diagnosed level 1 ductal carcinoma

[panama]

Hello..I am in Panama and have just gotten this path report and would like your opinon as to optimum therapy.  I have no breast cancer history in my family, I am 44. If you would be so kind to take the time to explain this to me, I would appreciate it. Thanks so much!!! Julie



My path report for reference is Histologic sections show a proliferative breast, with apocrine metaplasia, ductal dilation, estromal fibrosis, esclerosing adenosis and abundant lobular neoplasia, predominantly LN2 In three slides, C, E, H..this is proliferation os atypical small ducts, that infiltrate the fibroud estroma around benign ducts and lobules, that show a bland cytology, with no nuclear pleomorfism. These ducts are negative for P63, smooth muscle actin and calponin. The infiltrating ducts and some lobules w/. lobular neoplasia come near the inked margin of excision, (within less than 1mm). Infiltrating Ductal Carcinoma, not otherwise specified. Histologic grade: well differentiated (I/III). Without central necrosis. Nuclear grade:low nuclear grade (I/III) Tumor size: 0,8cm in greater diameter (on slide) Lobular neoplasia: Present. Multiple foci. Ductal Carcinoma in SITU: NOT Identified Linfatic Invasion: NOT identified. Perineural Invasion: NOT identified Microcalcificacions: present in lobular neoplasia and benign ducts. Surgical margin: IDC and LN are close to the inked surgical margin (within less than 1mm) Other findings: Fibrocystic changes



I have a follow up with an onco/gyn and would like to know any specifics I need to relay to him or questions I should ask. Thanks so very much

[CCF-RN,MSN-rf]

Dear Panama:  From this report, it sounds as though you have been diagnosed infiltrating ductal cancer and possibly some lobular cancer.  The surgical margins (edges) are positive (have cancer cells very close) and therefore, additional surgery may be recommended.  Additional treatment options would be determined based on the size of the tumor, and other factors such as lymph node status, hormone receptor status, etc.

[deevee]

I would meet with the breast surgeon to ask about the "close" margins and recommended treatment.  I, too, had multi-foci IDC stage 1A as well as extensive DCIS, LCIS, and atypical lobular hyperplasia.  In my case, my surgeon talked with the radiation oncologist and they decided the radiation therapy would take care of the close margins instead of the surgeon doing a re-excision.  Best wishes for your treatment and good health!

[panama]

Thanks for your response. So, how long are you out from this diagnosis and how are you doing?  I certainly hope you are well and cancer free. Thanks again, Julie

[panama]

thanks for your response.  I tumor was small, .8 cm. It was also not full of cancer as the initial center frozen biopsy showed no cancer cells at all. Had the pathologist not disected and done slides of many specimens, they would not have found the cells.  I was thrilled to have not had a core needle biopsy and hight chances for a false bill of health on this.

You are the first person to bring up the possiblity of lobular carcinoma as well. I have given this question to my gyno in FL, John's Hopkins and MD Andersen.  

Any SPECIFIC questions I should pose to the oncologist on Sat to confirm the path I should take? Thanks bunches, J

[deevee]

I am a 3-yr survivor and cancer free.  My original diagnosis after a stereotactic biopsy was DCIS.  After the lumpectomy, diagnosis was changed to IDC (largest 2mm).  Then I had a sentinel node biopsy with all 4 nodes negative, 6 wks of radiation therapy (RT), and Arimidex for 5 yrs.  (I had 3 additional biopsies within the first 15 months (both breasts), but thankfully all were negative.)  It's good your cancer was caught early!  I assume you had a lumpectomy and will most likely have RT.  Will you have a follow-up visit with your surgeon?  If you didn't have any lymph nodes taken out, ask if a sentinel node biopsy is recommended.  Be sure to ask about the close margins and your hormone receptor status (estrogen/progesterone positive?) to see if hormone therapy will be recommended.  I would also want to know my HER2 status, even though it won't affect treatment now, it would be good to know in case of new treatment advances in the future.