Diagnosis

[playgirl2]

Just seen copy of letter to my doctor, showing diagnosis of my lumpectomy.  It states
left breast: high grade DCIS with microscopic invasion: 22 mm: close to deep margin: ER 100% positive (QS7)
PR 100% positive (QS8): 0/1 nodes involved.

Can you please explain to me a little bit clearer what this all means? what was 100% positive, what is ER and PR?

thankyou
playgirl

[Cleveland Clinic]

Dear playgirl,  Many breast cancers, especially those diagnosed at an early stage, are hormonally responsive - meaning that their cells grow in the presence of the “female” hormones estrogen (“E”) and progesterone (“P”). Both are naturally manufactured by and circulate in the human body, although at amounts that decrease after menopause, and with increasing age.   E and P stimulate breast cancer by entering cells at multiple “docking” sites called hormone receptors. Estrogen receptors (or ER) attract and attach to E, while progesterone receptors (or PR) attract and attach to P. Pathologists use several techniques to test hormone receptors on tissue, and determine if the breast cancer cells respond, or attach, to E and P. Breast cancer is termed ER (or PR)-positive if its cells have more than a pre-specified baseline “cutoff” level of hormone receptors - the more a breast cancer responds, the higher its numerical test score.  So 100% positive would indicate that in this specimen 100% of the cells have hormone receptors.    This would suggest a type of breast cancer that is sensitive to hormonal manipulations and often times treatment will include medications to block or lower estrogen.

The other information such as high grade DCIS (ductal carcinoma in situ) with micro invasion means that some cancer cells have invaded the duct of the breast this can only be seen by looking at the specimen under the microscope.  0/1 means that out of the one lymph node that was examined no cancer cells were found in it.  Your doctor will put this information into context of your individual situation for you and use this information in order to recommend further treatment.

[japdip]

You really should get this explanation from your Physician/Surgeon/Oncologist or whomever you are to see next concerning your treatment. As far as the ER + notation goes, the tumor is estrogen dependant for growth. Don't take this the wrong way but whoever gave you the copy of the letter didn't do you a favor to my way of thinking. This type of information should come from your Physician in a face to face discussion.

[AnnaE]

That's for sure. I wonder how this happened that you got the letter, and no meeting with your doctor.

[mamaboulet]

Patients often find themselves in a position of having to wait through a weekend (or longer) for pathology reports via personal physician, either because physician didn't go to the office on friday, or went on vacation, or other similar reasons (ask the hundreds of women in this position), which leaves them in a state of anxiety concerning their biopsy or lumpectomy results, when many of them have already been through multiple painful waiting periods for whatever tests led up to the current test. Many of these women would rather have that pathology report in their hands as soon as possible, with or without the doctor. With many medical help sites online, like this one, as well as local breast health organizations and breast cancer advocates, these women can find somebody to partially decipher their reports while they are waiting for the doctor. The level of stress I've seen in women having to wait and wait for a doctor to go over their results, versus the level of stress from having to find help deciphering pathology reports, is much higher, bordering on PTS levels in some cases. At least the pathology report contains real information, specific to the patient, versus the general information and statistics available on the internet for freaked out waiting women to browse and panic about.
My doctor didn't even bother to contact me when my biopsy result came back benign, even though it was performed because of a BIRADS 5, which generally results in at least follow up checking to make sure the correct area was biopsied, nothing was overlooked, etc. I would have waited forever for the so-called discussion with the doctor about a pathology report had I not gone and gotten my own copy when I found out she didn't bother coming to work on friday or telling her patients she wasn't going to be there to look at incoming test results. I fired her.

[lizziecee]

Hi - brilliant post mamaboulet - right on the button. Here in England that doctor would have been reported to the General Medical council if it had happened to me. Shocking attitude, she needs some training in communication skills methinks.

[katarina777]

Not so fast. After my mastectomy, my surgeon went over the pathology report with me a week later in his office. When I walked out of there I realized that I did not remember a word he had said to me. So I walked back in and asked for a copy of the pathology report. Something like this could have happened. Another time, I asked for a copy of an MRI before having the test. It arrived in my mailbox before I was scheduled to go over the results with my doctor.