'm an idiot. please let me know if that's the case....mute point if RO says no. which led me to think about it like this-

it's apparently a slow, lazy cancer, and based on where it's located and it's size, if i had a mastectomy, they likey could get it all with good margins. now truth is, i'm a "mostly" B cup, so there's not a ton to work with, but if they loobed her off, and then found some up in the SN, chemo would come into play, right? if the sentinal node is clear, but i can't have radiation, would chemo be of any benefit?


and here's the biggest stupid question of all time - if this cancer is soooo hungry for estrogen, and i'm meopausal (as of 2/16) where's it getting it's fuel from, or is that why it's such a slug of a cancer. i KNOW you're not doctors, and i'm not asking for medical advice, rather, i'm looking for feedback

wow, why don't you write a book, dodes. sorry for the length, this almost turned into a stream of consciousness thing....


· Share on FacebookShare on Twitter

Comments

  • NotVeryBrave
    NotVeryBrave Member Posts: 1,287
    edited August 2017

    You might be a candidate for more localized radiation - either intraoperative or brachytherapy. A lumpectomy is generally not the best treatment if you have no radiation in the area afterwards.

    The SNB is actually the first group of lymph nodes. Sometimes it's only one but more likely it's two to five. I would expect chemo to be considered if cancer was found there.

    Postmenopausal women still have estrogen from their adrenal glands. I would think they would do a blood test to confirm menopause and suggest an AI instead of Tamoxifen - especially if there's a concern about interaction with Wellbutrin.

    Congrats on quitting smoking! Even if it's "again" - that's a positive step!


    · Share on FacebookShare on Twitter
  • Dodes
    Dodes Member Posts: 50
    edited August 2017

    good info to take with me when i go see the RO and MO, notverybrave. they did blood work at the BS's office, i'll have to check and see if they checked estrogen levels...


    · Share on FacebookShare on Twitter
  • SpecialK
    SpecialK Member Posts: 16,486
    edited August 2017

    dodes - first know that there are no stupid questions! Breast cancer has a steep learning curve, ask anything you want and someone will try to answer or point you in the right direction, and we have all been in the shoes you're in right now. Depending on margins there is a good possibility of escaping the need for rads with a mastectomy, but I would ask your RO about differing methods of radiating after a lumpectomy based on where the tumor was in your breast. Radiating the lung and the breast are two different fields, and potentially different methods - I don't know if one precludes the other. You could ask about the Canadian Protocol rads - shortened course of 3 weeks, or DIBH where you hold your breath during rads to help protect your heart/lungs from the field. Your RO can explain why these could work/not work for your individual situation. With a grade 1 tumor it is also possible that even if you had a spread into the nodes - which while not impossible, is unlikely - chemo may not be recommended due to unresponsiveness of the cancer cells. Since you are ER+ and Her2- I would request an Oncotype Dx test on a sample of the tumor post-surgically to help determine if chemo would be effective. This is a test that looks at the genetic profile of your tumor and analyzes effectiveness of chemo, when added to assumed anti-hormonal therapy. Post -menopausal women continue to produce estrogen in the adrenal glands - where the enzyme aromatase converts androgens into estrogen, and in body fat. The percentage of ER on your pathology report of 95% indicates that of 100 cells looked at under the microscope, 95 had estrogen receptors.

    · Share on FacebookShare on Twitter
  • Dodes
    Dodes Member Posts: 50
    edited August 2017

    thanks, specialK, i wasn't sure about the oncotype test, sooo much info!!! it'll be interesting to see what the radiologist says. i really am leaning toward MX, as i just want to get this on and over with. i've got enough plenty of issues keeping my SM under control

    i also just read that a high bmi is encouraging to er+ cancers. i for sure need to drop at least 20 if not 25 lbs, but man, it's hard to get this steroid weight off... it used to be easier! lol

    · Share on FacebookShare on Twitter

Categories