Nutrition Health Chat: Tuesday, Dec. 8th, 5-6 PM Eastern. Learn how vitamins, minerals, and phytonutrients affect your health. Free live Q&A. Join us!
Member Comments are provided by individuals and reflect their personal opinions only. Under NO circumstances should you act on any advice or opinion posted in this forum. ALWAYS check with your personal physician before taking any action regarding your health! MedHelp International and our partners, sponsors and affiliates have no obligation to monitor any comments posted on this site, or the content and/or accuracy of such exchanges. MedHelp International does not endorse the views of any user.
Breast Cancer (Expert Forum)
What to do now??
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.
What to do now??
by Lence, Feb 19, 2002 12:00AM
Have just had a lumpectomy & 2 sentinal nodes removed. Am node -ve; though some reactive histiocytes with nuclear variation & macronucleoli found in 1 node.
Pathology:Infiltrative ductal type carcinoma with ragged nests & cords of infiltrating tumour focally present within fibrous stroma. Within the area of invasive tumour are areas of high grade duct carc in-situ with central space necrosis but a significant spread beyond the areas of invasive tumour. Tumour cells show moderate to large size with moderate eosinophilic cytoplasm. Nucleii show moderate to severe nuclear pleomorphism with some focal tubule formation & high grade mitotic activity. Adjacent breast tissue shows some fibrous & mild blunt duct adenosis. Size 30mm. Nottingham grade III (score 8/9, nuclei 3, mitosis 3, tubules 2). Margins -ve.
Some areas of in-situ high grade duct carcinoma in-situ present in area of invasive tumour but no significant duct carc in-situ beyond invasive tumour. Focal intralymphatic permeation seen. ER moderate +ve. PR mod +ve. c-erbB-2 -ve.
An irregular piece of fatty tissue also removed shows fatty tumour without malignancy.
Should we seek a 2nd pathology evaluation? Should we request other factors (cathepsin D,epidermal growth factor,heat shock protein,etc)?
Is Chemo a must? Tamoxifen? What about Aromatase inhibitors? Iressor? Is ovarian suppression a must with endocrine therapy? What about combinational endocrine therapy's? Other new drugs/treatments? What are our maximum treatment options & stats without chemo & ovarian suppression but using everything else available?
Pathology:Infiltrative ductal type carcinoma with ragged nests & cords of infiltrating tumour focally present within fibrous stroma. Within the area of invasive tumour are areas of high grade duct carc in-situ with central space necrosis but a significant spread beyond the areas of invasive tumour. Tumour cells show moderate to large size with moderate eosinophilic cytoplasm. Nucleii show moderate to severe nuclear pleomorphism with some focal tubule formation & high grade mitotic activity. Adjacent breast tissue shows some fibrous & mild blunt duct adenosis. Size 30mm. Nottingham grade III (score 8/9, nuclei 3, mitosis 3, tubules 2). Margins -ve.
Some areas of in-situ high grade duct carcinoma in-situ present in area of invasive tumour but no significant duct carc in-situ beyond invasive tumour. Focal intralymphatic permeation seen. ER moderate +ve. PR mod +ve. c-erbB-2 -ve.
An irregular piece of fatty tissue also removed shows fatty tumour without malignancy.
Should we seek a 2nd pathology evaluation? Should we request other factors (cathepsin D,epidermal growth factor,heat shock protein,etc)?
Is Chemo a must? Tamoxifen? What about Aromatase inhibitors? Iressor? Is ovarian suppression a must with endocrine therapy? What about combinational endocrine therapy's? Other new drugs/treatments? What are our maximum treatment options & stats without chemo & ovarian suppression but using everything else available?
Doctor's Answer
by CCF-RN,MSN-JS, Feb 19, 2002 12:00AM
Dear Lence, Based on the information you’ve given regarding the size of the tumor (3cm), negative lymph nodes as well as, no metastasis (cancer spread) your breast cancer would be staged as stage IIA. The current consensus for treatment of stage IIA cancer, is treatment with adjuvant chemotherapy (Adjuvant treatment is treatment given after surgery to try to prevent or minimize the growth of microscopic deposits of tumor cells that might grow into a recurrent tumor).
Adjuvant chemotherapy has been shown to prolong the disease-free interval and survival and is recommended for most patients with tumors greater than 1 cm, regardless if the nodes are positive or negative, menopausal, or hormone receptor status. The chemotherapy is usually a combination of drugs and the inclusion of an anthracycline such as doxorubicin or epirubicin produces a small improvement in survival over nonanthracycline-containing regimens. The treatment lasts 4 to 6 months in most programs.
Decisions regarding adjuvant hormone therapy are based on the presence of hormone receptor protein in the tumor tissue (estrogen-receptors). If the tumor is positive for estrogen-receptors adjuvant hormonal therapy is offered. Currently five years of tamoxifen is standard adjuvant hormone therapy.
Radiation therapy for local control of disease would be part of the recommendation since a lumpectomy was performed.
Regarding your questions about 2nd opinion for pathology, if there is any question regarding the results that could be pursued, currently the other information would not necessarily impact treatment decisions at this time.
Use of other treatments outside standard of care would be up to your oncologist and usually in the setting of a clinical trial. Discuss with your oncologist what their recommendations are and risks and benefits to your individual situation. If they have recommendations outside of standard of care, whether part of a clinical trial or not, they will discuss with you the particular risks and benefits of those treatments.
Adjuvant chemotherapy has been shown to prolong the disease-free interval and survival and is recommended for most patients with tumors greater than 1 cm, regardless if the nodes are positive or negative, menopausal, or hormone receptor status. The chemotherapy is usually a combination of drugs and the inclusion of an anthracycline such as doxorubicin or epirubicin produces a small improvement in survival over nonanthracycline-containing regimens. The treatment lasts 4 to 6 months in most programs.
Decisions regarding adjuvant hormone therapy are based on the presence of hormone receptor protein in the tumor tissue (estrogen-receptors). If the tumor is positive for estrogen-receptors adjuvant hormonal therapy is offered. Currently five years of tamoxifen is standard adjuvant hormone therapy.
Radiation therapy for local control of disease would be part of the recommendation since a lumpectomy was performed.
Regarding your questions about 2nd opinion for pathology, if there is any question regarding the results that could be pursued, currently the other information would not necessarily impact treatment decisions at this time.
Use of other treatments outside standard of care would be up to your oncologist and usually in the setting of a clinical trial. Discuss with your oncologist what their recommendations are and risks and benefits to your individual situation. If they have recommendations outside of standard of care, whether part of a clinical trial or not, they will discuss with you the particular risks and benefits of those treatments.
