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Breast Cancer (Expert Forum)
Age 29 with IDC - Help with Pathology
Questions posted in the Breast Cancer Forum are answered by medical professionals from The Cleveland Clinic. Topics include Breast Biopsy, Chemotherapy, Hormone Therapy, Lumps, Lumpectomy, Lymph node dissection, Lymphedema, Mammograms, Mastectomy, Radiation Therapy, Reconstruction, Self Breast Exam, and Surgery.
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Age 29 with IDC - Help with Pathology
by Kimberlie, Oct 25, 2006 12:00AM
Daughter 29; lactating with IDC. Lumpectomy; sentinel node involvement in axillary.
Right Sentinel positive - 1.3 mm
Infiltrating Ductal Adenocarcinoma, Elston Grade II/III 2.3 cm.
4mm of superior margin
4mm of interior margin
7mm of posterior margin.
ER - Positive
PR - Negative
Her2/neu - Negative
6 nodes take; with malignancy in 1. 5 nodes clean
Dense Dosing of AC Chemo with either cytoxin or taxall; port recommended; Pet/CT also recommended at some point.
??? Looking at the report how aggressive is the cancer?
Cell type? Is she a good candidate for tomoxifin?
Anything else you can tell me would be appreciated.
Right Sentinel positive - 1.3 mm
Infiltrating Ductal Adenocarcinoma, Elston Grade II/III 2.3 cm.
4mm of superior margin
4mm of interior margin
7mm of posterior margin.
ER - Positive
PR - Negative
Her2/neu - Negative
6 nodes take; with malignancy in 1. 5 nodes clean
Dense Dosing of AC Chemo with either cytoxin or taxall; port recommended; Pet/CT also recommended at some point.
??? Looking at the report how aggressive is the cancer?
Cell type? Is she a good candidate for tomoxifin?
Anything else you can tell me would be appreciated.
Doctor's Answer
by CCF-RN,MSN-rf, Oct 25, 2006 12:00AM
Dear Kimberlie: Based on the information you have provided, your daughter has a moderately aggressive cancer (based on the grading system of 11/111). This is a ductal carcinoma, which means the cells originated in the ductal tissue of the breast. The cancer is ER positive (estrogen receptor). This means that the tumor may be "fed" by estrogen. Your daughter may benefit from hormone therapy (such as tamoxifen) to "block" the estrogen. This type of therapy is often started after chemotherapy.
If her chemo regimen consists of A and C, a port will be required for the A (Adriamycin) since it is highly toxic to the veins. I just finished four rounds of AC and the port, for me, was a blessing, no poking around every time for a vein. My oncologist doesn't believe a port is necessary for Taxol or Taxotere. I have learned that every oncologist has a different approach/protocol. I don't second guess mine.
Having a tumor that is ER+ is a favorable prognosis as it responds very well to hormonal treatment, Tamoxifen.
Mine was similar in pathology to your daughter's: 2.4 in size, fairly aggressive, ER+, HER2+, but no node involvement. I had a lumpectomy; finished chemo; started radiation; will begin Herceptin and Tamoxifen next week. In my opinion, you hit this with whatever you can so that you only have to go through this *&^% once.
It is a tough road, but treatment is doable. She is young and her energy will pull her through this with flying colors!
It is comforting to hear that those who have, like yourself, say it is 'doable'. I am with you though, I want them to do whatever it takes for her never to have to hear those words again.
I didn't know that the A in A/C chemo meant you would most likely get a port put in. Did they dense dose you with the AC?
That scares me. She was horribly sick when she was pregnant with her son, and has never tolerated even over the counter meds very well. I hope you wouldn't mind telling me how you made out with these drugs?
I am happy to hear you are though the worst of it!
Thanks for sharing.
She is nursing an 18 month old and found an almost quarter size very hard lump on the topside of her breast. Her La Lache leader asker her if it had pain, which might have been an indicator of a clogged duct or mastitis since she is nursing. There was no pain, and this lump just seemed to appear overnight! When I felt it, I was pretty shocked at the size and hardness of it. She made an appointment immediately with the Breast Center, (got her in within two days) but none of us really thought we would get the result from the biopsy that we did.
No previous mammograms.
I don't want to scare you if you are young, but from my crash course, (still so much to learn) the number of young woman getting this is shocking! One of my daughter's best friends was 32 and pregnant with her second child! She is two years out from treatment and she and her little girls are doing great!
Take Care,
Kim
I was thinking about you and wanted to thank you for the Idiots Guide. I will order that. Yes, the website you recommended has also been very helpful.
Hope you are doing well.
Kim
Suzi-q
Oncologists today have TONS of tools in their kit to combat any side effect of chemo. It's like the side effects listed on the aspirin bottle-you never get all the side effects that are mentioned, and remember everybody is different. The side effects of chemo are often predictable in terms of their onset, duration and severity (nausea, vomiting, low white and low red blood cell counts). Most oncologists prescribe before administration an antinausea med that REALLY WORKS. She'll have routine CBCs and if the reds or whites are low, she'll get Neulasta, Neupogen and/or Procrit. This is important because you do not want to delay treatment.
Unfortunately, hair loss almost always occurs. It is best that she prepare herself in advance. It is not only scalp hair but pubic, leg, underarm, and maybe lashes and brows. I suggest that she have it cut as short as possible prior to chemo. When it starts to fall out (literally), it's usually @day 18 of the first round. I bought a wig weeks in advance as I am not one for bandanas, scarves or turbans. (Not having leg or pubic hair is rather nice!). I never lost my lashes or brows, they just thinned out.
Breast cancer does not discriminate, any age, color, race, body weight, having children or not, etc. The statistics are alarming and scary. EARLY DETECTION remains the key to successful recovery. She, like me, will be a SURVIVOR!
Also, check out bcsupport.org. After you register (it is free), there are boards that discuss chemo/treatments. The tips and support I receive from LOTS OF WOMEN who post there is priceless.
Yes those books written by Dr. Susan Love are great info books. Just make sure you get the lastest editions. I got mine from the library. And I must tell you as informative as they are I would suggest she not read the back of the books. Most breast cancer books have that back section no one wants to read. Wish you all well. Please keep me posted. Keep your strength up also.
You each have made a huge impression on my heart and I pray for each.
Melanie is having the PET/scan and Bone scan on Monday along with her first Medical Oncologist appointment. I know she is going to be a survivor as I know each of you will be too.
I will look for you on regular BC chats that are more appropriate for daily concerns and support. I have written down books and websites that you have offered as encouragement and hope. My days will be spent gathering information and coming along side my daughter and family.
Again, each of you have offered invaluable insight; personal information and hope. I pray you each stay well.
Kim