Invasive ductal carcinoma

emotionalpond,

Welcome! Sorry it took so long for anyone to respond - the board isn't busy late at night.

I'm sorry that you've been diagnosed, but glad that you found us here. Most of us who are diagnosed don't have symptoms, so that's pretty common. It's good that you had the mammogram and that this was found.

Good luck with the lymph node biopsy. There are a couple of things you should know. First, a needle biopsy of a node might find cancer if it's there, but it might not. So even if the node is clear from the biopsy, it's still possible that when a few nodes are removed during surgery (and that's always done), that some microscopic cancer cells might show up. Hopefully not, but it's better to know that it's possible than to think that the needle biopsy was conclusive and then have a shock. The other thing to know is that unless your tumor is extremely small (do you have an estimate of the size of the area of cancer?), even being ER+/PR+/HER2- and node negative, chemo might still be recommended. For those who have ER+/HER2- tumors that are greater than 5mm in size, usually an Oncotype test is run on the breast tissue that is removed during surgery. This test evaluates the genes within the cancer itself, and based on that, you receive an Oncotype score. With the score come a metastatic risk assessment; based on that risk your oncologist will decide whether anti-hormone therapy alone will be recommended, or whether chemo + anti-hormone therapy will be recommended. On the other hand, even if you are node positive, with an ER+/HER2- cancer, the Oncotype test can be run and if the score is very low, sometimes chemo isn't recommended. That to some extent depends on your age. May I ask how old you are?

Hope that the node biopsy goes well and the results are clear. Let us know how it goes!

Hi Emotionalpond,

Beesie has given you a lot of good information. I would emphasize her point regarding a clear lymph node biopsy. I was clear but the very node they though suspicious in the USN and biopsied as clear did end up being microscopically positive post surgery. I had the Oncotype testing done and with a score of 4, chemo was ruled as Not Beneficial. My RO also felt radiation was over treatment and the risks outweighed the benefits. I am taking Tamoxifen since I am still premenopausal.

Yeah, when you are first diagnosed, it can be pretty surreal. You've entered a whole new world with all sorts of procedures you'd never heard of before, lots of jargon you've never heard before, and you have to make decisions about all these things. It's not where any of us ever wanted to be. But you'll find that it won't take long to become familiar with the basics of breast cancer, and you have all of us here to answer questions and provide support.

Emotionalpond....I love your handle. I'm also recently diagnosed with IDC and getting a 2nd opinion this Friday. I'm reading this is the worst part...Until surgery, final pathology and plan.

Jenn,

Ah, sorry the lymph node was positive. But it doesn't necessarily mean chemo. HER2 is very important - if you are HER2+ then chemo will definitely be recommended. If you are HER2-, then whether chemo is recommended depends on the final pathology (the size of the tumor, the grade of the tumor, the number of positive nodes) and possibly your Oncotype score. Unfortunately you have to wait until after surgery to have all the information you need for the chemo decision. And then it will be the Medical Oncologist who makes the recommendation - the surgeon is out of the picture at that point.

Do you have a surgery date?

And where are you in Canada? I'm in Toronto.

When it comes to chemo, the only opinion that counts is that of the Medical Oncologist. I've been around here a long time and I've seen lots of people have expectations set by something their surgeon said, and then based on the final pathology, the MO recommends something different. Anything that the surgeon or your doctor says is speculation only. Without knowing your HER2 status and without a final surgical pathology, the fact is that nobody knows whether chemo will be recommended for you or not. There is just not enough information available yet to know. So at this point, even the MO wouldn't know.

As for chemo prior to surgery, that is only done for HER2+ cancers, triple negative cancers (ER-/PR-/HER2-) or very large cancers. If there is any question as to whether chemo first might be appropriate, the patient must see the MO. Only the MO prescribes chemo and only the MO decides whether chemo should be done prior to surgery. So if your cancer does turn out to be HER2+, then it's very important that you see the MO - in fact in that case, seeing the MO is more important than seeing the surgeon. But if your cancer is HER2-, then you'll have surgery first so you may not see the MO until after surgery.