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|Understanding Pathology Results
Questions explaining and understanding pathology results.
|Asked||Publicly Submitted Question|
|8/3/2012||I was recently diagnosed with ER/PR positive Her2 negative breast cancer as a result of breast reduction surgery. The doctors were shocked to get the pathology report. Since that time I've had a sentinel node biopsy, which was positive and I'm scheduled for a PET scan. I've also had a breast MRI with contrast and a mammogram, to look for any residual disease in the breast. There were no findings. The Radiologist indicated that the findings were normal based on the breast surgery that was done (the MRI and mammogram was done 6 weeks after the breast surgery). The Oncologist that I am seeing has given me a diagnosis of invasive ductal T1 N1 Mx = IIA. He is recommending treatment that would include radiation to the breast and 6 courses of chemotherapy (Taxotere & Cytoxan) every 3 weeks. I am concerned about the chemo that is being recommended. After which, I would be monitored and scanned every three months to determine if there is any recurrence. I am not sure if the current findings warrant such an aggressive approach. I am wondering what would the risk be if I were to be monitored now for anything that changes before deciding about the chemo. I agree with the radiation - I believe that it is necessary to deal with any cells that may be undetectable in the area of the breast and lymph node area. The surgeon who performed the sentinel node biopsy - indicated that cells were found on the peripheral of the node. The tumors had not penetrated the lymph node and there were no traces of cells within the node. Also - because of how the tissue was removed, there is no way to determine what my margins are. The Oncologist has ordered the following tests - BRCA gene, oncotype DX and FISH test. My questions are: Is there a great amount of risk with only doing radiation now and waiting to start chemo, if/when needed if any changes occur? Given that the cells are grade 1, is there a typical rate of growth and typical path that the cells spread? What would a typical treatment plan be for this type of diagnosis? What are the risks associated with the chemo that has been recommended? Are there any other tests that should be done? - Thanks in advance for your response.|
|Replied||JHU's Breast Center Reply|
|8/4/2012||your situation is a complex one that requires a team of breast cancer specialists familiar with how to address your needs. Due to the margins not being able to be clearly identified now for re-excision to remove any residual breast cancer (am assuming one or more margins were positive) then skin sparing mastectomy is needed. if and only if the margins were all negative for at least 2 mms in all directions then radiation would be part of the treatment and no further surgery warranted. To determine whether chemo is needed request that oncotypeDX test be done . you are a perfect candidate for it. It helps determine if chemo would or wouldn't be beneficial and provides predictive scores for risk of recurrence. no routine scans are to be done after treatment unless the patient manifests new pain/symptoms that are unexplainable and may relate to distant metastasis. so get oncotypeDX done first, confirm that margins are all clear and if they aren't then time to meet with a breast surgical oncologist and breast reconstruction plastic surgeon. you are welcome to come to us. just call 443-287-2778.|
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