breast trauma

[NM]

Hi, I had a question earlier about the lump after trauma (pl. see below). I've seen surgeon since then, who says I need surgery. I have the results of biopsy with me:EO/ms
breast, left, 2 o'clock, core biopsy:
invasive ductal carcinoma and ductal carcinoma in-situ.
Comment: there are rare stromal calcifications. The duct cell carcinoma in-situ involves sclerosing adenosis, fibrocyctic changes in the background.Immunohistochemistry estr/progest receptors and her-2 imm. results are: her-2 staining score 0-1+: overexpr. ***. negative; estrogen reseptor 50%, progest. rec. 80%: some tissue antigenicity is affected by fixation methods. Negative res. must be interpreted with care, false negative can accure.
Can you please explain this? Also he did not see images, just read the summary. I did have a trauma 6mnth ago. What if the lump (which developed two weeks prior biopsy, and not palpable now after biopsy) is the result of trauma (this info is not in files)? Then I may only have a carcinoma in-situ (meaning don't need a surgery)? Also description "invasive" seems too general, what kind of cells they see, and is that refers to that lump? I don't know where to go for the explanation. Also there are alternative treatments with impressive results. I am not convinced and very confused. Thanks very much for the help.

[CCF-RN,MSN-JS]

Dear NM, Invasive ductal carcinoma means that cancer cells have invaded the wall of the duct which makes it possible for cancer to spread.  Nearly all breast cancers arise from glandular tissue and are adenocarcinomas, if it was a different cell type this would be noted.  Ductal carcinoma in situ (DCIS)means that abnormal cells are confined within the duct - this is considered a precancerous condition.  The finding of invasive ductal carcinoma is given priority in terms of determining what to do next in terms of treatment.  

The usual treatment plan is to do additional surgery in order to remove the cancerous area and make sure there is a margin of normal tissue around this area, also to check the lymph nodes for any spread.  The information from the additional surgery (tumor size, lymph node status etc.) is needed to determine whether further treatment is recommended.

The statement at the end of the pathology description "Negative results must be interpreted with care, false negative can occur" only means that if there were no findings (invasive cancer, or DCIS) we couldn't be sure that the specimen was adequate.

[surgeon]

First of all, cancer is generally easy to identify under the microscope. So when they say there's cancer, that's what it is. Second, invasive is also easy to tell. Third, it seems you had a core biopsy, so the entire cancer has not yet been removed, and all the info is therefore not yet available. But the standard treatment for invasive cancer is either to remove the cancer with a rim of normal tissue all around it, followed by radiation to the entire breast; or removal of the entire breast. In either case, lymph nodes under the arm get sampled also. Trauma has nothing to do with this. Whereas a lump from trauma could be hard to tell from a cancer by feel or sometimes by xray, there's no problem distinguishing the two under the microscope; and trauma absolutely does not cause breast cancer. As to "impressive" alternative treatments: it's a deadly mistake to forgo standard treatment. If you choose alternative treatments as adjuncts, well and good. But please, for your own sake, do the standard treatments as well. The place to get explanations is first from your surgeon; he or she would presumably also recommend an oncologist (medical cancer specialist.) Finally, the important data in the report mainly are the fact that there's invasive cancer. Much of the other is simply description of the adjacent tissue which has no significance, and standard terminology on many reports saying no test is perfect (that's in reference to the hormone status, not the diagnosis of cancer.)

[NM]

Still confused. What exactly they going to take out? Fibrosystic changes they see on sonogram? There no other visual/palpable findings... There no words about cells in report.

[surgeon]

I think you need to have more discussion with your surgeon; he/she is the one best able to explain your situation, and it seems you need more info. But basically, if you had a core biopsy, which is what the report you quoted states, you've only had the area sampled. As has been stated above, cancer treatment requires that the entire cancer be removed with a rim of normal tissue around it. A core sample tells you what's there, but does not remove the entire cancer. So, one way or another, that must be done. Details of your situation are required to explain exactly what will be done, which is why you need to have your surgeon clarify. The method would be to indentify the area from which the core was taken, and widely to remove that area. In some cases it's possible for the surgeon to do so by direct exam; in others, it would be necessary for a radiologist to place a guidewire into the area before the surgeon begins. And since it's not possible to use a microscope during the surgery, the surgeon takes what would be enough tissue to be confident the entire cancer would be removed. That requires judgement and experience; it sometimes (not often) happens that when the tissues are examined in the lab, it's found that one edge or another is not clear enough so more needs to be done.