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Breast Cancer Stage

My mother just got his breast removed. We have just received the surgical pathology report. It says:
Diagnosis: Left breast:
1. Infiltrating ductal carcinoma grade II on a scale of I to III according to modified Bloom and Richardson grading system.
2. Size of lesion: 3.5 x 2.5 x 1.5 cm.
3. Lesion is 0.2 cm from deep margin.
4. A small focus of lymphatic invasion is present which is 0.1 cm from deep margin.
5. Nipple and areola: Tumour free.
6. Total 08 lymph nodes are recovered, out of which 03 are positive for metastatic disease.
- size of largest metastatic deposit in the lymph node measeures 1.1 x 1 cm.
- No perinodal extension is present.

The doctor has recommended for chemotheraphy however my mother is feared from it. Please advise whether it is really needed and whether radiotheraphy can be opted instead of chemotheraphy and the survival rate for the stage shown in report.
4 Responses
587083 tn?1327123862
Hi,
I am sorry to hear about your Mother's breast cancer and I can surely understand your anxiety concerning her situation.
I really believe that your Mother has to follow her Doctor's recommendation.When cancer has metastasized to the lymph nodes,she definitely needs to do exactly as her Oncologist advised her,because cancer cells can move on to succeeding lymph nodes and organs.
Many women can be cured by surgery, radiotherapy, chemotherapy, hormone therapy or with the combination of several therapies.The right treatment extends the life and can prevent a second occurrence of the disease.The choice of the treatment of metastatic cancer of the breast depends on the multiplicity of factors, including: the characteristics of the tumor, the degree of the spreading of metastasis and their location.
Survival rates also depends on how breast cancer patients respond to their particular treatments.
Chemotherapy is not an easy thing to go through for anyone...but it does save lives.Sides effects can be alleviated by a variety of medicine that her Oncologist can prescribe for her in case she might need them.The bad symptoms caused by Chemotherapy will eventually disappears, when her treatments is over.
I sure hope that your Mother will do well with all her treatment,but please urge her to follow her Doctor's recommendations.
All the best to both of you...
Avatar universal
We just went to two of the best Oncologist for advise regarding further treatments!

Advise of first one:
He recommended to start radiotherapy immediately and asked for following reports:
- E.R. / P.R.
- HER2
- Ki-67

He further said that on the basis of the above three reports he will decide whether chemotherapy is required or not. He told us about a possible combination of the results of the above reports that was i think as follows:

- E.R /  P.R & HER2.. one of them must be negative and the other one positive, i did not exactly remember which one he told to be negative;
- Ki-67 must be below 15;

If the result would be as above then chemotherapy would not be required and radiotherapy would be sufficient.


Second Oncologist:
He told us to start chemotherapy immediately and asked for the same reports as the first one did. But he said that chemotherapy and radiotherapy both are required irrespective of the results of the test.


Please advise regarding the point of view of first oncologist and what should be done in the above case. The surgical pathology reports says as follows:

Diagnosis: Left breast:
1. Infiltrating ductal carcinoma grade II on a scale of I to III according to modified Bloom and Richardson grading system.
2. Size of lesion: 3.5 x 2.5 x 1.5 cm.
3. Lesion is 0.2 cm from deep margin.
4. A small focus of lymphatic invasion is present which is 0.1 cm from deep margin.
5. Nipple and areola: Tumour free.
6. Total 08 lymph nodes are recovered, out of which 03 are positive for metastatic disease.
- size of largest metastatic deposit in the lymph node measeures 1.1 x 1 cm.
- No perinodal extension is present.
587083 tn?1327123862
Hi again
I really cannot give you any advice concerning your mom's treatment.
All I can tell you is that when lymph nodes are positive for metastatic disease,then chemotherapy is certainly recommended.The drug is designed to kill any undetected cancer cells that may have spread to other areas of the body.
Having two different Oncologist's recommendations is a dilemma,but you could always seek a third opinion to make sure that your mom will proceed with the correct treatment planned for her particular situation.
Best wishes to both of you.
962875 tn?1314213636
Chemotherapy is considered the standard of care in cases with a tumor as large as the one your mother had, PLUS 3 positive lymph nodes.  (I'm a bit surprised one of the oncologists recommended a different approach--unless your mother has other serious medical problems, which might make it risky for her to take chemotherapy?)

Chemotherapy is a systemic treatment which is intended to affect cancer cells, even microinvasions that cannot yet be detected, anywhere in the body, whereas radiation is a local treament which can only affect cancer cells in the specific area targeted.

If one of the additional tests, the HER2, turns out to be positive, it will no doubt be recommended that she also be treated with Herceptin, and if she has positive results for the  ER/PR hormone receptor tests, it is likely that there will also be a recommendation for tamoxifen or an AI (aromatase inhibitor), depending upon her status in regard to menopause.

Some of these treatments are difficult to tolerate due to possible side effects, but they offer the best chance for preventing spread or recurrence of the cancer, and for survival.

As zouzi indicated, we cannot provide medical advice regarding what treatment is best in the specific case of your mother.  Since the two oncologists advised different initial approaches, you could either ask them to provide further explanation of the rationale for their recommendations, or seek a third opinion from someone who could detail the pros and cons of the approaches recommended by the first two, respected oncologists.

Please keep us posted on what treatment decisions are made, and how your mother is doing.

Best wishes to both you and your mother...
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