Don't understand pathology report!

Anonymous
Anonymous Member Posts: 1,376
edited July 2018 in Surgery - Before, During, and After

Others in this forum recommended I review a copy of my oncology report, which I now have. I'm trying to understand it so I can educate myself before I meet with an oncologist. I even downloaded and reviewed the Pathology Report Guide 2017 from this site...still I'm in the dark.

The doctor's office sent two surgical pathology reports and there are some differences between them. Am I wrong in assuming the the most recent one from my lumpectomy is the most accurate?

Here's information I've gleaned thus far:

Invasive
Size: about .8 cm
Grade 1**
Stage pT1b pN0(i-) liason
Lymphatic or vacular involvement
Margins: negative/clear
Fish Analysis: HER2 Breast: negative
K167: High, Tumor Stained: 21%, Intensity: Strong

** I'm a bit confused since I was originally told in April that I have "infiltrating moderately differentiated ductal carcinoma, grade 2" but the July pathology report sates: "infiltrating well differentiated ductal carcinoma, grade 1, measuring .08 cm."

Why the difference? Is the pathology report after my lumpectomy more accurate??

The copy of a pre-lumpectomy surgical pathology report from April also says the following:

Estrogen Receptors - 95% with strong staining, favorable
Progesterone Receptors - 95% with intermediate to strong staining, favorable

Can someone help me understand if you think the doctor may recommend hormone therapy and radiation? At age 74, I don't want to take either.

Thanks for any insights you can provide, even if you say I should just forget trying to understand it and wait until I meet with an oncologist.


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Comments

  • moth
    moth Member Posts: 4,800
    edited July 2018

    post surgery pathology generally trumps biopsy pathology just because they're dealing with a whole tissue sample, not a scrambled chunk drawn in a tube. But pathology is not quite an exact science. They're looking at tiny cells which are squashed and mangled from being retrieved and set in preservative and stained, and trying to make an assessment based on the structures.

    Grade 1 means the cells are very neat and organized and are thus spreading slowly, because they're taking the time to make precise copies of themselves. At the other end, Grade 3 cells are a mess because they're replicating quickly and just doing it any which way. They're slobs.

    Grade 1 is more favourable as a diagnosis.

    Given the strong hormone receptor status it seems to me they will recommend aromatase inhibitors for you to keep this cancer from coming back.

    I know we talked on another thread about radiation and your age - it's possible they may be amenable to skipping rads if you take the AIs. I'll be curious to see what they recommend. I think if you're otherwise healthy and active and want to maximize lifespan, then full treatment still makes sense, in spite of your age. You might be looking at 20+ great years ahead of you, hopefully without this thing coming back.

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited July 2018

    Thank you moth for your reply, which is always so helpful. I admire your understanding of this stuff and your clear way of explaining it to an utter newbie!

    I looked up Arimidex at my RX website the other day and it says it's not covered by my insurance and will cost just over $1000 per month. I haven't yet looked up Aromasin and Femara but this type of cost will bankrupt me in a few years!!

    According to this site, Aromatase inhibitors tend to cause fewer serious side effects than tamoxifen, such as blood clots, stroke, and endometrial cancer. But aromatase inhibitors can cause more heart problems, more bone loss (osteoporosis), and more broken bones than tamoxifen.

    My dad was a heart patient and my mother had osteoporosis so I'm concerned about this. If I have to have treatment, I'd prefer radiation to hormone therapy.

    I'll be sure to post what the oncologist recommends. I've been told I will be assigned one about three days after my Aug. 6 appointment with the surgeon. I surely hope so because the waiting is becoming so stressful!

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited July 2018

    many of the aromatase inhibitors now have generics and cost a fraction of the cost of the brand names tablets.or for some, nothing. I took letrozole which is the generic Femara...cost me $5 per month.

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited July 2018

    Thank you so very much, voraciousreader! I looked up letrozole and, currently, there would be zero monthly fee on my insurance plan. But the potential side effects are some of the worst I've personally ever read. As I've mentioned elsewhere in this forum, I've had very bad side effects throughout my life from most medicines.

    If I must choose, I'd prefer radiation over hormone thereapy.

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  • Georgia1
    Georgia1 Member Posts: 1,321
    edited July 2018

    Hi Viewfinder. Just thought I'd chime in to second Moth and try to clarify a couple of things:

    It's not really a choice between radiation and anti-hormone medication, since they do different things. Radiation reduces the risk of cancer recurring in the affected breast. Hormone therapy reduces the risk of recurrence in your entire body.

    If you fear the side effects of an AI, you could discuss taking Tamoxifen instead. It actually helps with bone density. And with your high ER percentage, hormone therapy would work particularly well for you.

    I don't think it's correct to say Tamoxifen has more side effects. They're just different.



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  • Anonymous
    Anonymous Member Posts: 1,376
    edited July 2018

    Thanks again, Georgia.

    That it's not really a choice between radiation and anti-hormone medication makes a lot of sense. Major decisions to make, for sure.

    I'm not one that typically shares with others especially in public even under a forum handle, but cancer is different than other things I've faced in life, and there have been many. This is the first time I've ever felt very panicked. I've read others experience this so know it's not unique to me.

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  • Georgia1
    Georgia1 Member Posts: 1,321
    edited July 2018

    Absolutely. Thinking good thoughts for you.

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