Breast Cancer report for my mother

[deepaksharma]

Th
BIOPSY REPORT: Specimen received in formalin in two containers. Specimen 1 consists of masectomy specimen with attached skin, nipple, areola and axillary tissue. The entire specimen measures 36x20x6.5 cms. Nipple is retracted with minimal ulceration of the skin. There is a curvilinear surgical incisionmeasuring 5 cms situated 2 cms away from the areola in the inner upper quadrant. Beneath the incision there is a lumpectomy cavity 4 cms in diameter. The walls are irregular and firm in consistency and lined by reddish brown material.
Section through wall shows greyish white area. Cavity is situated 4.5 cms beneath the fascia at the base. The resected fascia grossly appears free of tumor. Cut section thorugh remaining breast shows yello white areas. Multiple lymphnodes isolated varying in size from 0.5 cms to 2.5 cms. Cut surface is greyish white.
Specimen 2 consists of single fibrofatty piece of tissue measuring 3x2x1 cms. Cut surface shows yellow brown tissue.
DIAGNOSIS - Invasive duct carcinoma of the breast. Tumor infiltration is present in the squamous epithelium of the nipple - Paget's disease of the nipple. The resected base is free from the tumor. All the fifteen lymph nodes are infiltrated by the tumor (15/15). There are multiple nodular foci of tumor in the soft tissue sent in specimen 2.
The tumor cells are negative for estrogen and progesterone receptors.
THE DOCTOR HAS ADVISED: 4 cycles of AC (adriamycin)(doxorubicin) followed by 4 cycles of TTaxol)(pacitaxel).

Want to check the meaning of these reports. This was done in Delhi, India.
Thanks,
Deepak

[deepaksharma]

My mother went thru the first chemo session last thursday. Here are some other reports. Want to get a second opinion on the tests and recommendations so far.

The 1st chemotherapy dose was given on Thursday, Feb 7, 2002. She has had no side effects to the medicine (except for slight fatigue). She went for a haircut on saturday (the doc said that long hair hurt when they fall due to chemo).
Her right hand has swollen a bit (becoz of fluid assimilation in the hand as all the lymph nodes have been removed) (the LN help in fluid circulation in the arm). An arm stocking has been ordered which is useful in such a situation and it works on compression principle. The stockings would be ready by Wednesday.
The doc had advised injections on 2nd, 4th & 6th day of chemo to
boost blood count. 2 injections have been given. The last one would be given tomorrow.
We will be taking her to the hospital on 20th to get the blood
tests done. The doc will also put a chemo port on 20th. The chemo port will be used to give all injections and the chemotherapy drug. Since 6 doses have to be given through the veins and there is a high chance of the veins getting blocked after 3-4 doses, using a chemo port is advised.

The next dose of chemo is planned for Thursday, Feb 28, 2002.
FNAC report of the Neck Lymph Node:
SITE OF ASPIRATION: US Guided FNAC - Right Lower deep cervical LN
ASPIRATION MATERIAL: Received 4 slides
MICROSCOPIC EXAM: Shows loose clumps and sheest of malignant ductal cells with moderate degree of plemorphism and anaplasia infiltrating the stroma. Background shows RBC.
OPINION: Metastasis carcinoma in a diagnosed case of carcinoma
breast.
Comments: C5 - Definitive cytological evidence of malignancy on a
representative cell sample.
The Doc has started on the following chemo drugs:
a) Docetaxel - 120 mg
b) Epirubicin - 120 mg
The next chemo would also use the same drugs. The next doses he'll decide depending upon her condition.

[CCF-RN,MSN-rf]

The bone scan report appears negative.  This information suggests that the disease is locally advanced - not metastatic. The echocardiogram is to check your mother's heart to determine if it is okay to proceed with the Adriamycin (it is cardiotoxic and cannot be given to people who have heart damage).

[deepaksharma]

Thanks for your reply. Have some more details on my mother's report.
Further report
And 2 tablets of tamoxifen everyday for 5 years. (this is known as hormonal therapy) (works if the cancer cells are positive estrogen, progesterone receptors) (though in mummy's case they are negative, he has still advised as there is no side effect of this medicine and it does help to an extent)
BONE SCAN REPORT:
    99m Tc MDP BONE SCAN
Clinical Data: Ca breast. To look for skeletal metastases.
     Examination performed: Radionuclide bone scan performed following intravenous injection of 20 mci of 99m Tc MDP. Static images obtained at 3 hours in whole body anterior and posterior views.
     Findings: Overall skeletal uptake of tracer is good with nominal soft tissue uptake.
     Tracer distribution in the skull, sternum, ribs, scapulae, pelvis and extremities is homogenous. Both kidneys are well visualised.
     Impression: No scan evidence of skeletal metastases seen.
     ECHOCARDIOGRAM REPORT:

     Measurement:
        Aorta(ed)       29mm
        LA   (es)       30mm
        RA              Normal
        RVID (ed)       Normal
        LVID (ed)       49mm
        LVIS (es)       32mm
        IVS  (ed)       10mm
        LV PW(ed)       10mm
        EF              60%
     VALVES:
        Mitral valve - Normal
        Aortic valve - Normal
        Tricupsid valve - Normal
        Pulmonary valve - Normal
        Pericarddium - Normal
     2D Data including wall motion analysis:
        No LV regional wall motion abnormality seen.
        Good LV & RV systolic function
     Doppler Studies:
        Color
        No AR, TR, MR.
     Pulse:
        A/e 1.5:1 reduced LV compliance
     Impression:
        No LV regional wall motion abnormality seen.
        Good LV & RV systolic function.
        LVEF = 60%
        Reduced LV compliance
Can you please let me know the severity of these reports. My mother just finished her first Chemo treatment today.
Thanks,Deepak

[CCF-RN,MSN-rf]

Dear Deepak:  This report indicates a locally advanced breast cancer.  There is cancer involving the nipple, breast tissue, 15 of 15 lymph nodes removed as well as multiple nodules within the fat pad.  The recommendation of AC + T is appropriate.  Did they test for Her2/neu receptors?  If these are positive, herceptin may be an option for the future.