Just Diagnosed - What does this report tell me?
Hello - the doctor called but I'm not clear what she was telling me - she was stumbling around trying to get the words out. There is cancer in the left breast and I think also the right? The nuclear grade is intermediate on the left. What do you all think I can expect moving forward?
Final Pathologic Diagnosis
A. Stereotactic Core Biopsy Right Breast with Calcifications:
- Breast parenchyma associated with coarse microcalcifications in the benign sclerosed ducts.
- Background breast parenchyma shows flat epithelial atypia, atypical lobular hyperplasia and
stromal fibrosis.
B. Stereotactic Core Biopsy Right Breast no Calcifications:
- Benign breast parenchyma with proliferative fibrocystic changes composed of usual ductal
hyperplasia, dilated ducts and stromal fibrosis.
- Negative for atypia and malignancy.
C, D. Stereotactic Core Biopsy Left Breast with and without Calcifications:
- Ductal carcinoma in situ, focal microinvasion cannot be completely excluded.
- Immunostains for calponin and p63 are pending and will be reported in an addendum.
- See surgical pathology cancer case summary
Surgical Pathology Cancer Case Summary
Procedure: Stereotactic core biopsy
Specimen Laterality: Left
Tumor Site: Upper outer quadrant
Size of DCIS: 4 mm
Histologic Type: Ductal carcinoma in situ
Architectural Patterns: Cribriform
Nuclear Grade: Intermediate
Necrosis: Focal
Microcalcifications: Present
Additional Pathologic Findings: None
Ancillary Studies:
Estrogen Receptor (Clone SP1): Positive; 96 % positive, 2.9 intensity (scale 0-3)
Progesterone Receptor (Clone IE2): Positive; 48 % positive, 2.0 intensity (scale 0-3)
Comments
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Looks to me like ALH in your right breast, and a small area of DCIS in your left. ER+ is good--that means anti-hormonals can help prevent recurrence. I had ALH 10 years ago, with a quick and easy excisional biopsy. The rest of my history is below.
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hi Massgirl - so sorry for you. I was in your shoes just a couple months ago. Please read the DCIS info on bc.org. Of course your doctors are the experts, but from my experience here's what I would expect.
Your BS may talk to you about doing a lumpectomy of the DCIS and remove the surrounding tissue to rule out micro invasion/any invasive cancer. I did this in a hospital under general anesthesia and it was outpatient. It was really easy with almost no downtime or pain post surgically. My results were back in about 5 days.
After the pathology results are in, your BS will go over your options for treatment. DCIS is usually treated like invasive cancer because not enough is known about when/if it will infiltrate the duct. However, by definition - in situ means it has not spread beyond the duct. Pure DCIS is not treated with chemo. I believe the standard of care is typically lumpectomy, radiation and hormone therapy (since you're HR+) Radiation may not be recommended though. Depending on your family history and other factors you may opt, or the doctors may suggest, mastectomy although with a small tumor that's considered by some to be very aggressive/overkill treatment. You may want to consider getting a second opinion, especially if what your heart is telling you to do doesn't jive with what your BS is suggesting.
Your BS may have you meet with a genetic counselor, MO and RO. You may also talk to a nurse navigator to help you through this process. It's hard in the beginning - so much unknown. Once you decide what you're going to do about the DCIS and have things scheduled, it gets easier.
FWIW- I didn't see anything in your path report indicating cancer in the right breast but again, I'm no expert. Atypia, fibrosis, hyperplasia, etc (I believe) are benign conditions that may be considered red flags because they're sometimes found in conjunction with bc but not always. Actually fibrosis is just dense tissue, I believe. About 50% of women have dense breasts.
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Thank you HopeWins and Ingerp - being so new to all this is a bit scary and the terminology is all so foreign. I'm seeing the BS next Tuesday, October 8th, so should have a plan in place. I'm also seeking a second opinion as the hospital I went to for mammogram and biopsy may not be the best; will be interesting if they both suggest the same treatment.
The nurse navigator that I spoke with was wonderful - she had more to say than my PC who gave me the news!
Anxiously but optimistacally waiting for October 8th!
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Massgirl, if this biopsy turns out to be the extent of it at 4mm DCIS I would say you are very lucky it was caught this early.
Very best luck to you.
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Thank you all for sharing and providing me with knowledge during this stressful and confusing time.
There were additional pathological findings which are confusing me - it seems everything is benign; so I must be misunderstanding?
Addendum:
Pathology of the right breast calcifications demonstrates flat epithelial atypia
and atypical lobular hyperplasia. Calcifications are seen associated with usual
ductal hyperplasia.Pathology of the left breast calcifications demonstrates DCIS.
Both are benign and concordant. Surgical consultation recommended.
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MassGirl--you can look up ALH and DCIS. DCIS is considered a Stage 0 cancer.
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Hi- As far as cancer goes, this is a great result. Nothing invasive!!
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MassGirl55, "the doctor called but I'm not clear what she was telling me - she was stumbling around trying to get the words out."
I would fire that doctor, pronto. You need one who can get the damn words out and explain EXACTLY what is going on.
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I do plan to find a new primary care at the beginning of the new year.
I saw the breast surgeon today and she is recommending removal of the ALH in the right breast. The left breast shows DCIS and possible microinvasion so definitely surgery, radiation, and medication. I'm scheduled for a second opinion on the 14th and I'm anxious to hear if they agree with the recommendation from today.
How long after surgery does pathology send the final results? I thought the doctor said 4-6 weeks but that seems like a very long time!
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