Diagnosis

[AMNEA]

My mother diagnosed with Infiltrating ductal carcinoma with the following report:

Mastectomy specimen left, presenting ellipse of skin meas 21 x 15 cm with subjacent breast to the depth of 4.5 cm. The nipple is not retracted. On sectioning it shows mostly fatty breast with presence of a grey ruuery FI Tumor Mass Meas 3 x 3 x 2.5 cm. Axillary Fat Pad with lymphnodes dissected largest meas up to 1 cm

Diagnosis of tissue recieved:

- Infiltrating Ductal Carcinoma Grade III SBR.
- Nipple and Skin are tumor free.
-Metastic tumor to three of twenty-eight dissected axillary lymphnodes with focal capsular infiltration.

My questions are:

1-what is the size of the tumor ?
2-To what stage this case belongs ?
3-what is the prognosis of such a case. Is it good or bad ?
4-what is the survival rates of this case.
5-what do they mean by "Focal Capsular Infiltration".
6-Is the infected nodes Enlarged or they are just infected with some cancer cells.
7-To what level the removed nodes belong ?
8-Is it ER and PR reciptor. (The doctor mention that my mom has to take drugs for 5 years followinn checmo and radio therapy)

Thank you very much for your help

[AMNEA]

Dear Sir

Could you please help me understand the following pathology report for my mother:

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Microscopic Description:

- Immunohistochemistry: - Hormonal Receptors, Estrogen and Progesteron
                     - MIB-1 (Ki67), cerb-b2 (her2neu)

-Sections examination show positivity of 75-80 of tumor cells by estrogen and progesteron receptors; with marked intensity
-Proliferating Index elevated up to 33%
-There is heterogenous mild to marked membranous expression of cerb-B2

Diagnosis: Left Breast Tumor, Immunohistochemical Evaluation:

- Hormonal Receptor positive (ER+, PR+)
-Proliferating index (ki67) elevated (33%)
-Cerb-B2 Expression, Heterogenous score 1-3 (Positive) (Her2/Neu)


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My questions:

1- what each item of the above report means.
2- The doctor say that my mother need 6 weeks of radiotherapy. Is it applicable to my mom case ( Left modified Radical Mastectomy - 3 cm tumor- 3 positive axalliry lympho nodes out of 28 removed nodes with focal capsular infilteration)
3- Which chemotherapy is the most effective one for my mother case : TAC, FAC, CMF, CAF, AC (knowing that she is now taking a six cycle: 5FU chemo drug along with Adriamycin and a third drug I could not read its name)

Thank you for your help

Amna

[AMNEA]

Dear Sir

The doctor make the following diagnosis form my mom and all the tests are ok : Bone Scan, X-ray for the chest, liver, lungs and kidneys tests. ALl these tests were clean.

I asked the doctor about the stage and he said that my mom case belong to Stage IIB ( Tumor < 5 cm and spread to 1-3 axillary nodes)

I have also read on different sites on the internet the following


"Stage II: The tumor is larger than 2 cm in diameter but not larger than 5 cm (2 inches), or it has spread to 1-3 axillary (underarm) lymph nodes on the same side as the breast cancer. The tumor may also be larger than 5 cm but has not spread to lymph nodes.

Stage III: The tumor is smaller than 5 cm in diameter and has spread to 4-9 axillary lymph nodes, or the tumor is larger than 5 cm and has spread to 1-9 axillary nodes or the tumor grown into the chest wall or skin and 0-9 nodes are involved, or the tumor is any size and has spread to 10 or more nodes in the axilla or to lymph nodes under the clavicle. Patients with stage III cancer show no signs that the cancer has spread to distant organs or bone>"

So I would like to know why you said its stage III breast cancer.

Thank you

[CCF-RN,MSN-rf]

Dear AMNEA:  1) The size of the tumor is based on the largest dimension - in this case - 3cm (about an inch and a half).  2) Based on the known information, your mother's breast cancer is stage 2B.  3&4) The approximate 5 year survival statistics (realize that statistics cannot be applied to individuals) is 75%.  This is a fairly good prognosis.  5) Focal capsular infiltration states that the cancer cells in the lymph nodes are present at the edge or outside of the lymph nodes in a few places.  6) The lymph nodes are not necessarily enlarged but 3 of them contain cancer cells.  7) I'm not clear what you are asking here.  8)  I see nothing in the report that describes estrogen or progesterone receptors.  I am assuming, based only on your comment of "drugs for 5 years" that it is positive.

[surgeon]

sorry: I mis-read the number of nodes.

[surgeon]

1) it says the tumor is 3 x 3 x 2.5 cm; an inch is 2.5 cm, so it's roughly the size of a cubic inch --  a bit bigger.
2) from the info presented, it's stage 3. Other tests would be needed to see if it's a higher stage ( 3 means it got to the lymph nodes -- 4 would mean it's somewhere outside the area of the breast and lymph nodes, and you can't tell that from just looking at the tissues removed so far.
3) and 4) Prognosis and survival are more or less the same: and those numbers apply to studies of large groups of people. There's no way to predict what will happen to an individual. The majority of women with the information given so far would still be alive 5 years later.
5)It means some cancer cells grew throught the outer edge of the lymph node. Sometimes when that's seen, it's considered a reason to give radiation treatments to the underam area
6) the maximum size mentioned of 1 cm is bigger than normal. However, that really isn't of importance. Lymph nodes can be enlarged for various reasons. What's significant is that some had cancer in them
7) the report didn't say, so we can't tell; the only way to know is if the pathologist separates the levels in examining the tissues, and reports what's in the various sections
8) ER and PR are tests that are done on the tumor by sending a sample for additional testing. It's routine to do so, but the reports come later, separate from the report you quoted.