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Age 29 with IDC - Help with Pathology
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Age 29 with IDC - Help with Pathology

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.
    
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Avatar_n_tn
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.

12 Comments
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Avatar_n_tn
Sorry to hear of her diagnosis.  It's a tough club to be in.

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!
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165308_tn?1323190145
Dear Kimberlie-  So sorry to hear of your daughter's situation.  I am sure it is so hard on you, too.  May I ask what were her symptoms?  I am asking because she is so young and baseline mammographies aren't usually given at that age unless there is something suspicious.  Your daughter and you will be in my prayers.  Suzi-q
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Avatar_n_tn
Can you tell me who registers you for this 'club' so that I can have her spot in it?  Sorry, I just hate to think about her having to go through this.  Actually, I hate the thought of any woman having to face this horrid diagnosis!
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.
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Avatar_n_tn
Thanks for the prayers.  
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
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Visit breastcancer.org for much needed info. I hate this club business.
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Avatar_n_tn
You said it!  I will be happy when this 'club' finally has no new members!
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
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165308_tn?1323190145
Dear Kimberlie...you are so right about the truly unbelieveable rate of young women getting this dreaded disease.  I have a mammo scheduled for the 14 of Nov.  I am 40.  My baseline was done 5 years ago where microcalcifications were found..thank goodness, benign...but I am now at a greater risk because of them. I will continue to keep your daughter and you in my prayers.  Thank you for the update and please keep us posted.
Suzi-q
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Avatar_n_tn
I did not have dose dense chemo.  Every three weeks for four times was my course of treatment.  I did VERY WELL with the chemo. Did I feel "myself"?  No, but it was in no way disabling. I work full time and am very active. I never missed a day of work except the day of treatment.  I KEPT VERY BUSY and DID NOT DWELL ON IT, that is the key.  She will be so busy taking care of the baby!

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.
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127512_tn?1193745816
Hay Kimberlie. Thanks for checking in on me. I went to my oncologist today for all of my results and he said he did not think chemo would benefit me. So he wanted to put me on tamoxifen but due to those side effect we discussed having my ovaries removed then on to AI's. So I am calling my OBGYN today to schedule a visit to talk about the procedure.
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.
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Avatar_n_tn
Thank each of you for the encouragment.  I am not good at following the forums everyday, but can't say enough about the caring; sharing and support that is offered here!
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
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Avatar_n_tn
Thank you.  We are all in this thing together, bound by the rotten curve thrown at us.  Stay strong.  Sending you and Melanie good thoughts and lots of hugs.
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