JUST DIAGNOSED WITH IDC

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Spikar
Spikar Member Posts: 16
edited August 2017 in IDC (Invasive Ductal Carcinoma)

Just had my biopsy results. Can someone with experience read below please and try to explain what I should expect (severity, treatment etc)?

I am having my first surgeon appointment/meeting in two weeks and it seems like eternity.

BREAST, RIGHT AT 9:30, 8 CM FROM NIPPLE, BIOPSY:

-- INVASIVE DUCTAL CARCINOMA, NUCLEAR GRADE 2, SEE NOTE.

Sections show fibrous and desmoplastic breast tissue infiltrated by an intermediate nuclear grade ductal carcinoma. The tumor is present in small nests and ductal structures. The longest span of tumor in an individual core measures 6 mm. No lymphovascular space invasion is seen.

BREAST CANCER BIOMARKER RESULTS

(Invasive)

Estrogen Receptor (ER): Positive (moderate to strong, >90%).

Progesterone Receptor (PR): Positive (strong, 100%).

Ki-67: 10%

HER-2 by IHC: Equivocal (2+).

HER-2 by FISH: Pending.

Cold ischemia and fixation times meet requirements specified in the latest version of ASCO/CAP guidelines, unless otherwise specified. Estrogen receptor (ER), progesterone receptor (PR) and HER-2 IHC studies are performed on formalin-fixed, paraffin-embedded tissue by immunohistochemistry, using antibody clone SP1 for ER, 1E2 for PR and 4B5 for HER-2 IHC by an FDA-cleared vendor (Ventana). Detection is by a biotin-free, multimer-based system. The intensity of staining is graded as weak, moderate or strong, and percent of positive tumor nuclei is estimated. Estrogen and progesterone receptor status are interpreted as positive (at least weak staining in 1% of tumor nuclei) or negative (<1% of tumor nuclei). HER2 IHC is graded as negative (0 and 1+ staining), equivocal (2+ staining) and positive (3+ staining). This assay has not been validated on decalcified tissues. Results should be interpreted with caution given the likelihood of false negativity on decalcified specimens.

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Comments

  • ElaineTherese
    ElaineTherese Member Posts: 3,328
    edited August 2017

    Well, you are ER+/PR+, which means that your oncologist will probably recommend hormonal therapy --Tamoxifen or an aromatase inhibitor (AI) -- after your surgery.

    Your invasive tumor seems small (6 mm), so you may have the option of a lumpectomy or mastectomy.

    The big question is whether or not the FISH test shows you are HER2+. If you are HER2+, your oncologist may recommend Taxol (a chemo) and Herceptin (targeted therapy).

    If you are HER2-, your doctor can request that an oncotype test be performed on your tumor to determine whether the benefits of chemo outweigh the risks.

    Hope this helps!

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  • T-Sue
    T-Sue Member Posts: 217
    edited August 2017

    Spikar, I'm so sorry for your recent diagnosis. I've been there and I think it's the hardest part mentally. Not knowing exactly what your dealing with and what the game plan will be - ugh. Sometimes your radiologist or surgeon or even your insurance may have a "breast cancer navigator" who can help you interpret your report and help you figure out the process for treatment. Worth asking.

    Elaine summed up your info well. 6mm is considered small, they may do a lumpectomy and radiation. If it's HER2+ (like mine), the recommendation may change to mastectomy and chemo. At the time, this was devastating news for me, but now I'm glad to have had a double mastectomy and get all that breast tissue out of me!

    Hang in there and come to these forums for support!

    Hugs from Colorado!


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  • ChiSandy
    ChiSandy Member Posts: 12,133
    edited August 2017

    Grade 2 and strong hormone receptors, no lymphovascular invasion, 6mm—all encouraging signs!

    HER2+ requires chemo (helps the targeted therapy work), but the choice of mastectomy vs. lumpectomy depends more upon the size of the tumor (especially relative to that of the breast) and its position—but more than anything else on what level of uncertainty you are willing to accept. There are plenty of women who have had chemo and targeted therapy yet elected lumpectomy. You can always go back later and get a mastectomy, but once a breast is gone it’s gone.

    An “equivocal” 2+ HER2 result on IHC often gets downgraded to 1+, considered negative, on FISH. If it turns out you are HER2-, there is an excellent chance your OncotypeDX (or other genomic test on a sample of the tumor) score will be low enough to let you avoid chemo. The lower the score, the less aggressive the tumor and the lower the likelihood of cells that divide rapidly enough to be vulnerable to chemo.


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  • Spikar
    Spikar Member Posts: 16
    edited August 2017

    Just had my FISH results:

    Block A1 was sent to Integrated Oncology for HER2/CEP17 by FISH (Fluorescent In-situ Hybridization), with the following result.

    HER2 FISH INTERPRETATION: Negative

    Average HER2 Copy Number: 3.40

    Ratio of average HER2/CEP17: 1.4

    Can someone please explain those numbers to me? I am having my first appointment with my surgeon in a couple of days and I need to know what to ask/expect?

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